title: Inverse treatment planning and stereotactic intensity-modulated radiation therapy (IMRT) of the tumor and lymph node levels for nasopharyngeal carcinomas. Description of treatment technique, plan comparison, and case study.
abstract: OBJECTIVE
  Inverse treatment planning and intensity-modulated radiation therapy (IMRT) promise advantages in the treatment of tumors of the head and neck region. Currently published studies use IMRT only in the treatment of the primary tumor. In these studies, the lymph nodes of the neck were treated using conventional techniques. The feasibility of an IMRT technique which allows treatment of the complete target volume, including the primary tumor and lymph nodes, without a beam split is described.
  
  
  METHODS
  For inverse treatment planning, the KonRad planning system was used. The primary as well as the secondary PTV (bilateral lymph node levels) were treated with one intensity-modulated primary plan. To increase the dose in the primary PTV and suspicious lymph nodes, an intensity-modulated boost plan was performed. The "step and shoot" IMRT technique was used. A plan comparison between the described IMRT approach and an IMRT approach using a split-beam technique was performed focusing on the treatment time. A patient with a carcinoma of the nasopharynx was treated with curative intent by a combined radiochemotherapy.
  
  
  RESULTS
  The median total dose to the primary PTV was 70 Gy, to suspicious lymph nodes > or = 66.0 Gy, and to the secondary PTV 52 Gy. The defined maximum doses to the organs at risk were not exceeded, and the median dose to the protected parotid gland amounted to 21 Gy. Comparison of the treatment time between both IMRT approaches revealed only a slightly shorter treatment time (1-3 min) for the split-beam IMRT technique without considering the remaining conventional treatment parts of the split-beam IMRT technique. The patient achieved a complete response, and 18 months after treatment no signs of recurrent disease are visible.
  
  
  CONCLUSIONS
  IMRT allows the treatment of the target volumes with high doses combined with an excellent sparing of the organs at risk. The IMRT approach presented here makes the treatment of the whole target volume with a single-beam arrangement feasible and does not increase the treatment time compared to a split-beam IMRT technique. Treatment time was comparable to a conventional three-field technique combined with electrons. This IMRT technique can prevent over- or underdosage at field matchlines in the head and neck region and, moreover, is able to spare parotid glands and therefore better avoid xerostomia compared to conventional techniques.
authors.affiliation: Department of Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany. m.muenter@dkfz.de
authors.forename: Marc W
authors.initials: MW
authors.lastname: Münter
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Holger
authors.initials: H
authors.lastname: Hof
authors.forename: Simeon
authors.initials: S
authors.lastname: Nill
authors.forename: Peter
authors.initials: P
authors.lastname: Häring
authors.forename: Thomas
authors.initials: T
authors.lastname: Bortfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy*; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012984:Software; D013238:Stereotaxic Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D002945:Cisplatin; D005472:Fluorouracil