title: Is there a "mucosa-sparing" benefit of IMRT for head-and-neck cancer?
abstract: OBJECTIVE
  To investigate whether intensity-modulated radiation therapy (IMRT) allows more mucosal sparing than standard three-field technique (3FT) radiotherapy for early oropharyngeal cancer.
  
  
  METHODS
  Whole-field IMRT plans were generated for 5 patients with early-stage oropharyngeal cancer according to Radiation Therapy Oncology Group 0022 (66 Gy/30 fractions/6 weeks) guidelines with and without a dose objective on the portion of mucosa not overlapping any PTV. 3FT plans were also generated for the same 5 patients with two fractionation schedules: conventional fractionation (CF) to 70 Gy/35 fractions/7 weeks and concomitant boost (CB) to 72 Gy/40 fractions/6 weeks. Cumulative dose volume histograms (DVHs) of the overall mucosal volume (as per in-house definition) from all trials were compared after transformation into the linear quadratic equivalent dose at 2 Gy per fraction with a time factor correction.
  
  
  RESULTS
  Compared with IMRT without dose objective on the mucosa, a 30-Gy maximum dose objective on the mucosa allows approximately 20% and approximately 12% mean absolute reduction in the percentage of mucosa volume exposed to a dose equivalent to 30 Gy (p < 0.01) and 70 Gy (p < 0.01) at 2 Gy in 3 and 7 weeks, respectively, without detrimental effect on the coverage of other regions of interest. Without mucosal dose objective, IMRT is associated with a larger amount of mucosa exposed to clinically relevant doses compared with both concomitant boost and conventional fractionation; however, if a dose objective is placed, the reverse is true, with up to approximately 30% reduction in the volume of the mucosa in the high-dose region compared with both concomitant boost and conventional fractionation (p < 0.01).
  
  
  CONCLUSIONS
  Intensity-modulated radiation therapy can be potentially provide more mucosal sparing than traditional approaches.
authors.affiliation: Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX 77555-0711, USA. gisangui@utmb.edu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Endres
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Gunn
authors.forename: Brent
authors.initials: B
authors.lastname: Parker
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D006801:Humans; D009061:Mouth Mucosa / Q000528:radiation effects*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D050397:Radiotherapy, Intensity-Modulated; D020545:Respiratory Mucosa / Q000528:radiation effects*