title: Sequentially delivered boost plans are superior to simultaneously delivered plans in head and neck cancer when the boost volume is located further away from the parotid glands.
abstract: OBJECTIVE
  To find parameters that predict which head and neck patients benefit from a sequentially delivered boost treatment plan compared to a simultaneously delivered plan, with the aim to spare the salivary glands.
  
  
  METHODS
  We evaluated 50 recently treated head and neck cancer patients. Apart from the clinical plan with a sequentially (SEQ) given boost using an Intensity Modulated Radiotherapy Technique (IMRT), a simultaneous integrated boost (SIB) technique plan was constructed with the same beam set-up. The mean dose to the parotid glands was calculated and compared. The elective nodal areas were bilateral in all cases, with a boost on either one side or both sides of the neck.
  
  
  RESULTS
  When the parotid gland volume and the Planning Target Volume (PTV) for the boost overlap there is on average a lower dose to the parotid gland with a SIB technique (-1.2 Gy), which is, however, not significant (p=0.08). For all parotid glands with no boost PTV overlap, there is a benefit from a SEQ technique compared to a SIB technique for the gland evaluated (on average a 2.5 Gy lower dose to the parotid gland, p<0.001). When the distance between gland and PTV is 0-1 cm, this difference is on average 0.8 Gy, for 1-2 cm distance 2.9 Gy and for glands with a distance greater than 2 cm, 3.3 Gy. When the lymph nodes on the evaluated side are also included in the boost PTV, however, this relationship between the distance and the gain of a SEQ seems less clear.
  
  
  CONCLUSIONS
  A sequentially delivered boost technique results in a better treatment plan for most cases, compared to a simultaneous integrated boost IMRT technique, if the boost PTV is more than 1 cm away from at least one parotid gland.
authors.affiliation: The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam, The Netherlands. e.lamers@nki.nl
authors.forename: Emmy
authors.initials: E
authors.lastname: Lamers-Kuijper
authors.forename: Wilma
authors.initials: W
authors.lastname: Heemsbergen
authors.forename: Anke
authors.initials: A
authors.lastname: van Mourik
authors.forename: Coen
authors.initials: C
authors.lastname: Rasch
mesh_terms: D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D016014:Linear Models; D009367:Neoplasm Staging; D010306:Parotid Gland / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*