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Radiation Oncology
Published in: Radiation Oncology 1/2013

Open Access 01-12-2013 | Research

Constraining the brachial plexus does not compromise regional control in oropharyngeal carcinoma

Authors: Robert W Mutter, Benjamin H Lok, Pinaki R Dutta, Nadeem Riaz, Jeremy Setton, Sean L Berry, Anuj Goenka, Zhigang Zhang, Shyam S Rao, Suzanne L Wolden, Nancy Y Lee

Published in: Radiation Oncology | Issue 1/2013

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Abstract

Background

Accumulating evidence suggests that brachial plexopathy following head and neck cancer radiotherapy may be underreported and that this toxicity is associated with a dose–response. Our purpose was to determine whether the dose to the brachial plexus (BP) can be constrained, without compromising regional control.

Methods

The radiation plans of 324 patients with oropharyngeal carcinoma (OPC) treated with intensity-modulated radiation therapy (IMRT) were reviewed. We identified 42 patients (13%) with gross nodal disease <1 cm from the BP. Normal tissue constraints included a maximum dose of 66 Gy and a D05 of 60 Gy for the BP. These criteria took precedence over planning target volume (PTV) coverage of nodal disease near the BP.

Results

There was only one regional failure in the vicinity of the BP, salvaged with neck dissection (ND) and regional re-irradiation. There have been no reported episodes of brachial plexopathy to date.

Conclusions

In combined-modality therapy, including ND as salvage, regional control did not appear to be compromised by constraining the dose to the BP. This approach may improve the therapeutic ratio by reducing the long-term risk of brachial plexopathy.
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Metadata
Title
Constraining the brachial plexus does not compromise regional control in oropharyngeal carcinoma
Authors
Robert W Mutter
Benjamin H Lok
Pinaki R Dutta
Nadeem Riaz
Jeremy Setton
Sean L Berry
Anuj Goenka
Zhigang Zhang
Shyam S Rao
Suzanne L Wolden
Nancy Y Lee
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2013
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-8-173

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