Skip to main content
SpringerLink
Log in

Evaluation of radiotherapy techniques for radical treatment of lateralised oropharyngeal cancers

Dosimetry and NTCP

Untersuchung von Strahlentherapieverfahren zur radikalen Bestrahlung von unilateralen Oropharynxtumoren

Dosimetrie und Komplikationswahrscheinlichkeit in Normalgeweben

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Aim

The aim of this study was to investigate potential advantages and disadvantages of three-dimensional conformal radiotherapy (3DCRT), multiple fixed-field intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in terms of dose to the planning target volume (PTV), organs at risk (OARs) and normal tissue complication probability (NTCP) for delivering ipsilateral radiotherapy.

Materials and methods

3DCRT, IMRT and VMAT were compared in patients with well-lateralised primary tonsillar cancers who underwent primary radical ipsilateral radiotherapy. The following parameters were compared: conformity index (CI); homogeneity index (HI); dose–volume histograms (DVHs) of PTVs and OARs; NTCP, risk of radiation-induced cancer and dose accumulation during treatment.

Results

IMRT and VMAT were superior to 3DCRT in terms of CI, HI and dose to the target volumes, as well as mandible and dose accumulation robustness. The techniques were equivalent in terms of dose and NTCP for the contralateral oral cavity, contralateral submandibular gland and mandible, when specific dose constraint objectives were used on the oral cavity volume. Although the volume of normal tissue exposed to low-dose radiation was significantly higher with IMRT and VMAT, the risk of radiation-induced secondary malignancy was dependant on the mathematical model used.

Conclusion

This study demonstrates the superiority of IMRT/VMAT techniques over 3DCRT in terms of dose homogeneity, conformity and consistent dose delivery to the PTV throughout the course of treatment in patients with lateralised oropharyngeal cancers. Dosimetry and NTCP calculations show that these techniques are equivalent to 3DCRT with regard to the risk of acute mucositis when specific dose constraint objectives were used on the contralateral oral cavity OAR.

Zusammenfassung

Ziel

Das Ziel dieser Studie war die Untersuchung potenzieller Vor- und Nachteile der dreidimensionalen, konformalen Strahlentherapie (3DCRT), der intensitätsmodulierten Strahlentherapie (IMRT) in Step-and-Shoot-Technik und der intensitätsmodulierten Rotationstherapie (“volumetric-modulated arc therapy”, VMAT) für die ipsilaterale Bestrahlung von Oropharynxtumoren hinsichtlich der Dosisverteilung im Planungszielvolumen (PTV), den Risikoorganen (OAR) und der Komplikationswahrscheinlichkeit in Normalgeweben (NTCP).

Materialien und Methoden

Für die radikale Primärtherapie unterschiedlicher Fälle von streng unilateralen primären Tonsillenkarzinomen wurden Dosisverteilungen von 3DCRT, IMRT und VMAT verglichen. Hierfür wurden Konformitätsindex (CI), Homogenitätsindex (HI), Dosis-Volumen-Histogramme (DVH) des PTV und der OAR, NTCP, Risiko von strahleninduzierten Zweittumoren und die aufsummierte applizierte Gesamtdosis untersucht.

Ergebnisse

Die Bestrahlungspläne von IMRT und VMAT waren in Bezug auf CI, HI, Dosisverteilung im Zielvolumen und im Unterkiefer sowie der tatsächlich applizierten Dosis der 3DCRT überlegen. Bezüglich der Dosisverteilung, der NTCP der kontralateralen Mundhöhle, Gl. submandibularis und des Unterkiefers bei Anwendung einer dedizierten Dosisvolumenbeschränkung der Mundhöhle waren die Techniken äquivalent. Obwohl das Niedrigdosisvolumen bei IMRT und VMAT signifikant höher war als bei 3DCRT, war das erwartete Risiko strahleninduzierter Zweittumoren abhängig vom verwendeten mathematischen Modell.

Schlussfolgerung

Die untersuchten IMRT-/VMAT-Techniken sind der 3DCRT bei der Bestrahlung streng unilateraler oropharyngealer Tumoren in Bezug auf die Dosishomogenität, Konformität und konsistente Bestrahlung des PTV während der gesamten Behandlungsdauer überlegen. Dosimetrie und NTCP-Berechnungen zeigen, dass diese Techniken in Bezug auf das Risiko einer akuten Mukositis bei Anwendung einer spezifischen Dosisbeschränkung auf die kontralaterale Mundhöhle äquivalent zu 3DCRT sind.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. O’Sullivan B et al (2001) The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys 51:332–343

    Article  PubMed  Google Scholar 

  2. Al-Mamgani A, Rooij P van, Fransen D, Levendag P (2013) Unilateral neck irradiation for well-lateralized oropharyngeal cancer. Radiother Oncol 106:69–73

    Article  PubMed  Google Scholar 

  3. Chronowski GM et al (2012) Unilateral radiotherapy for the treatment of tonsil cancer. Int J Radiat Oncol Biol Phys 83:204–209

    Article  PubMed  Google Scholar 

  4. Jackson SM et al (1999) Cancer of the tonsil: the results of ipsilateral radiation treatment. Radiother Oncol 51:123–128

    Article  CAS  PubMed  Google Scholar 

  5. Jensen K, Overgaard M, Grau C (2007) Morbidity after ipsilateral radiotherapy for oropharyngeal cancer. Radiother Oncol 85:90–97

    Article  PubMed  Google Scholar 

  6. Lynch J et al (2014) Multiple cervical lymph node involvement and extra-capsular extension predict for contralateral nodal recurrence after ipsilateral radiotherapy for squamous cell carcinoma of the tonsil. Oral Oncol 50:901–906

    Article  PubMed  Google Scholar 

  7. Feng FY et al (2007) Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 68:1289–1298

    Article  PubMed  Google Scholar 

  8. Nutting CM et al (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hall EJ, Wuu CS (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56:83–88

    Article  PubMed  Google Scholar 

  10. Gregoire V, Eisbruch A, Hamoir M, Levendag P (2006) Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol 79:15–20

    Article  PubMed  Google Scholar 

  11. Gregoire V et al (2003) CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines. Radiother Oncol 69:227–236

    Article  PubMed  Google Scholar 

  12. Humphreys M et al (2005) Assessment of a customised immobilisation system for head and neck IMRT using electronic portal imaging. Radiother Oncol 77:39–44

    Article  PubMed  Google Scholar 

  13. Desikan RS et al (2006) An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest. Neuroimage 31:968–980

    Article  PubMed  Google Scholar 

  14. ICRU Report 83 (2010) Prescribing, recording, and reporting intensity-modulated photon-beam therapy (IMRT). J ICRU 10:55–59

    Article  Google Scholar 

  15. Gondi V, Hermann BP, Mehta MP, Tome WA (2013) Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors. Int J Radiat Oncol Biol Phys 85:348–354

    Article  PubMed  Google Scholar 

  16. Withers HR, Thames HD Jr, Peters LJ (1983) A new isoeffect curve for change in dose per fraction. Radiother Oncol 1:187–191

    Article  CAS  PubMed  Google Scholar 

  17. Bhide SA et al (2010) Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy. Radiother Oncol 97:86–91

    Article  PubMed  Google Scholar 

  18. Weistrand O, Svensson S (2015) The ANACONDA algorithm for deformable image registration in radiotherapy. Med Phys 42:40–53

    Article  PubMed  Google Scholar 

  19. Mayo C, Yorke E, Merchant TE (2010) Radiation associated brainstem injury. Int J Radiat Oncol Biol Phys 76:36–41

    Article  Google Scholar 

  20. Kirkpatrick JP, Kogel AJ van der, Schultheiss TE (2010) Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:S42–S49

    Article  PubMed  Google Scholar 

  21. Tsai CJ et al (2013) Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys 85:415–420

    Article  PubMed  Google Scholar 

  22. Lee IJ et al (2009) Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 75:1084–1091

    Article  PubMed  Google Scholar 

  23. Ben-David MA et al (2007) Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys 68:396–402

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gomez DR et al (2011) Correlation of osteoradionecrosis and dental events with dosimetric parameters in intensity-modulated radiation therapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 81:e207–e213

    Article  PubMed  Google Scholar 

  25. Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA (1999) 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 45:577–587

    Article  CAS  PubMed  Google Scholar 

  26. Murdoch-Kinch CA, Kim HM, Vineberg KA, Ship JA, Eisbruch A (2008) Dose-effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 72:373–382

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lillicrap SC, Morgan HM, Shakeshaft JT (2000) X‑ray leakage during radiotherapy. Br J Radiol 73:793–794

    Article  CAS  PubMed  Google Scholar 

  28. Tubiana M (2009) Can we reduce the incidence of second primary malignancies occurring after radiotherapy? A critical review. Radiother Oncol 91:4–15 (discussion 1–3)

    Article  PubMed  Google Scholar 

  29. Ruben JD et al (2008) The effect of intensity-modulated radiotherapy on radiation-induced second malignancies. Int J Radiat Oncol Biol Phys 70:1530–1536

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was undertaken in The Royal Marsden NHS Foundation Trust which received a proportion of its funding from the NHS Executive; the views expressed in this publication are those of the authors and not necessarily those of the NHS Executive.  This work was supported by Cancer Research UK Programme Grants C46/A10588 and C7224/A13407.  The authors also acknowledge the support of the National Institute for Health Research Royal Marsden and Institute of Cancer Research Biomedical Research Centre.

Author information

Authors and Affiliations

  1. Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK

    D. McQuaid, A. Dunlop, S. Nill, C. Franzese, C. M. Nutting, K. J. Harrington, K. L. Newbold &  S. A. Bhide

  2. Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK

    D. McQuaid, A. Dunlop, S. Nill, C. Franzese, C. M. Nutting, K. J. Harrington, K. L. Newbold &  S. A. Bhide

  3. The Institute of Cancer Research, SW3 6JB, London, UK

    D. McQuaid, A. Dunlop, S. Nill, C. M. Nutting, K. J. Harrington, K. L. Newbold &  S. A. Bhide

  4. The Institute of Cancer Research, SM2 5NG, Sutton, UK

    D. McQuaid, A. Dunlop, S. Nill, C. M. Nutting, K. J. Harrington, K. L. Newbold &  S. A. Bhide

Authors
  1. D. McQuaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Dunlop
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Nill
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Franzese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. M. Nutting
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. J. Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. L. Newbold
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. A. Bhide
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. A. Bhide.

Ethics declarations

Conflict of interest

D. McQuaid, A. Dunlop, S. Nill, C. Franzese, C. M. Nutting, K. J. Harrington, K. L. Newbold and S.A. Bhide state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McQuaid, D., Dunlop, A., Nill, S. et al. Evaluation of radiotherapy techniques for radical treatment of lateralised oropharyngeal cancers. Strahlenther Onkol 192, 516–525 (2016). https://doi.org/10.1007/s00066-016-0980-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-016-0980-1

Keywords

Schlüsselwörter

Search

Navigation