Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT

Christopher Wilke; Vinita Takiar; He Wang; Amy C. Moreno; Shih Ming Samuel Tung; Sean R. Quinlan-Davidson; Adam S. Garden; David I. Rosenthal; Clifton D. Fuller; Gary B. Gunn; Jay P. Reddy; William H. Morrison; Congjun Wang; George Zhao; Katherine A. Hutcheson; Jack Phan

doi:10.1002/acm2.13009

Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT

Christopher Wilke, Vinita Takiar, He Wang, Amy C. Moreno, Shih Ming Samuel Tung, Sean R. Quinlan-Davidson, Adam S. Garden, David I. Rosenthal, Clifton D. Fuller, Gary B. Gunn, Jay P. Reddy, William H. Morrison, Congjun Wang, George Zhao, Katherine A. Hutcheson, Jack Phan

Research output: Contribution to journal › Article › peer-review

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Abstract

PURPOSE: To determine the optimal dose-volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.

MATERIALS AND METHODS: Thirty patients with stage II-IVA oropharynx cancers received definitive radiotherapy with split-field IMRT (SF-IMRT) to the bilateral neck between 2008 and 2013. Each case was re-planned using whole-field IMRT (WF-IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.

RESULTS: Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF-IMRT than SF-IMRT (22.1 vs 25.8 Gy; P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF-IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy; P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy; P < 0.01).

CONCLUSIONS: Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.

SUMMARY: We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split-field IMRT (SF-IMRT), whole-field IMRT (WF-IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non-laryngeal organs at risk among techniques.

Original language	English (US)
Pages (from-to)	37-44
Number of pages	8
Journal	Journal of Applied Clinical Medical Physics
Volume	22
Issue number	1
DOIs	https://doi.org/10.1002/acm2.13009
State	Published - Jan 2021
Externally published	Yes

Bibliographical note

Funding Information:
This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787-01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248-01/R56DE025248-01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007-10).

Funding Information:
Dr. Fuller receives academic‐industrial institutional grant funding from Elekta AB, and has received travel compensation from Elekta AB.

Funding Information:
This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787‐01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248‐01/R56DE025248‐01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825‐01); NCI Early Phase Clinical Trials in Imaging and Image‐Guided Interventions Program (1R01CA218148‐01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007‐10).

Publisher Copyright:
© 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Keywords

IMRT
Larynx
VMAT
dosimetry
oropharynx
split-field
Radiotherapy Dosage
Oropharyngeal Neoplasms/radiotherapy
Humans
Organs at Risk
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/acm2.13009

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Wilke, C., Takiar, V., Wang, H., Moreno, A. C., Tung, S. M. S., Quinlan-Davidson, S. R., Garden, A. S., Rosenthal, D. I., Fuller, C. D., Gunn, G. B., Reddy, J. P., Morrison, W. H., Wang, C., Zhao, G., Hutcheson, K. A., & Phan, J. (2021). Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT. Journal of Applied Clinical Medical Physics, 22(1), 37-44. https://doi.org/10.1002/acm2.13009

Wilke, C, Takiar, V, Wang, H, Moreno, AC, Tung, SMS, Quinlan-Davidson, SR, Garden, AS, Rosenthal, DI, Fuller, CD, Gunn, GB, Reddy, JP, Morrison, WH, Wang, C, Zhao, G, Hutcheson, KA & Phan, J 2021, 'Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT', Journal of Applied Clinical Medical Physics, vol. 22, no. 1, pp. 37-44. https://doi.org/10.1002/acm2.13009

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title = "Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT",

abstract = "PURPOSE: To determine the optimal dose-volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.MATERIALS AND METHODS: Thirty patients with stage II-IVA oropharynx cancers received definitive radiotherapy with split-field IMRT (SF-IMRT) to the bilateral neck between 2008 and 2013. Each case was re-planned using whole-field IMRT (WF-IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.RESULTS: Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF-IMRT than SF-IMRT (22.1 vs 25.8 Gy; P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF-IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy; P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy; P < 0.01).CONCLUSIONS: Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.SUMMARY: We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split-field IMRT (SF-IMRT), whole-field IMRT (WF-IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non-laryngeal organs at risk among techniques.",

keywords = "IMRT, Larynx, VMAT, dosimetry, oropharynx, split-field, Radiotherapy Dosage, Oropharyngeal Neoplasms/radiotherapy, Humans, Organs at Risk, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated",

author = "Christopher Wilke and Vinita Takiar and He Wang and Moreno, {Amy C.} and Tung, {Shih Ming Samuel} and Quinlan-Davidson, {Sean R.} and Garden, {Adam S.} and Rosenthal, {David I.} and Fuller, {Clifton D.} and Gunn, {Gary B.} and Reddy, {Jay P.} and Morrison, {William H.} and Congjun Wang and George Zhao and Hutcheson, {Katherine A.} and Jack Phan",

note = "Funding Information: This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787-01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248-01/R56DE025248-01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007-10). Funding Information: Dr. Fuller receives academic‐industrial institutional grant funding from Elekta AB, and has received travel compensation from Elekta AB. Funding Information: This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787‐01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248‐01/R56DE025248‐01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825‐01); NCI Early Phase Clinical Trials in Imaging and Image‐Guided Interventions Program (1R01CA218148‐01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007‐10). Publisher Copyright: {\textcopyright} 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.",

year = "2021",

month = jan,

doi = "10.1002/acm2.13009",

language = "English (US)",

volume = "22",

pages = "37--44",

journal = "Journal of Applied Clinical Medical Physics",

issn = "1526-9914",

publisher = "American Institute of Physics Publising LLC",

number = "1",

}

TY - JOUR

T1 - Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT

AU - Wilke, Christopher

AU - Takiar, Vinita

AU - Wang, He

AU - Moreno, Amy C.

AU - Tung, Shih Ming Samuel

AU - Quinlan-Davidson, Sean R.

AU - Garden, Adam S.

AU - Rosenthal, David I.

AU - Fuller, Clifton D.

AU - Gunn, Gary B.

AU - Reddy, Jay P.

AU - Morrison, William H.

AU - Wang, Congjun

AU - Zhao, George

AU - Hutcheson, Katherine A.

AU - Phan, Jack

N1 - Funding Information: This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787-01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248-01/R56DE025248-01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825-01); NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007-10). Funding Information: Dr. Fuller receives academic‐industrial institutional grant funding from Elekta AB, and has received travel compensation from Elekta AB. Funding Information: This research was supported in part by the Andrew Sabin Family Foundation; Dr. Fuller is a Sabin Family Foundation Fellow. Dr. Fuller receives funding and salary support from the National Institutes of Health (NIH), including: the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program award(1R25EB025787‐01); the National Institute for Dental and Craniofacial Research Award (1R01DE025248‐01/R56DE025248‐01); a National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant (NSF 1557679); the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award (1R01CA214825‐01); NCI Early Phase Clinical Trials in Imaging and Image‐Guided Interventions Program (1R01CA218148‐01); an NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program (P30CA016672) and an NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award (P50 CA097007‐10). Publisher Copyright: © 2020 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

PY - 2021/1

Y1 - 2021/1

N2 - PURPOSE: To determine the optimal dose-volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.MATERIALS AND METHODS: Thirty patients with stage II-IVA oropharynx cancers received definitive radiotherapy with split-field IMRT (SF-IMRT) to the bilateral neck between 2008 and 2013. Each case was re-planned using whole-field IMRT (WF-IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.RESULTS: Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF-IMRT than SF-IMRT (22.1 vs 25.8 Gy; P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF-IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy; P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy; P < 0.01).CONCLUSIONS: Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.SUMMARY: We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split-field IMRT (SF-IMRT), whole-field IMRT (WF-IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non-laryngeal organs at risk among techniques.

AB - PURPOSE: To determine the optimal dose-volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.MATERIALS AND METHODS: Thirty patients with stage II-IVA oropharynx cancers received definitive radiotherapy with split-field IMRT (SF-IMRT) to the bilateral neck between 2008 and 2013. Each case was re-planned using whole-field IMRT (WF-IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.RESULTS: Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF-IMRT than SF-IMRT (22.1 vs 25.8 Gy; P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF-IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy; P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy; P < 0.01).CONCLUSIONS: Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.SUMMARY: We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split-field IMRT (SF-IMRT), whole-field IMRT (WF-IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non-laryngeal organs at risk among techniques.

KW - IMRT

KW - Larynx

KW - VMAT

KW - dosimetry

KW - oropharynx

KW - split-field

KW - Radiotherapy Dosage

KW - Oropharyngeal Neoplasms/radiotherapy

KW - Humans

KW - Organs at Risk

KW - Radiotherapy Planning, Computer-Assisted

KW - Radiotherapy, Intensity-Modulated

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Defining the dose-volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split-field IMRT, whole-field IMRT and VMAT

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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