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Open Access Research article

Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer

Nam P Nguyen17*, Paul Vos2, Vincent Vinh-Hung3, Misty Ceizyk1, Lexie Smith-Raymond1, Michelle Stevie1, Benjamin Slane1, Alexander Chi4, Anand Desai1, Shane P Krafft1, Siyoung Jang5, Russ Hamilton1, Ulf Karlsson6 and Dave Abraham1

Author Affiliations

1 Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA

2 Biostatistics, East Carolina University, Greenville, NC, USA

3 Department of Radiation Oncology, University Hospitals of Geneva, Geneva, Switzerland

4 Department of Radiation Oncology, University of West Virginia, Morgantown, VA, USA

5 Department of Radiation Oncology, University of Pittsburg, Pittsburg, PA, USA

6 Department of Radiation Oncology, Marshfield Clinic, Marshfield, WI, USA

7 University of Arizona, 1501 N. Campbell Ave., Tucson, AZ 85724-5081, USA

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BMC Cancer 2012, 12:175  doi:10.1186/1471-2407-12-175

Published: 11 May 2012

Abstract

Background

To evaluate the feasibility of image-guided radiotherapy based on helical Tomotherapy to spare the contralateral parotid gland in head and neck cancer patients with unilateral or no neck node metastases.

Methods

A retrospective review of 52 patients undergoing radiotherapy for head and neck cancers with image guidance based on daily megavoltage CT imaging with helical tomotherapy was performed.

Results

Mean contralateral parotid dose and the volume of the contralateral parotid receiving 40 Gy or more were compared between radiotherapy plans with significant constraint (SC) of less than 20 Gy on parotid dose (23 patients) and the conventional constraint (CC) of 26 Gy (29 patients). All patients had PTV coverage of at least 95% to the contralateral elective neck nodes. Mean contralateral parotid dose was, respectively, 14.1 Gy and 24.7 Gy for the SC and CC plans (p < 0.0001). The volume of contralateral parotid receiving 40 Gy or more was respectively 5.3% and 18.2% (p < 0.0001)

Conclusion

Tomotherapy for head and neck cancer minimized radiotherapy dose to the contralateral parotid gland in patients undergoing elective node irradiation without sacrificing target coverage.

Keywords:
Head and neck cancer; Tomotherapy; Parotid sparing