Murat OKUTAN, Burak ŞENGÜL, Canan KÖKSAL, Evren Ozan GÖKSEL, Kübra ÖZKAYA TORAMAN, Musa ALTUN, Bayram DEMİR

A Dosimetric Plan Study to Increase the Dose from 63 Gy to 70 Gy in Early-Stage Glottic Larynx Cancer

OBJECTIVEThe present study aims to compare the treatment plan parameters of different radiotherapy techniques[3D-Conformal Radiotherapy (3D-CRT), Dynamic – Intensity Modulated Radiotherapy (D-IMRT), IntensityModulated Arc Therapy (IMAT) and Helical Tomotherapy (HT)] in Early-Stage Glottic Larynx(EGL) cancer to increase the treatment dose from 63 Gy to 70 Gy.METHODSThe dose prescription was defined as 2.12 Gy per fraction to a total of 33 fractions. 95% of PlanningTreatment Volume-63 Gy (PTV-63) and Planning Treatment Volume-70 (PTV- 70) treatment volumesreceived the treatment dose of at least 63 and 70 Gy, respectively. The conventional-boost techniquewas used for 3D-CRT and the simultaneous integrated boost technique was used for other techniques.RESULTSThe doses obtained from carotid arteries, thyroid and submandibular glands using IMRT, IMAT, andHT were significantly lower than 3D-CRT. The study results pointed out the possibility of giving a treatmentdose of 70 Gy to the PTV of EGL with all planning techniques, with some advantages and disadvantagesbetween them. All IMRT techniques provided superiority to 3D-CRT on the doses of thecarotid artery, the thyroid gland, the submandibular glands, and the pharyngeal constrictor muscleswith less variation between them.CONCLUSIONThe IMAT and 3D-CRT techniques yielded lower monitor unit values compared to other techniques.Normal tissue radiation exposure was lowest with the 3D-CRT technique. We recommend to increasethe treatment dose from 63 Gy to 70 Gy in the radiotherapy of EGL cancer but to select the techniqueaccording to the patient’s condition.

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1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87–108.
2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127(12):2893– 917.
3. Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE. Abeloff’s. Clinical Oncology. 5th ed. Elsevier Inc; 2013.
4. Higgins KM, Shah MD, Ogaick MJ, Enepekides D. Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg 2009;38(6):603–12.
5. Halperin EC, Brady LW, Wazer DE, Perez CA. Perez and Brady’s principles and practice of radiation oncology. 6th ed. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2013.
6. Zumsteg ZS, Riaz N, Jaffery S, Hu M, Gelblum D, Zhou Y, et al. Carotid sparing intensity-modulated radiation therapy achieves comparable locoregional control to conventional radiotherapy in T1-2N0 laryngeal carcinoma. Oral Oncol 2015;51(7):716–23.
7. Fujita M, Rudoltz MS, Canady DJ, Patel P, Machtay M, Pittard MQ, et al. Second malignant neoplasia in patients with T1 glottic cancer treated with radiation. Laryngoscope 1998;108(12):1853–5.
8. Mendenhall WM, Werning JW, Hinerman RW, Amdur RJ, Villaret DB. Management of T1-T2 glottic carcinomas. Cancer 2004;100(9):1786–92.
9. Rosier JF, Grégoire V, Counoy H, Octave-Prignot M, Rombaut P, Scalliet P, et al. Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation. Radiother Oncol 1998;48(2):175–83.
10. Dorresteijn LD, Kappelle AC, Boogerd W, Klokman WJ, Balm AJ, Keus RB, et al. Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years. J Clin Oncol 2002;20(1):282–8.
11. Smith GL, Smith BD, Buchholz TA, Giordano SH, Garden AS, Woodward WA, et al. Cerebrovascular disease risk in older head and neck cancer patients after radiotherapy. J Clin Oncol 2008;26(31):5119– 25.
12. Tell R, Sjödin H, Lundell G, Lewin F, Lewensohn R. Hypothyroidism after external radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 1997;39(2):303–8.
13. Murdoch-Kinch CA, Kim HM, Vineberg KA, Ship JA, Eisbruch A. Dose-effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008;72(2):373–82.
14. Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 2010;76(3 Suppl):S42–S9.
15. Rosenthal DI, Fuller CD, Barker JL Jr, Mason B, Garcia JA, Lewin JS, et al. Simple carotid-sparing intensitymodulated radiotherapy technique and preliminary experience for T1-2 glottic cancer. Int J Radiat Oncol Biol Phys 2010;77(2):455–61.
16. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003;56(1):83–8.
17. Ekici K, Pepele EK, Yaprak B, Temelli O, Eraslan AF, Kucuk N, et al. Dosimetric comparison of helical tomotherapy, intensity-modulated radiation therapy, volumetric-modulated arc therapy, and 3-dimensional conformal therapy for the treatment of T1N0 glottic cancer. Med Dosim. 2016;41(4):329–33.
18. Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT): ICRU Report No: 83, J ICRU 2010;10(1). Available at: https://academic.oup.com/jicru/article-abstract/10/1/ NP/910527?redirectedFrom=fulltext. Accessed Mar 17, 2020.
19. Gomez D, Cahlon O, Mechalakos J, Lee N. An investigation of intensity-modulated radiation therapy versus conventional two-dimensional and 3D-conformal radiation therapy for early stage larynx cancer. Radiat Oncol 2010;5:74.
20. Ding C, Chun SG, Sumer BD, Nedzi LA, Abdulrahman RE, Yordy JS, et al. Phantom-to-clinic development of hypofractionated stereotactic body radiotherapy for early-stage glottic laryngeal cancer. Med Dosim 2017;42(2):90–6.
21. Yamazaki H, Nishiyama K, Tanaka E, Koizumi M, Chatani M. Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time. Int J Radiat Oncol Biol Phys 2006;64(1):77–82.
22. Martin JD, Buckley AR, Graeb D, Walman B, Salvian A, Hay JH. Carotid artery stenosis in asymptomatic patients who have received unilateral head- -and-neck irradiation. Int J Radiat Oncol Biol Phys 2005;63(4):1197–205.
23. Garcia-Serra A, Amdur RJ, Morris CG, Mazzaferri E, Mendenhall WM. Thyroid function should be monitored following radiotherapy to the low neck. Am J Clin Oncol 2005;28(3):255–8.
24. Matthiesen C, Herman Tde L, Singh H, Mascia A, Confer M, Simpson H, et al. Dosimetric and radiobiologic comparison of 3D conformal, IMRT, VMAT and proton therapy for the treatment of early-stage glottic cancer. J Med Imaging Radiat Oncol 2015;59(2):221–8.
25. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21(1):109–22.
26. Esik O, Csere T, Stefanits K, Szakáll S Jr, Lengyel Z, Sáfrány G, et al. Increased metabolic activity in the spinal cord of patients with long-standing Lhermitte’s sign. Strahlenther Onkol 2003;179(10):690–3.
27. Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2007;68(5):1289–98.
28. Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002;53(1):23–8.