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Radiotherapy planning techniques to reduce lung irradiation in head and neck cancer patients with mediastinal involvement

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Abstract

The number of patients with head and neck squamous cell carcinoma (HNC) with mediastinal involvement is small, and appropriate treatment techniques have not been widely discussed. This study aimed to compare the efficacy of radiotherapy planning techniques in reducing lung irradiation while retaining target coverage. Among all HNC patients with mediastinal involvement who underwent radiotherapy between 2007 and 2014 at our hospital, seven consecutive patients were included in this study. Four different treatment plans were generated for each patient as follows: seven-field intensity-modulated radiation therapy (IMRT), modified IMRT in which the lateral beams avoided the lungs, three-full-arc volumetric-modulated arc therapy (VMAT), and VMAT with lung avoidance. We compared the outcomes of IMRT and VMAT plans using the paired t-test. After modifications were made to avoid lung irradiation, IMRT values for V5Gy and V20Gy decreased from 713.2 to 503.6 cm3 (p = 0.011) and from 338.8 cm3 to 267.0 cm3 (p = 0.058), respectively. In the case of VMAT, lung V5Gy and V20Gy values decreased from 754.8 to 601.0 cm3 (p = 0.004) and from 328.5 to 255.7 cm3 (p = 0.020), respectively. Other factors did not significantly differ between the plans. In both IMRT and VMAT planning, lung doses were significantly reduced following the modification of the beams that cross the lungs with target coverage maintenance.

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Funding

This work was partially supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (A), [Grant Number JP25253078].

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Authors and Affiliations

  1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan

    Mitsue Kawamura, Michio Yoshimura, Mitsuhiro Nakamura, Nobutaka Mukumoto, Hideaki Hirashima, Hiraku Iramina & Takashi Mizowaki

  2. Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Mitsuhiro Nakamura

  3. Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Yoshitomo Ishihara & Masahiro Hiraoka

Authors
  1. Mitsue Kawamura
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  2. Michio Yoshimura
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  3. Mitsuhiro Nakamura
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  4. Yoshitomo Ishihara
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  5. Nobutaka Mukumoto
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  6. Hideaki Hirashima
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  7. Hiraku Iramina
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  8. Masahiro Hiraoka
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  9. Takashi Mizowaki
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Correspondence to Michio Yoshimura.

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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kawamura, M., Yoshimura, M., Nakamura, M. et al. Radiotherapy planning techniques to reduce lung irradiation in head and neck cancer patients with mediastinal involvement. Radiol Phys Technol 13, 128–135 (2020). https://doi.org/10.1007/s12194-020-00559-2

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  • DOI: https://doi.org/10.1007/s12194-020-00559-2

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