title: Sparing functional anatomical structures during intensity-modulated radiotherapy: an old problem, a new solution.
abstract: During intensity-modulated radiotherapy, an organ is usually assumed to be functionally homogeneous and, generally, its anatomical and spatial heterogeneity with respect to radiation response are not taken into consideration. However, advances in imaging and radiation techniques as well as an improved understanding of the radiobiological response of organs have raised the possibility of sparing the critical functional structures within various organs at risk during intensity-modulated radiotherapy. Here, we discuss these structures, which include the critical brain structure, or neural nuclei, and the nerve fiber tracts in the CNS, head and neck structures related to radiation-induced salivary and swallowing dysfunction, and functional structures in the heart and lung. We suggest that these structures can be used as potential surrogate organs at risk in order to minimize their radiation dose and/or irradiated volume without compromising the dose coverage of the target volume during radiation treatment.
authors.affiliation: Department of Radiation Oncology, Hubei Cancer Hospital, 116 South Road, Zhuodaoquan, Wuhan 430079, China.
authors.forename: Wenyong
authors.initials: W
authors.lastname: Tan
authors.forename: Guang
authors.initials: G
authors.lastname: Han
authors.forename: Shaozhong
authors.initials: S
authors.lastname: Wei
authors.forename: Desheng
authors.initials: D
authors.lastname: Hu
mesh_terms: D019583:Dose Fractionation, Radiation; D006801:Humans; D009369:Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D059351:Organ Sparing Treatments; D011829:Radiation Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated
keywords: CNS tumor; cardiac protection; head and neck cancer; intensity-modulated radiotherapy; organ at risk; structure; thoracic tumor