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Author Dogan, N. ♦ Padgett, K. ♦ Evans, J. ♦ Sleeman, W. ♦ Song, S. ♦ Fatyga, M.
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword APPLIED LIFE SCIENCES ♦ ACCOUNTING ♦ ACCURACY ♦ BIOMEDICAL RADIOGRAPHY ♦ COMPUTERIZED TOMOGRAPHY ♦ ESOPHAGUS ♦ HEAD ♦ IMAGES ♦ LIMITING VALUES ♦ NECK ♦ NEOPLASMS ♦ PATIENTS ♦ PLANNING ♦ RADIATION DOSE DISTRIBUTIONS ♦ RADIATION DOSES ♦ RADIOTHERAPY
Abstract Purpose: Adaptive Radiotherapy (ART) with frequent CT imaging has been used to improve dosimetric accuracy by accounting for anatomical variations, such as primary tumor shrinkage and/or body weight loss, in Head and Neck (H&N) patients. In most ART strategies, the difference between the planned and the delivered dose is estimated by generating new plans on repeated CT scans using dose-volume constraints used with the initial planning CT without considering already delivered dose. The aim of this study was to assess the dosimetric gains achieved by re-planning based on prior dose by comparing them to re-planning not based-on prior dose for H&N patients. Methods: Ten locally-advanced H&N cancer patients were selected for this study. For each patient, six weekly CT imaging were acquired during the course of radiotherapy. PTVs, parotids, cord, brainstem, and esophagus were contoured on both planning and six weekly CT images. ART with weekly re-plans were done by two strategies: 1) Generating a new optimized IMRT plan without including prior dose from previous fractions (NoPriorDose) and 2) Generating a new optimized IMRT plan based on the prior dose given from previous fractions (PriorDose). Deformable image registration was used to accumulate the dose distributions between planning and six weekly CT scans. The differences in accumulated doses for both strategies were evaluated using the DVH constraints for all structures. Results: On average, the differences in accumulated doses for PTV1, PTV2 and PTV3 for NoPriorDose and PriorDose strategies were <2%. The differences in Dmean to the cord and brainstem were within 3%. The esophagus Dmean was reduced by 2% using PriorDose. PriorDose strategy, however, reduced the left parotid D50 and Dmean by 15% and 14% respectively. Conclusion: This study demonstrated significant parotid sparing, potentially reducing xerostomia, by using ART with IMRT optimization based on prior dose for weekly re-planning of H&N cancer patients.
ISSN 00942405
Educational Use Research
Learning Resource Type Article
Publisher Date 2015-06-15
Publisher Place United States
Journal Medical Physics
Volume Number 42
Issue Number 6


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