title: Spinal cord planning risk volumes for intensity-modulated radiation therapy of head-and-neck cancer.
abstract: OBJECTIVE
  To assess planning organ at risk volume (PRV) margins of the spinal cord in intensity-modulated radiotherapy (IMRT) of oropharyngeal cancers, by modeling the effect of geometric uncertainties to estimate the probability of the spinal cord receiving a particular dose.
  
  
  METHODS
  Five patients with oropharyngeal cancer were treated by IMRT with simultaneous doses of 66 Gy (gross disease) and 54 Gy (subclinical disease) in 30 fractions. Spinal cord doses were limited to 45 Gy. The probability, due to random and systematic patient positioning uncertainties (3-mm standard deviation), of the cord receiving a particular dose was determined. The effect of an on-line setup correction protocol was also modeled.
  
  
  RESULTS
  The mean probability of a maximum spinal cord dose of 45 Gy was 1%, with a 6-mm PRV margin. The mean probability of a maximum dose exceeding 40 Gy was 37% (range, 13-77%); this probability is reduced with a setup correction protocol.
  
  
  CONCLUSIONS
  A spinal cord PRV generated with a 6-mm margin leads to a 99% probability of maintaining the maximum spinal cord dose below 45 Gy. The application of an on-line setup correction protocol reduces the cord dose by approximately 5 Gy.
authors.affiliation: Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. Stephan.Breen@rmp.uhn.on.ca
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Breen
authors.forename: Tim
authors.initials: T
authors.lastname: Craig
authors.forename: Andrew
authors.initials: A
authors.lastname: Bayley
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.forename: David
authors.initials: D
authors.lastname: Jaffray
mesh_terms: D019583:Dose Fractionation, Radiation; D006801:Humans; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011336:Probability; D011832:Radiation Injuries / Q000517:prevention & control*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000528:radiation effects*