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Radiation Oncology

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Open Access 01-12-2011 | Research

Sparing the contralateral submandibular gland without compromising PTV coverage by using volumetric modulated arc therapy

Authors: Patricia Doornaert, Wilko FAR Verbakel, Derek HF Rietveld, Ben J Slotman, Suresh Senan

Published in: Radiation Oncology | Issue 1/2011

Abstract

Background

Salivary gland function decreases after radiation doses of 39 Gy or higher. Currently, submandibular glands are not routinely spared. We implemented a technique for sparing contralateral submandibular glands (CLSM) during contralateral elective neck irradiation without compromising PTV coverage.

Methods

Volumetric modulated arc therapy (RapidArc™) plans were applied in 31 patients with stage II-IV HNC without contralateral neck metastases, all of whom received elective treatment to contralateral nodal levels II-IV. Group 1 consisted of 21 patients undergoing concurrent chemo-radiotherapy, with elective nodal doses of 57.75 Gy (PTV_elect) and 70 Gy to tumor and pathological nodes (PTV_boost) in 7 weeks. Group 2 consisted of 10 patients treated with radiotherapy to 54.45 Gy to PTV_elect and 70 Gy to PTV_boost in 6 weeks. All clinical plans spared the CLSM using individually adapted constraints. For each patient, a second plan was retrospectively generated without CLSM constraints ('non-sparing plan').

Results

PTV coverage was similar for both plans, with 98.7% of PTV_elect and 99.2% of PTV_boost receiving ≥95% of the prescription dose. The mean CLSM dose in group 1 was 33.2 Gy for clinical plans, versus 50.6 Gy in 'non-sparing plans' (p < 0.001). In group 2, mean CLSM dose was 34.4 Gy for clinical plans, and 46.8 Gy for non-sparing plans (p = 0.002).

Conclusions

Elective radiotherapy to contralateral nodal levels II-IV using RapidArc consistently limited CLSM doses well below 39 Gy, without compromising PTV-coverage. Future studies will reveal if this extent of dose reduction can reduce patient symptoms.

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Title: Sparing the contralateral submandibular gland without compromising PTV coverage by using volumetric modulated arc therapy
Authors: Patricia Doornaert
Wilko FAR Verbakel
Derek HF Rietveld
Ben J Slotman
Suresh Senan
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2011
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-6-74

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sparing the contralateral submandibular gland without compromising PTV coverage by using volumetric modulated arc therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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