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The Dosimetric Outcome of a Rotational Planning Target Volume in Patients With Oropharyngeal Cancers

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Abstract

An isotropic expanded Planning Target Volume (PTV) neglects patient’s off-axis rotation. This study designs a rotational PTV that is used instead of the standard 3-mm Clinical Target Volume (CTV) expanded PTV in oropharyngeal cancers with the goal to reduce pharyngeal constrictor muscle (PCM) mean dose. 10 patients were retrospectively evaluated. For off-axis rotation, the image was rotated around the longitudinal axis (cervical spinal canal) ± 5 degrees. These new CTVs were combined to form the rotational PTV. The standard and rotational treatment plans were designed with the goal to keep the superior and middle PCM-CTV70 mean dose to less than 50 Gy. There were a 355 cGy reduction in the superior PCM mean dose (form 5332 to 4977 cGy) and a 506 cGy reduction in middle PCM mean dose (from 4185 to 3679 cGy). 60% of patients may have at least a 20% reduction in dysphagia probability based on a Normal Tissue Complication Probability (NTCP) formula. The superior and middle PCM mean dose were reduced to less than 50 Gy in 40 and 20% of cases. There was an association between superior PCM mean dose and overlap volume of PTV70 and superior PCM in both standard (r = 0.92, p = 0.001) and rotational (r = 0.84, p = 0.002) plans. This association was present for middle PCM and PTV70 (r = 0.52, p = 0.02 and r = 0.62, p = 0.006). Rotational PTV can lower the mean dose to superior and middle PCMs, ultimately leading to lower dysphagia rates.

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Abbreviations

CTV:

Clinical target volume

GTV:

Gross tumor volume

ICRU:

International commission on radiation units and measurements

IMRT:

Intensity modulated radiation therapy

IRB:

Institutional review board

MDADI:

MD Anderson dysphagia inventory

NTCP:

Normal tissue complication probability

OAR:

Organ at risk

PCM:

Pharyngeal constrictor muscle

PEG:

Percutaneous endoscopic gastrostomy

PTV:

Planning target volume

RTOG:

Radiation therapy oncology group

VMAT:

Volumetric modulated arc therapy

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Funding

Mona Arbab received American College of Radiation Oncology Resident Seed Grant in 2020 for this project. Mark Langer and Jeffrey Ge have received the NIH R03 (CA249545) Grant for this project.

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Authors and Affiliations

  1. Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, RT041, Indianapolis, IN, 46202, USA

    Mona Arbab, Gregory Bartlett, Benjamin Dawson & Mark Langer

  2. Department of Mechanical Engineering, Stony Brook University, Stony Brook, NY, USA

    Jeffrey Ge

Authors
  1. Mona Arbab
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  2. Gregory Bartlett
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  3. Benjamin Dawson
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  4. Jeffrey Ge
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  5. Mark Langer
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Contributions

All authors contributed to the study conception and design. The study design was performed by MA, JG, and ML. The material preparation, data collection, and analysis were performed by MA, GB, and BD. The first draft of the manuscript was written by MA and ML and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mona Arbab.

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Arbab, M., Bartlett, G., Dawson, B. et al. The Dosimetric Outcome of a Rotational Planning Target Volume in Patients With Oropharyngeal Cancers. Dysphagia 37, 848–855 (2022). https://doi.org/10.1007/s00455-021-10341-0

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  • DOI: https://doi.org/10.1007/s00455-021-10341-0

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