Importance of contouring the cervical spine levels in initial intensity-modulated radiation therapy radiation for head and neck cancers: implications for re-irradiation.
OBJECTIVE
To evaluate the maximum differential cervical spinal (C-spine) cord dose in intensity-modulated radiation therapy (IMRT) plans of patients undergoing radiotherapy for treatment of head and neck cancer.


METHODS
The C-spine of ten head and neck cancer patients that were planned using IMRT and each cervical vertebral body and the right and left sides was contoured by splitting the cord in the center. Dose-volume histograms (DVH) and maximum point doses were obtained for each contour and compared.


RESULTS
The dose to the cord varied with the location of the primary tumor but such variation was not consistently seen. This report provides information that is critical for planning reirradiation treatments. We recommend that contouring of the C-spine cord with IMRT should include outlining of each cervical cord level and identification of the right and the left sides of the cord on each plan.
Parashar
Bhupesh
B
Department of Radiation Oncology, Weill Cornell Medical Center, New York, NY 10021, USA. bup9001@med.cornell.edu
Kuo
Chi
C
Kutler
David
D
Kuhel
William
W
Sabbas
Albert
A
Wernicke
Gabriella
G
Nori
Dattatreyudu
D
D002574:Cervical Vertebrae; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013116:Spinal Cord / Q000528:radiation effects*