%0 Journal Article
%T 3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing
%A Thomas G Wendt
%A Nasrin Abbasi-Senger
%A Henning Salz
%A Ines Pinquart
%A Sven Koscielny
%A Susi-Marie Przetak
%A Tilo Wiezorek
%J Radiation Oncology
%D 2006
%I BioMed Central
%R 10.1186/1748-717x-1-18
%X 39 patients with squamous cell cancer of the head and neck irradiated using 3D-c-IMRT were evaluable for dose distribution within PTVs and at one parotid gland and 38 patients for toxicity analysis. 10 patients were treated primarily, 29 postoperatively, 19 received concomittant cis-platin based chemotherapy, 20 3D-c-IMRT alone. Initially the dose distribution was calculated with Helax ˋ and photon fluence was modulated using metallic compensators made of tin-granulate (n = 22). Later the dose distribution was calculated with KonRad ˋ and fluence was modified by MCP 96 alloy compensators (n = 17). Gross tumor/tumor bed (PTV 1) was irradiated up to 60每70 Gy, [5 fractions/week, single fraction dose: 2.0每2.2 (simultaneously integrated boost)], adjuvantly irradiated bilateral cervical lymph nodes (PTV 2) with 48每54 Gy [single dose: 1.5每1.8]). Toxicity was scored according the RTOG scale and patient-reported xerostomia questionnaire (XQ).Mean of the median doses at the parotid glands to be spared was 25.9 (16.3每46.8) Gy, for tin graulate 26 Gy, for MCP alloy 24.2 Gy. Tin-granulate compensators resulted in a median parotid dose above 26 Gy in 10/22, MCP 96 alloy in 0/17 patients. Following acute toxicities were seen (∼0每2/3): xerostomia: 87%/13%, dysphagia: 84%/16%, mucositis: 89%/11%, dermatitis: 100%/0%. No grade 4 reaction was encountered. During therapy the XQ forms showed ∼0每2/3): 88%/12%. 6 months postRT chronic xerostomia ∼0每2/3 was observed in 85%/15% of patients, none with ∼4 xerostomia.3D-c-IMRT using metallic compensators along with inverse calculation algorithm achieves sufficient parotid gland sparing in virtually all advanced head and neck cancers. Since the concept of lower single (and total) doses in the adjuvantly treated volumes reduces acute morbidity 3D-c-IMRT nicely meets demands of concurrent chemotherapy protocols.Intensity modulated radiotherapy (IMRT) by modulating the beam intensity (photon fluence) across each treatment field allows for better d
%U http://www.ro-journal.com/content/1/1/18