title: Split-field vs extended-field intensity-modulated radiation therapy plans for oropharyngeal cancer: Which spares the larynx? Which spares the thyroid?
abstract: Radiation of the low neck can be accomplished using split-field intensity-modulated radiation therapy (sf-IMRT) or extended-field intensity-modulated radiation therapy (ef-IMRT). We evaluated the effect of these treatment choices on target coverage and thyroid and larynx doses. Using data from 14 patients with cancers of the oropharynx, we compared the following 3 strategies for radiating the low neck: (1) extended-field IMRT, (2) traditional split-field IMRT with an initial cord-junction block to 40Gy, followed by a full-cord block to 50Gy, and (3) split-field IMRT with a full-cord block to 50Gy. Patients were planned using each of these 3 techniques. To facilitate comparison, extended-field plans were normalized to deliver 50Gy to 95% of the neck volume. Target coverage was assessed using the dose to 95% of the neck volume (D95). Mean thyroid and larynx doses were computed. Extended-field IMRT was used as the reference arm; the mean larynx dose was 25.7 ± 7.4Gy, and the mean thyroid dose was 28.6 ± 2.4Gy. Split-field IMRT with 2-step blocking reduced laryngeal dose (mean larynx dose 15.2 ± 5.1Gy) at the cost of a moderate reduction in target coverage (D95 41.4 ± 14Gy) and much higher thyroid dose (mean thyroid dose 44.7 ± 3.7Gy). Split-field IMRT with initial full-cord block resulted in greater laryngeal sparing (mean larynx dose 14.2 ± 5.1Gy) and only a moderately higher thyroid dose (mean thyroid dose 31 ± 8Gy) but resulted in a significant reduction in target coverage (D95 34.4 ± 15Gy). Extended-field IMRT comprehensively covers the low neck and achieves acceptable thyroid and laryngeal sparing. Split-field IMRT with a full-cord block reduces laryngeal doses to less than 20Gy and spares the thyroid, at the cost of substantially reduced coverage of the low neck. Traditional 2-step split-field IMRT similarly reduces the laryngeal dose but also reduces low-neck coverage and delivers very high doses to the thyroid.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Radiation Medicine, Oregon Health Sciences University, Portland, OR.
authors.forename: Celeste I
authors.initials: CI
authors.lastname: Leary
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA.
authors.forename: Erin
authors.initials: E
authors.lastname: Shugard
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA. Electronic address: yoms@radonc.ucsf.edu.
authors.forename: Sue S
authors.initials: SS
authors.lastname: Yom
mesh_terms: D006801:Humans; D007830:Larynx / Q000528:radiation effects*; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013961:Thyroid Gland / Q000528:radiation effects*
keywords: Extended field IMRT; Isocentric match; Low-anterior neck field; Split field