title: Unilateral and bilateral neck SIB for head and neck cancer patients : Intensity-modulated proton therapy, tomotherapy, and RapidArc.
abstract: OBJECTIVE
  To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer.
  
  
  METHODS
  A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared.
  
  
  RESULTS
  All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001-1.1 Gy) than both rotational techniques did (parotid gland: 6-10 Gy; submandibular gland: 15-20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory.
  
  
  CONCLUSIONS
  For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ-at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level.
authors: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. carmen.stromberger@charite.de.
authors: Carmen
authors: C
authors: Stromberger
authors: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center Milan, Milan, Italy.
authors: Luca
authors: L
authors: Cozzi
authors: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Volker
authors: V
authors: Budach
authors: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center Milan, Milan, Italy.
authors: Antonella
authors: A
authors: Fogliata
authors: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Pirus
authors: P
authors: Ghadjar
authors: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Waldemar
authors: W
authors: Wlodarczyk
authors: Praxis für Strahlentherapie, Klinikum Frankfurt Oder, Frankfurt Oder, Germany.
authors: Basil
authors: B
authors: Jamil
authors: Clinic for Oral and Maxillofacial Surgery, Berlin, Germany.
authors: Jan D
authors: JD
authors: Raguse
authors: Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Arne
authors: A
authors: Böttcher
authors: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors: Simone
authors: S
authors: Marnitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000628:therapy*; D061766:Proton Therapy / Q000379:methods*; D011832:Radiation Injuries / Q000517:prevention & control; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods; D011882:Radiotherapy, High-Energy / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*
keywords: Chemoradiation; Helical tomotherapy; Organs at risk; Simultaneous integrated boost; Volumetric arc therapy