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Study of dosimetric indices and dose constraints to critical organs for head and neck tumours treated with inverse planned simultaneous integrated boost intensity-modulated radiotherapy

Published online by Cambridge University Press:  04 December 2017

Atia Atiq ,
Maria Atiq ,
Khalid Iqbal ,
Qurat-ul-ain Shamsi  and
Saeed Ahmad Buzdar
Atia Atiq*
Affiliation:
Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Maria Atiq
Affiliation:
Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Khalid Iqbal
Affiliation:
Shaukat Khanum Memorial Cancer Hospital & Research Center, Radiation Oncology Department, Lahore, Pakistan
Qurat-ul-ain Shamsi
Affiliation:
Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Saeed Ahmad Buzdar
Affiliation:
Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
*
Correspondence to: Atia Atiq, Physics Department, The Islamia University of Bahawalpur, Bahawalpur, Punjab 63100, Pakistan. Tel: +923336387927. E-mail: atiaatiq@hotmail.com
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Abstract

Aim

This study aimed to investigate tolerance dose to organs at risk (OARs) as well as degree of conformity and homogeneity for head and neck cancer patients by using simultaneous integrated boost intensity-modulated radiotherapy technique (SIB IMRT).

Materials and methods

This study analysed 15 head and neck cancer patients receiving treatment using inverse planned SIB IMRT technique. Using a beam energy of 6 MV, two dose levels of 70 and 55·4 Gy were used to treat the tumour. Doses of 2 Gy in 35 fractions and 1·68 Gy in 33 fractions were simultaneously delivered for effective planning target volume (PTV1) and boost planning target volume (PTV2), respectively.

Results

Dose distribution in PTV and critical organs lies within tolerance dose guidelines protecting spinal cord, brain stem, optic chiasm, optic nerve, thus reducing the risk of damage to normal tissues. Minor deviation from tolerance limit was observed for parotid glands. This technique provided highly conformal and homogenous dose distribution as well as better sparing of OARs, hence verifying quality assurance results to be satisfactory.

Findings

SIB IMRT technique offers best solution for preserving organ function by keeping dose below tolerance level. Treatment of head and neck carcinoma using SIB IMRT is feasible, more efficient, and dose escalation is achieved in a single plan.

Keywords

conformity indexdose constraintshead and neck cancerhomogeneity indexsimultaneous integrated boost
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 2 , June 2018 , pp. 179 - 187
Copyright
© Cambridge University Press 2017 

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References

1. Fogliata, A, Bolsi, A, Cozzi, L, Bernier, J. Comparative dosimetric evaluation of the simultaneous integrated boost with photon intensity modulation in head and neck cancer patients. Radiother Oncol 2003; 69 (3): 267–275.Google Scholar
2. Caraman, A, Buzea, C G, Ojica, S, Oprea, M, Zara, A D, Iancu, D T. A comparison between 3D-CRT, intensity modulated radiotherapy, and volumetric modulated arc therapy techniques for head and neck cancer. J Adv Res Phys 2016; 6 (1): 011601.Google Scholar
3. Grundmann, O, Mitchell, G C, Limesand, K H. Sensitivity of salivary glands to radiation: from animal models to therapies. J Dent Res 2009; 88 (10): 894–903.Google Scholar
4. Rubin, P, Casarett, G. A direction for clinical radiation pathology. In Radiation Effects and Tolerance, Normal Tissue. Front Radiat Ther Oncol 1972; 6: 1–16.Google Scholar
5. Emami, B, Lyman, J, Brown, A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21 (1): 109–122.Google Scholar
6. Jones, D. ICRU report 50—prescribing, recording and reporting photon beam therapy. Med Phys 1994; 21 (6): 833–834.Google Scholar
7.Prescribing, I.C.R.U. recording and reporting photon beam therapy (supplement to ICRU report 50). ICRU Report No. 62, 1999. Bethesda, MD.Google Scholar
8. Gomez-Millan, J, Fernández, J R, Carmona, J A. Current status of IMRT in head and neck cancer. Rep Pract Oncol Radiother 2013; 18 (6): 371–375.Google Scholar
9. Pathak, P, Vashisht, S. A quantitative analysis of intensity-modulated radiation therapy plans and comparison of homogeneity indices for the treatment of gynecological cancers. J Med Phys 2013; 38 (2): 67–73.Google Scholar
10. Cozzi, L, Fogliata, A, Lomax, A, Bolsi, A. A treatment planning comparison of 3D conformal therapy, intensity modulated photon therapy and proton therapy for treatment of advanced head and neck tumours. Radiother Oncol 2001; 61 (3): 287–297.Google Scholar
11. Ang, K K, Zhang, Q, Rosenthal, D I et al. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol 2014; 32 (27): 2940–2950.Google Scholar
12. Tsudou, S, Takegawa, H, Ueda, Y et al. Accumulated dose of intensity-modulated radiotherapy for head and neck cancer using deformable registration of two sets of computed tomography images. J Nucl Med Radiat Ther 2015; 6: 264–270.Google Scholar
13. Lønbro, S, Dalgas, U, Primdahl, H, Overgaard, J, Overgaard, K. Feasibility and efficacy of progressive resistance training and dietary supplements in radiotherapy treated head and neck cancer patients–the DAHANCA 25A study. Acta Oncol 2013; 52 (2): 310–318.Google Scholar
14. Bjørndal, K, Krogdahl, A, Therkildsen, M H et al. Salivary gland carcinoma in Denmark 1990–2005: a national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncol 2011; 47: 677–682.Google Scholar
15. Daoud, M, Saleh, Y, Habash, A. Simultaneous integrated boost by RapidArc therapy plus temozolomide for treatment of patients with glioblastoma multiform: a single institution experience. Int J Cancer Ther Oncol 2015; 3 (3): 3314.Google Scholar
16. El-Ghoneimy, E G, Hassan, M A, El-Bestar, M F, Othman, O M, Mashhour, K N. A dosimetric comparative study between conformal and intensity modulated radiation therapy in the treatment of primary nasopharyngeal carcinomas: the Egyptian experience. Chinese-German J Clin Oncol 2012; 11 (11): 626–631.Google Scholar
17. Xia, P, Lee, N, Liu, Y M et al. A study of planning dose constraints for treatment of nasopharyngeal carcinoma using a commercial inverse treatment planning system. Int J Radiat Oncol Biol Phys 2004; 59 (3): 886–896.Google Scholar
18. Scorsetti, M, Fogliata, A, Castiglioni, S et al. Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients. Radiat Oncol 2010; 5 (1): 93.Google Scholar
19. Shaw, E, Kline, R, Gillin, M et al. Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993; 27 (5): 1231–1239.Google Scholar
20. Knöös, T, Kristensen, I, Nilsson, P. Volumetric and dosimetric evaluation of radiation treatment plans: radiation conformity index. Int J Radiat Oncol Biol Phys 1998; 42 (5): 1169–1176.Google Scholar
21. Krishna, G S, Srinivas, V, Ayyangar, K M, Reddy, P Y. Comparative study of old and new versions of treatment planning system using dose volume histogram indices of clinical plans. J Med Phys 2016; 41 (3): 192–197.Google Scholar
22. Murphy, M J, Chang, S, Gibbs, I, Le, Q T, Martin, D, Kim, D. Image-guided radiosurgery in the treatment of spinal metastases. Neurosurg Focus. 2001; 11 (6): 1–7.Google Scholar
23. Das, I J, Cheng, C W, Chopra, K L, Mitra, R K, Srivastava, S P, Glatstein, E. Intensity-modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. J Natl Cancer Inst 2008; 100 (5): 300–307.Google Scholar
24. Kataria, T, Sharma, K, Subramani, V, Karrthick, K P, Bisht, S S. Homogeneity index: an objective tool for assessment of conformal radiation treatments. J Med Phys 2012; 37 (4): 207–213.Google Scholar
25. Lu, J Y, Cheung, M L, Li, M, Huang, B T, Xie, W J, Xie, L X. Dosimetric evaluation of a simple planning technique for improving intensity-modulated radiotherapy for nasopharyngeal cancer. PloS One. 2015; 10 (7): e0129461.Google Scholar
26. Wu, Q, Manning, M, Schmidt-Ullrich, R, Mohan, R. The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study. Int J Radiat Oncol Biol Phys 2000; 46 (1): 195–205.Google Scholar
27. Ling, C C, Burman, C, Chui, C S et al. Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation. Int J Radiat Oncol Biol Phys 1996; 35 (4): 721–730.Google Scholar
28. Sakthi, N, Keall, P, Mihaylov, I et al. Monte Carlo-based dosimetry of head-and-neck patients treated with SIB-IMRT. Int J Radiat Oncol Biol Phys 2006; 64 (3): 968–977.Google Scholar
29. Yang, W, Zeng, B, Qiu, Y et al A dosimetric comparison of dose escalation with simultaneous integrated boost for locally advanced non-small-cell lung cancer. BioMed Res Int2017; 2017: 9736362, 7 pp.Google Scholar
30. Cox, J D, Stetz, J, Pajak, T F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346.Google Scholar
31. Kim, J W, Cho, J H, Keum, K C et al. IMRT with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer: plan evaluation and treatment outcome. Jpn J Clin Oncol 2012; 42 (12): 1152–1160.Google Scholar
32. Boden, G. Radiation myelitis of the brain-stem. J Fac Radiol 1950; 2 (1): 79–94.Google Scholar
33. Deasy, J O, Moiseenko, V, Marks, L, Chao, K C, Nam, J, Eisbruch, A. Radiotherapy dose–volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010; 76 (3): S58–S63.Google Scholar
34. de Arruda, F F, Puri, D R, Zhung, J et al. Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 2006; 64 (2): 363–373.Google Scholar
35. Chao, K C, Deasy, J O, Markman, J et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 2001; 49 (4): 907–916.Google Scholar
36. Eisbruch, A, Ten Haken, R K, Kim, H M, Marsh, L H, Ship, J A. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999; 45 (3): 577–587.Google Scholar
37. Eisbruch, A, Kim, H M, Terrell, J E, Marsh, L H, Dawson, L A, Ship, J A. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 50 (3): 695–704.Google Scholar
38. Eisbruch, A, Ship, J A, Dawson, L A et al. Salivary gland sparing and improved target irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg 2003; 27 (7): 832–837.Google Scholar
39. Milano, M T, Constine, L S, Okunieff, P. Normal tissue tolerance dose metrics for radiation therapy of major organs. Semin Radiat Oncol 2007; 17 (2): 131–140.Google Scholar
40. Mira, J G, Wescott, W B, Starcke, E N, Shannon, I L. Some factors influencing salivary function when treating with radiotherapy. Int J Radiat Oncol Biol Phys 1981; 7 (4): 535–541.Google Scholar
41. Lee, N, Harris, J, Garden, A S et al. Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: Radiation Therapy Oncology Group phase II trial 0225. J Clin Oncol 2009; 27 (22): 3684–3690.Google Scholar
42. Kristensen, I, Nilsson, K, Nilsson, P. Comparative proton and photon treatment planning in pediatric patients with various diagnoses. Int J Part Ther 2015; 2 (2): 367–375.Google Scholar
43. Lu, J Y, Zhang, J Y, Li, M et al. A simple optimization approach for improving target dose homogeneity in intensity-modulated radiotherapy for sinonasal cancer. Sci Rep 2015; 5: 15361–15369.Google Scholar
44. Süss, P, Bortz, M, Küfer, K H, Thieke, C. The critical spot eraser—a method to interactively control the correction of local hot and cold spots in IMRT planning. Phys Med Biol 2013; 58 (6): 1855–1867.Google Scholar
45. Peszynska-Piorun, M, Malicki, J, Golusinski, W. Doses in organs at risk during head and neck radiotherapy using IMRT and 3D-CRT. Radiol Oncol 2012; 46 (4): 328–336.Google Scholar
46. Hunt, M A, Zelefsky, M J, Wolden, S et al. Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer. Int J Radiat Oncol Biol Phys 2001; 49 (3): 623–632.Google Scholar
47. Mohan, R, Wu, Q, Manning, M, Schmidt-Ullrich, R. Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys 2000; 46 (3): 619–630.Google Scholar
48. Khayaiwong, P, Tungboonduangjit, P, Suriyapee, S et al. Dosimetric comparison between simultaneous integrated boost and sequential intensity-modulated radiotherapy techniques in nasopharyngeal carcinoma. Challenges of Quality Assurance in Radiation Medicine, 6th Annual Scientific Meeting, Phitsanulok, Thailand, 77, 2012.Google Scholar
49. Moorthy, S, Elhateer, H, Das Majumdar, S K, Shubber, Z, Murthy, N. Hypofractionated IMRT breast treatment with simultaneous versus sequential boost techniques. J Nucl Med Radiat Ther 2012; 3: 130–134.Google Scholar
50. Chen, S W, Yang, S N, Liang, J A, Shiau, A C, Lin, F J. Comparative dosimetric study of two strategies of intensity-modulated radiotherapy in nasopharyngeal cancer. Med Dosim 2006; 30 (4): 219–227.Google Scholar
51. Shamsi, Q U, Atiq, M, Atiq, A, Buzdar, S A, Iqbal, K. Analysis of dosimetric indices for evaluating intensity modulated radiotherapy plans of head and neck cancer patients. J Radiol Radiat Ther 2017; 5 (1): 1065–1070.Google Scholar