Pranshu Mohindra1,2, Erich Urban3, Jonathan D Pagan4, Heather M Geye1, Vatsal B Patel5, R Adam A Bayliss1, Edward T Bender1, Paul M Harari1. 1. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 2. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. 3. Department of Radiation Oncology, Aurora Cancer Center, Grafton, Wisconsin. 4. University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas. 5. University of Connecticut, School of Medicine, Farmington, Connecticut.
Abstract
BACKGROUND: We sought to validate the consensus recommendation and assess dosimetric significance of selective omission of nodal level V from intensity-modulated radiotherapy (IMRT) clinical target volume (CTV) for oropharyngeal cancer. METHODS: IMRT plans and clinical outcomes for 112 patients with oropharyngeal cancer (nodal classification N0-N2b) were analyzed for coverage of ipsilateral and contralateral nodal level V. Additionally, new IMRT plans were generated in 6 randomly selected patients to assess its dosimetric impact. RESULTS: With median follow-up of 3.4 years, there were no failures identified in nodal level V with or without nodal level V omission. Upon dosimetric evaluation, significant reduction in integral dose, V10 Gy , V20 Gy , V30 Gy , V40 Gy , and V50 Gy was observed by excluding unilateral and bilateral level V from the CTV. CONCLUSION: We clinically validate the consensus recommendation for selective omission of level V nodal coverage in IMRT planning of patients with oropharyngeal cancer and demonstrate significant dosimetric advantages.
BACKGROUND: We sought to validate the consensus recommendation and assess dosimetric significance of selective omission of nodal level V from intensity-modulated radiotherapy (IMRT) clinical target volume (CTV) for oropharyngeal cancer. METHODS: IMRT plans and clinical outcomes for 112 patients with oropharyngeal cancer (nodal classification N0-N2b) were analyzed for coverage of ipsilateral and contralateral nodal level V. Additionally, new IMRT plans were generated in 6 randomly selected patients to assess its dosimetric impact. RESULTS: With median follow-up of 3.4 years, there were no failures identified in nodal level V with or without nodal level V omission. Upon dosimetric evaluation, significant reduction in integral dose, V10 Gy , V20 Gy , V30 Gy , V40 Gy , and V50 Gy was observed by excluding unilateral and bilateral level V from the CTV. CONCLUSION: We clinically validate the consensus recommendation for selective omission of level V nodal coverage in IMRT planning of patients with oropharyngeal cancer and demonstrate significant dosimetric advantages.
Authors: Stanley Gutiontov; Jonathan Leeman; Benjamin Lok; Paul Romesser; Nadeem Riaz; C Jillian Tsai; Nancy Lee; Sean McBride Journal: Oral Oncol Date: 2016-05-27 Impact factor: 5.337