The Effect of Radiotherapy Technique on Carotid Artery Dose in Patients with Early Stage Glottic Larynx Cancer

Year 2021, Volume: 28 Issue: 1, 9 - 12, 11.03.2021

Beyza Şirin Özdemir , Zeynep Rukiye Özge Can

https://doi.org/10.17343/sdutfd.623353

Abstract

Objective: The
aim of this study was to compare two radiotherapy techniques in early stage
glottic laryngeal cancer patients in terms of radiotherapy dose applied to the
carotid artery.

Material - Methods:
In this study, we included 10 early-stage (T1/2) glottic larynx cancer
patients. Both intensity-modulated
radiotherapy (IMRT) and 3-dimension conformal radiotherapy (3DCRT) treatment
plans were prepared for each patient. Treatment volumes (CTV, PTV) were created
for all patients. The entire larynx was described as CTV to include both false
and true vocal cords, anterior-posterior commissures, arytenoids, aryepiglottic
folds, subglottic region. For planning target volüme (PTV), while 5-mm was added
to CTV in all directions, 3-mm margin was given to protect the carotid artery
and spinal cord in posterolaterally. Spinal cord and carotid artery were
contoured as the organ at risk (OAR). The doses of the target volumes, the OAR
volumes, the homogeneity index (HI) were compared.

Results: PTV
parameters (Dmin, Dmean, Dmax, D90, D95) was compared in the 2 different
technique.  IMRT in comparison to 3DCRT
significantly reduced the high-dose volumes (V30, V35, V50) of carotid artery
(p < 0.001), but not to the low dose volume (V10). CI was similar (0.9 vs.
0.9, p = 0.3) compared to 3DCRT. However, HI was significantly improved with
IMRT (0.1 vs. 0.08, p < 0.001). The maximum dose of the spinal cord was lower in
3DCRT compared to IMRT (18 Gy vs. 44Gy).

Conclusion: IMRT
is a superior radiotherapy (RT) technique in patients with T1/T2 glottic cancer
in terms of protecting carotid artery.

Keywords

Radiotherapy, glottic cancer, carotid artery, 3DCRT, IMRT

Erken Evre Glottik Larenks Kanserli Hastalarda Radyoterapi Tekniğinin Karotis Arter Dozu Üzerine Etkisi

Abstract

Amaç: Bu
çalışmanın amacı, erken evre glottik larenks kanser tanılı hastalarda iki
radyoterapi tekniğinin karotis arter dozları açısından karşılaştırılmasıdır.

Gereç - Yöntemler:
Bu çalışmaya, 10 erken evre (T1 / 2) glottik larenks kanser tanılı hastayı
dahil ettik. Her bir hasta için hem yoğunluk ayarlı radyoterapi (YART) hem de 3
boyutlu konformal radyoterapi (3BKRT) tedavi planları hazırlandı. Tüm hastalar
için tedavi volümleri (CTV, PTV) oluşturuldu. Tüm larinks, gerçek ve yalancı vokal
kordlar, anterior-posterior komissürler, aritenoidler, aryepiglottik kıvrımlar,
subglottik bölge dahil edilecek şekilde klinik hedef volüm (CTV) olşturuldu.
Planlanan hedef volümü (PTV) oluşturmak için, tüm yönlerde CTV'ye 5 mm eklenirken,
karotis arter ve spinal kordu korumak adına posterolateral yönde 3 mm'lik marj
verildi. T1/T2 glottik kanserlerde lenfatik nodal metastaz riski çok düşük
olduğu için, elektif nodal ışınlama yapılmadı. Spinal kord ve karotis arterler
kritik organlar (OAR) olarak konturlandı. Hedef hacim dozları, OAR hacimleri,
homojenlik indeksi (HI) karşılaştırıldı. Ek olarak, karotis arter için V30
<% 20, V10 <% 50 değerlendirildi ve spinal kordun maksimum dozu 45Gy ile
sınırlandırıldı. Conformite indeksi (CI) hesaplandı. İstatistiksel analiz için
Mann Whitney testi kullanıldı ve p <0.05 anlamlı kabul edildi.

Bulgular: PTV
parametreleri (Dmin, Dmean, Dmax, D90, D95) iki farklı teknikte
karşılaştırıldı. 3BKRT’ye kıyasla YART, karotis arterde yüksek doz hacimlerini
(V30, V35, V50) belirgin olarak düşürürken (p < 0.001), düşük doz hacimleri
(V10) her iki teknikte de yüksek seyretti. Her iki teknikte de CI benzer olup
(0.9 vs. 0.9, p = 0.3), HI YART’de daha iyiydi (0.1 vs. 0.08, p < 0.001).
Spinal kord maksimum dozları 3BKRT’de daha düşüktü (18 Gy vs. 44Gy).

Sonuç: IMRT,
T1 / T2 glottik kanserli hastalarda karotis arterin korunması açısından üstün
bir radyoterapi (RT) tekniğidir.

Keywords

Radyoterapi, Glottik kanser, Karotid arter, 3BKRT, IMRT

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