Limits...
Technical advances and pitfalls in head and neck radiotherapy.

Parvathaneni U, Laramore GE, Liao JJ - J Oncol (2012)

Bottom Line: However, these benefits come with a serious and sobering price.Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose".The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.

ABSTRACT
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

No MeSH data available.


Related in: MedlinePlus

IMRT plan for the same patient above with a locally advanced nasopharyngeal cancer demonstrating sharp dose gradient at the level of the skull base, clivus, and upper cervical spine in close proximity to temporal lobe brain, brainstem, and spinal cord. CBCT was used for daily alignment to ensure setup accuracy (see Figure 3).
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369487&req=5

fig4: IMRT plan for the same patient above with a locally advanced nasopharyngeal cancer demonstrating sharp dose gradient at the level of the skull base, clivus, and upper cervical spine in close proximity to temporal lobe brain, brainstem, and spinal cord. CBCT was used for daily alignment to ensure setup accuracy (see Figure 3).

Mentions: IMRT plans with target volumes in close proximity to critical structures including nasopharyngeal, nasal cavity and paranasal sinus, orbital and periorbital tumors where PTVs are in close proximity to brainstem, spinal cord, temporal lobes, and optic apparatus (eyes, optic chiasm, optic nerves). Daily CBCT ensures the accuracy of setup necessary to deliver these plans (Figure 4).


Technical advances and pitfalls in head and neck radiotherapy.

Parvathaneni U, Laramore GE, Liao JJ - J Oncol (2012)

IMRT plan for the same patient above with a locally advanced nasopharyngeal cancer demonstrating sharp dose gradient at the level of the skull base, clivus, and upper cervical spine in close proximity to temporal lobe brain, brainstem, and spinal cord. CBCT was used for daily alignment to ensure setup accuracy (see Figure 3).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369487&req=5

fig4: IMRT plan for the same patient above with a locally advanced nasopharyngeal cancer demonstrating sharp dose gradient at the level of the skull base, clivus, and upper cervical spine in close proximity to temporal lobe brain, brainstem, and spinal cord. CBCT was used for daily alignment to ensure setup accuracy (see Figure 3).
Mentions: IMRT plans with target volumes in close proximity to critical structures including nasopharyngeal, nasal cavity and paranasal sinus, orbital and periorbital tumors where PTVs are in close proximity to brainstem, spinal cord, temporal lobes, and optic apparatus (eyes, optic chiasm, optic nerves). Daily CBCT ensures the accuracy of setup necessary to deliver these plans (Figure 4).

Bottom Line: However, these benefits come with a serious and sobering price.Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose".The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.

ABSTRACT
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

No MeSH data available.


Related in: MedlinePlus