title: Importance of contouring the cervical spine levels in initial intensity-modulated radiation therapy radiation for head and neck cancers: implications for re-irradiation.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York, NY 10021, USA. bup9001@med.cornell.edu
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.forename: Chi
authors.initials: C
authors.lastname: Kuo
authors.forename: David
authors.initials: D
authors.lastname: Kutler
authors.forename: William
authors.initials: W
authors.lastname: Kuhel
authors.forename: Albert
authors.initials: A
authors.lastname: Sabbas
authors.forename: Gabriella
authors.initials: G
authors.lastname: Wernicke
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
mesh_terms: 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*