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Int J Radiat Oncol Biol Phys. 2010 Jun 1;77(2):462-7. doi: 10.1016/j.ijrobp.2009.05.020. Epub 2009 Jul 4.

Comparison of methods to reduce dose to swallowing-related structures in head and neck cancer.

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1
Department of Radiation Oncology, University of Alabama at Birmingham, USA. jjcaudell@gmail.com

Abstract

INTRODUCTION:

Emerging data suggest that reduction of dose to the larynx and pharyngeal constrictor may lower the risk of swallowing complications such as long-term gastrostomy dependence and aspiration. Organ avoidance becomes difficult when the primary tumor or involved nodes are present at the level of the larynx.

MATERIALS AND METHODS:

Fifteen patients with Stage III-IV squamous cell carcinoma of the head and neck with high-dose target volume at the level of the larynx (but not involving the glottic larynx) were planned with whole-field IMRT (WF-IMRT), as well as a low anterior neck field dynamically matched to an IMRT plan (D-SCLV). Plans were compared with respect to coverage of targets and sparing of normal tissues including the larynx, inferior pharyngeal constrictor (IPC), parotid, and cord.

RESULTS:

There was no significant difference between the two techniques in coverage of the high- or intermediate-dose planning target volumes (PTVs). Coverage of the elective nodal PTV was inferior with the D-SCLV technique, with a mean of 96.5% vs. 86.3% of the volume receiving the prescription dose (p = 0.001) compared with WF-IMRT plans. However, the D-SCLV technique significantly reduced mean dose to the larynx (43.7 vs. 46.7 Gy, p = 0.05) and IPC (39.1 vs. 46.1 Gy, p = 0.002). There was no significant difference in dose to the parotid or cord.

CONCLUSION:

Given the steep dose responses seen in studies examining the association between swallowing toxicity and dose to the larynx and IPC, dose reductions using the D-SCLV technique may be clinically significant.

PMID:
19577862
DOI:
10.1016/j.ijrobp.2009.05.020
[Indexed for MEDLINE]
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