Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer

Is What You Plan What You Get?

Jennifer C. O'Daniel, Adam S. Garden, David Schwartz, He Wang, Kian K. Ang, Anesa Ahamad, David I. Rosenthal, William H. Morrison, Joshua A. Asper, Lifei Zhang, Shih Ming Tung, Radhe Mohan, Lei Dong

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45% of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage.

Original languageEnglish (US)
Pages (from-to)1290-1296
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number4
DOIs
StatePublished - Nov 15 2007

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salivary glands
Intensity-Modulated Radiotherapy
Parotid Gland
Head and Neck Neoplasms
radiation therapy
cancer
dosage
alignment
Bone and Bones
bones
Cervical Vertebrae
planning
margins
tumors
Neoplasms
Radiotherapy
Software
vertebrae
Therapeutics
markers

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer : Is What You Plan What You Get? / O'Daniel, Jennifer C.; Garden, Adam S.; Schwartz, David; Wang, He; Ang, Kian K.; Ahamad, Anesa; Rosenthal, David I.; Morrison, William H.; Asper, Joshua A.; Zhang, Lifei; Tung, Shih Ming; Mohan, Radhe; Dong, Lei.

In: International Journal of Radiation Oncology Biology Physics, Vol. 69, No. 4, 15.11.2007, p. 1290-1296.

Research output: Contribution to journalArticle

O'Daniel, JC, Garden, AS, Schwartz, D, Wang, H, Ang, KK, Ahamad, A, Rosenthal, DI, Morrison, WH, Asper, JA, Zhang, L, Tung, SM, Mohan, R & Dong, L 2007, 'Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer: Is What You Plan What You Get?', International Journal of Radiation Oncology Biology Physics, vol. 69, no. 4, pp. 1290-1296. https://doi.org/10.1016/j.ijrobp.2007.07.2345
O'Daniel, Jennifer C. ; Garden, Adam S. ; Schwartz, David ; Wang, He ; Ang, Kian K. ; Ahamad, Anesa ; Rosenthal, David I. ; Morrison, William H. ; Asper, Joshua A. ; Zhang, Lifei ; Tung, Shih Ming ; Mohan, Radhe ; Dong, Lei. / Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer : Is What You Plan What You Get?. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 69, No. 4. pp. 1290-1296.
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abstract = "Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45{\%} of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91{\%} of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage.",
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AU - Garden, Adam S.

AU - Schwartz, David

AU - Wang, He

AU - Ang, Kian K.

AU - Ahamad, Anesa

AU - Rosenthal, David I.

AU - Morrison, William H.

AU - Asper, Joshua A.

AU - Zhang, Lifei

AU - Tung, Shih Ming

AU - Mohan, Radhe

AU - Dong, Lei

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N2 - Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45% of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage.

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