Evaluation of spinal cord doses in patients with head and neck cancer receiving radiotherapy
Yıl 2009,
Cilt: 24 Sayı: 1, 1 - 8, 01.02.2009
Vildan Kaya
Melek Gamze Aksu
Aylin Fidan Korcum
Nina Tunçel
Öz
OBJECTIVES Spinal cord doses were analyzed for head and neck cancer patients receiving radiotherapy with three-field technique. METHODS Eighteen patients (12 males, 6 females) with head and neck carcinoma were evaluated. Spinal cord doses were evaluated for each treatment phase. Biologically effective doses (BED) were calculated for the maximum spinal doses in all patients and compared to the 92 Gy, which was the BED of the spinal cord tolerance dose of 46 Gy. RESULTS The maximum spinal cord dose ranged from 4399 to 4954 cGy. The median dose at the junction of the lateral and anterior fields was 4131 cGy. BED of the maximum spinal doses ranged between 75-98 Gy (median 91), and in seven patients it was over 92 Gy; total spinal dose was over 46 Gy in 13 patients. CONCLUSION Spinal cord doses in each phase should be calculated separately with BED values for assessment of the cumulative spinal cord doses.
Kaynakça
- 1. Mendenhall WM, Riggs CE, Cassisi NJ. Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, R o s e n b e rg SA, editors. Cancer: Principles and Practice of Oncology. Philadelphia: Lippincott Williams&Wilkins; 2005. p. 662-732.
- 2. Ton-Van J, Lefebvre JL, Stern JC, Buisset E, CocheDequeant B, Vankemmel B. Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas. Am J Surg 1991;162(4):337-40.
- 3. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27(10):843-50.
- 4. Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three metaanalyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000;355(9208):949-55.
- 5. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350(19):1945-52.
- 6. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350(19):1937-44
- 7. Joiner MC, Bentzen SM. Time-dose relationships: the Lineer-Quadratic approach. In: Steel GG, editor. Basic clinical radiobiology. 3rd ed. New York: Arnold; 2002. p. 120-31.
- 8. Meeks SL, Williams RO, Bova FJ, Mendenhall WM, Buatti JM. The midline dose distribution for a threefield radiotherapy technique. Med Dosim 1999;24(2):91-8.
- 9. Marcus RB Jr, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 1990;19(1):3-8.
- 10. Allison R, Vaughan J, Thurber A, Rajecki M, Vongtama V, Barry T. Spinal cord dose is higher than expected in head and neck radiation. Med Dosim 1999;24(2):135-9.
- 11. Zhu L, Kron T, Barnes K, Johansen S, O'Brien P. Junctioning of lateral and anterior fields in head and neck cancer: a dosimetric assessment of the monoisocentric technique (including reproducibility). Int J Radiat Oncol Biol Phys 1998;41(1):227-32.
- 12.R o b e rge D, Gosselin M, Sultanem K, Corns R, Shenouda G. Safety of a simple asymmetric jaw technique in the treatment of head and neck cancer. Radiother Oncol 2003;68(2):149-52.
- 13. Vernon MR, Maheshwari M, Schultz CJ, Michel MA, Wong SJ, Campbell BH, et al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 2008;70(3):678-84.
- 14. Newbold K, Partridge M, Cook G, Sohaib SA, Charles-Edwards E, Rhys-Evans P, et al. Advanced imaging applied to radiotherapy planning in head and neck cancer: a clinical review. Br J Radiol 2006;79(943):554-61.
- 15.Chen L, Nguyen TB, Jones E, Chen Z, Luo W, Wang L, et al. Magnetic resonance-based treatment planning for prostate intensity-modulated radiotherapy: creation of digitally reconstructed radiographs. Int J Radiat Oncol Biol Phys 2007;68(3):903-11.
- 16.Rovirosa A, Berenguer J, Sanchez-Reyes A, Torres M, Casals JM, Farrus B, et al. Simulation by a diagnostic CT for the early vocal cord carcinoma. Med Dosim 1997;22(1):13-6.
- 17.Rovirosa A, Berenguer J, Sánchez-Reyes A, Farrús B, Casas F, Biete A. A CT-based simulation for head and neck tumors in centers without CT-simulator and 3Dplanning system. Med Dosim 1995;20(2):111-5.
- 18. Thames HD Jr, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys 1982;8(2):219-26.
- 19. Scalliet P, Cosset JM, Wambersie A. Application of the LQ model to the interpretation of absorbed dose distribution in the daily practice of radiotherapy. Radiother Oncol 1991;22(3):180-9.
Radyoterapi uygulanan baş-boyun kanserli hastalarda medulla spinalis dozlarının incelenmesi
Yıl 2009,
Cilt: 24 Sayı: 1, 1 - 8, 01.02.2009
Vildan Kaya
Melek Gamze Aksu
Aylin Fidan Korcum
Nina Tunçel
Öz
AMAÇ Üç alan tekniği ile radyoterapi uygulanan baş-boyun kanserli hastalarda medulla spinalis dozları incelendi. GEREÇ VE YÖNTEM Baş-boyun karsinomlu 18 hasta (12 erkek, 6 kadın) retrospektif olarak değerlendirildi. Medulla spinalis dozları tedavinin her fazında ayrı ayrı değerlendirildi ve maksimum medulla spinalis dozu için biyolojik efektif dozlar (BED) hesaplandı. Medulla spinalis tolerans dozu olarak kabul edilen 46 Gy'in BED eşdeğeri olan 92 Gy ile karşılaştırıldı. BULGULAR Maksimum medulla spinalis dozları 4399-4954 cGy arasında değişmekteydi. Lateral ve ön alan birleşim bölgesindeki medyan doz 4131 cGy idi. Maksimum medulla spinalis dozları için BED değerleri 75-98 (medyan 91) cGy arasında değişmekteydi. Toplam medulla spinalis dozu 13 hastda 46 Gy'in üzerinde olmasına karşın, BED eşdeğerleri sadece yedi hastada 92 Gy'in üzerindeydi. SONUÇ Toplam medulla spinalis dozunun değerlendirilmesinde her fazdaki medulla spinalis dozları ayrı ayrı değerlendirilip BED eşdeğerleri de dikkate alınmalıdır.
Kaynakça
- 1. Mendenhall WM, Riggs CE, Cassisi NJ. Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, R o s e n b e rg SA, editors. Cancer: Principles and Practice of Oncology. Philadelphia: Lippincott Williams&Wilkins; 2005. p. 662-732.
- 2. Ton-Van J, Lefebvre JL, Stern JC, Buisset E, CocheDequeant B, Vankemmel B. Comparison of surgery and radiotherapy in T1 and T2 glottic carcinomas. Am J Surg 1991;162(4):337-40.
- 3. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27(10):843-50.
- 4. Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three metaanalyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000;355(9208):949-55.
- 5. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350(19):1945-52.
- 6. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350(19):1937-44
- 7. Joiner MC, Bentzen SM. Time-dose relationships: the Lineer-Quadratic approach. In: Steel GG, editor. Basic clinical radiobiology. 3rd ed. New York: Arnold; 2002. p. 120-31.
- 8. Meeks SL, Williams RO, Bova FJ, Mendenhall WM, Buatti JM. The midline dose distribution for a threefield radiotherapy technique. Med Dosim 1999;24(2):91-8.
- 9. Marcus RB Jr, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 1990;19(1):3-8.
- 10. Allison R, Vaughan J, Thurber A, Rajecki M, Vongtama V, Barry T. Spinal cord dose is higher than expected in head and neck radiation. Med Dosim 1999;24(2):135-9.
- 11. Zhu L, Kron T, Barnes K, Johansen S, O'Brien P. Junctioning of lateral and anterior fields in head and neck cancer: a dosimetric assessment of the monoisocentric technique (including reproducibility). Int J Radiat Oncol Biol Phys 1998;41(1):227-32.
- 12.R o b e rge D, Gosselin M, Sultanem K, Corns R, Shenouda G. Safety of a simple asymmetric jaw technique in the treatment of head and neck cancer. Radiother Oncol 2003;68(2):149-52.
- 13. Vernon MR, Maheshwari M, Schultz CJ, Michel MA, Wong SJ, Campbell BH, et al. Clinical outcomes of patients receiving integrated PET/CT-guided radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 2008;70(3):678-84.
- 14. Newbold K, Partridge M, Cook G, Sohaib SA, Charles-Edwards E, Rhys-Evans P, et al. Advanced imaging applied to radiotherapy planning in head and neck cancer: a clinical review. Br J Radiol 2006;79(943):554-61.
- 15.Chen L, Nguyen TB, Jones E, Chen Z, Luo W, Wang L, et al. Magnetic resonance-based treatment planning for prostate intensity-modulated radiotherapy: creation of digitally reconstructed radiographs. Int J Radiat Oncol Biol Phys 2007;68(3):903-11.
- 16.Rovirosa A, Berenguer J, Sanchez-Reyes A, Torres M, Casals JM, Farrus B, et al. Simulation by a diagnostic CT for the early vocal cord carcinoma. Med Dosim 1997;22(1):13-6.
- 17.Rovirosa A, Berenguer J, Sánchez-Reyes A, Farrús B, Casas F, Biete A. A CT-based simulation for head and neck tumors in centers without CT-simulator and 3Dplanning system. Med Dosim 1995;20(2):111-5.
- 18. Thames HD Jr, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys 1982;8(2):219-26.
- 19. Scalliet P, Cosset JM, Wambersie A. Application of the LQ model to the interpretation of absorbed dose distribution in the daily practice of radiotherapy. Radiother Oncol 1991;22(3):180-9.