title: Simple carotid-sparing intensity-modulated radiotherapy technique and preliminary experience for T1-2 glottic cancer.
abstract: OBJECTIVE
  To investigate the dosimetry and feasibility of carotid-sparing intensity-modulated radiotherapy (IMRT) for early glottic cancer and to report preliminary clinical experience.
  
  
  METHODS
  Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) datasets from 6 T1-2 conventionally treated glottic cancer patients were used to create both conventional IMRT plans. We developed a simplified IMRT planning algorithm with three fields and limited segments. Conventional and IMRT plans were compared using generalized equivalent uniform dose and dose-volume parameters for in-field carotid arteries, target volumes, and organs at risk. We have treated 11 patients with this simplified IMRT technique.
  
  
  RESULTS
  Intensity-modulated radiotherapy consistently reduced radiation dose to the carotid arteries (p < 0.05) while maintaining the clinical target volume coverage. With conventional planning, median carotid V35, V50, and V63 were 100%, 100%, and 69.0%, respectively. With IMRT planning these decreased to 2%, 0%, and 0%, respectively (p < 0.01). Radiation planning and treatment times were similar for conventional radiotherapy and IMRT. Treatment results have been excellent thus far.
  
  
  CONCLUSIONS
  Intensity-modulated radiotherapy significantly reduced unnecessary radiation dose to the carotid arteries compared with conventional lateral fields while maintaining clinical target volume coverage. Further experience and longer follow-up will be required to demonstrate outcomes for cancer control and carotid artery effects.
authors.affiliation: Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. dirosenthal@mdanderson.org
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Barker
authors.forename: Bryan
authors.initials: B
authors.lastname: Mason
authors.forename: John A
authors.initials: JA
authors.lastname: Garcia
authors.forename: Jan S
authors.initials: JS
authors.lastname: Lewin
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
authors.forename: C Richard
authors.initials: CR
authors.lastname: Stasney
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
mesh_terms: D000465:Algorithms; D002339:Carotid Arteries / Q000528:radiation effects*; D005240:Feasibility Studies; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D047368:Tumor Burden
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