title: Improving target dose coverage and organ-at-risk sparing in intensity-modulated radiotherapy of advanced laryngeal cancer by a simple optimization technique.
abstract: OBJECTIVE
  To evaluate a simple optimization technique intended to improve planning target volume (PTV) dose coverage and organ-at-risk (OAR) sparing in intensity-modulated radiotherapy (IMRT) of advanced laryngeal cancer.
  
  
  METHODS
  Generally acceptable initial IMRT plans were generated for 12 patients and were improved individually by the following two techniques: (1) base dose function-based (BDF) technique, in which the treatment plans were reoptimized based on the initial IMRT plans; (2) dose-controlling structure-based (DCS) technique, in which the initial IMRT plans were reoptimized by adding constraints for hot and cold spots. The initial, BDF and DCS IMRT plans and additionally generated volumetric modulated arc therapy (VMAT) plans were compared concerning homogeneity index (HI) and conformity index (CI) of PTVs prescribed at 70 Gy/60 Gy (PTV70/PTV60), OAR sparing, monitor units (MUs) per fraction and total planning time.
  
  
  RESULTS
  Compared with the initial IMRT and DCS IMRT plans, the BDF technique provided superior HI/CI, by approximately 19-37%/4-11%, and lower doses to most OARs, by approximately 1-7%, except for the comparable HI of PTV60 to DCS IMRT plans. Compared with VMAT plans, the BDF technique provided comparable HI, CI and most-OAR sparing, except for the superior HI of PTV70, by approximately 13%. The BDF technique produced more MUs and reduced the planning time.
  
  
  CONCLUSIONS
  The BDF optimization technique for IMRT of advanced laryngeal cancer can improve target dose homogeneity and conformity, spare most OARs and is efficient.
  
  
  CONCLUSIONS
  A novel optimization technique for improving IMRT was assessed and found to be effective and efficient.
authors.affiliation: 1 Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Lu
authors.forename: L-L
authors.initials: LL
authors.lastname: Wu
authors.forename: J-Y
authors.initials: JY
authors.lastname: Zhang
authors.forename: J
authors.initials: J
authors.lastname: Zheng
authors.forename: M L-M
authors.initials: ML
authors.lastname: Cheung
authors.forename: C-C
authors.initials: CC
authors.lastname: Ma
authors.forename: L-X
authors.initials: LX
authors.lastname: Xie
authors.forename: B-T
authors.initials: BT
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome