Differences in Parotid Dosimetry and Expected Normal Tissue Complication Probabilities in Whole Brain Radiation Plans Covering C1 Versus C2
There is no consensus standard regarding the placement of the inferior field border in whole brain radiation therapy (WBRT) plans, with most providers choosing to cover the first versus (vs.) second cervical vertebrae (C1 vs. C2). We hypothesize that extending coverage to C2 may increase predicted r...
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description | There is no consensus standard regarding the placement of the inferior field border in whole brain radiation therapy (WBRT) plans, with most providers choosing to cover the first versus (vs.) second cervical vertebrae (C1 vs. C2). We hypothesize that extending coverage to C2 may increase predicted rates of xerostomia.
Fifteen patients underwent computed tomography (CT) simulation; two WBRT plans were then produced, one covering C2 and the other covering C1. The plans were otherwise standard, and patients were prescribed doses of 25, 30 and 37.5 gray (Gy). Dose-volume statistics were obtained and normal tissue complication probabilities (NTCPs) were estimated using the Lyman-Burman-Kutcher model. Mean parotid dose and predicted xerostomia rates were compared for plans covering C2 vs. C1 using a two-sided patient-matched t-test. Plans were also evaluated to determine whether extending the lower field border to cover C2 would result in a violation of commonly accepted dosimetric planning constraints.
The mean dose to both parotid glands was significantly higher in WBRT plans covering C2 compared to plans covering C1 for all dose prescriptions (p |
doi_str_mv | 10.7759/cureus.1217 |
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Fifteen patients underwent computed tomography (CT) simulation; two WBRT plans were then produced, one covering C2 and the other covering C1. The plans were otherwise standard, and patients were prescribed doses of 25, 30 and 37.5 gray (Gy). Dose-volume statistics were obtained and normal tissue complication probabilities (NTCPs) were estimated using the Lyman-Burman-Kutcher model. Mean parotid dose and predicted xerostomia rates were compared for plans covering C2 vs. C1 using a two-sided patient-matched t-test. Plans were also evaluated to determine whether extending the lower field border to cover C2 would result in a violation of commonly accepted dosimetric planning constraints.
The mean dose to both parotid glands was significantly higher in WBRT plans covering C2 compared to plans covering C1 for all dose prescriptions (p<0.01). Normal tissue complication probabilities were also significantly higher when covering C2 vs. C1, for all prescribed doses (p<0.01). Predicted median rates of xerostomia ranged from <0.03%-21% for plans covering C2 vs. <0.001%-12% for patients treated with plans covering C1 (p<0.01), dependent on the treatment dose and NTCP model. Plans covering C2 were unable to constrain at least one parotid to <20 Gy in 31% of plans vs. 9% of plans when C1 was covered. A total parotid dose constraint of <25 Gy was violated in 13% of plans covering C2 vs. 0% of plans covering C1.
Coverage of C2 significantly increases the mean parotid dose and predicted NTCPs and results in more frequent violation of commonly accepted dosimetric planning constraints.]]></description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.1217</identifier><identifier>PMID: 28589066</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Exocrine glands ; Oral diseases ; Palliative care ; Radiation Oncology ; Radiation therapy ; Tomography</subject><ispartof>Curēus (Palo Alto, CA), 2017-05, Vol.9 (5), p.e1217-e1217</ispartof><rights>Copyright © 2017, Orton et al. This work is licensed under the Creative Commons Attribution License (https://creativecommons.org/licenses/by/3.0/) (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2017, Orton et al. 2017 Orton et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453748/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453748/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28589066$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Orton, Andrew</creatorcontrib><creatorcontrib>Gordon, John</creatorcontrib><creatorcontrib>Vigh, Tyler</creatorcontrib><creatorcontrib>Tonkin, Allison</creatorcontrib><creatorcontrib>Cannon, George</creatorcontrib><title>Differences in Parotid Dosimetry and Expected Normal Tissue Complication Probabilities in Whole Brain Radiation Plans Covering C1 Versus C2</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description><![CDATA[There is no consensus standard regarding the placement of the inferior field border in whole brain radiation therapy (WBRT) plans, with most providers choosing to cover the first versus (vs.) second cervical vertebrae (C1 vs. C2). We hypothesize that extending coverage to C2 may increase predicted rates of xerostomia.
Fifteen patients underwent computed tomography (CT) simulation; two WBRT plans were then produced, one covering C2 and the other covering C1. The plans were otherwise standard, and patients were prescribed doses of 25, 30 and 37.5 gray (Gy). Dose-volume statistics were obtained and normal tissue complication probabilities (NTCPs) were estimated using the Lyman-Burman-Kutcher model. Mean parotid dose and predicted xerostomia rates were compared for plans covering C2 vs. C1 using a two-sided patient-matched t-test. Plans were also evaluated to determine whether extending the lower field border to cover C2 would result in a violation of commonly accepted dosimetric planning constraints.
The mean dose to both parotid glands was significantly higher in WBRT plans covering C2 compared to plans covering C1 for all dose prescriptions (p<0.01). Normal tissue complication probabilities were also significantly higher when covering C2 vs. C1, for all prescribed doses (p<0.01). Predicted median rates of xerostomia ranged from <0.03%-21% for plans covering C2 vs. <0.001%-12% for patients treated with plans covering C1 (p<0.01), dependent on the treatment dose and NTCP model. Plans covering C2 were unable to constrain at least one parotid to <20 Gy in 31% of plans vs. 9% of plans when C1 was covered. A total parotid dose constraint of <25 Gy was violated in 13% of plans covering C2 vs. 0% of plans covering C1.
Coverage of C2 significantly increases the mean parotid dose and predicted NTCPs and results in more frequent violation of commonly accepted dosimetric planning constraints.]]></description><subject>Exocrine glands</subject><subject>Oral diseases</subject><subject>Palliative care</subject><subject>Radiation Oncology</subject><subject>Radiation therapy</subject><subject>Tomography</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV1LHTEQhoO0VFGvel8C3hTk2CS7-boR2qP9AGlLse1lmM3OamR3c5rsiv4G_3RzOEexvZph8szLvHkJec3ZidbSvvNzwjmfcMH1DtkTXJmF4aZ-8azfJYc53zDGONOCafaK7AojjWVK7ZGHs9B1mHD0mGkY6XdIcQotPYs5DDilewpjS8_vVugnbOnXmAbo6WXIeUa6jMOqDx6mEMtmig00oQ9T2Ej9vo490g8JSv8D2rDFehhz2bzFFMYruuT0F6Y8l5E4IC876DMebus--fnx_HL5eXHx7dOX5fuLhRdWT4saKlTailZLw5llnTUaoWqbRrGOadvIYq_m0EjNFWfSdlZ6D8CFAeUtVvvkdKO7mpsBW4_jlKB3qxQGSPcuQnD_vozh2l3FWydrWenaFIG3W4EU_8yYJzeE7LEv1jDO2XFbvpmpWlcFPfoPvYlzGou9QkmhlJFqTR1vKJ9izgm7p2M4c-uc3SZnt8650G-e3__EPqZa_QXccKXj</recordid><startdate>20170503</startdate><enddate>20170503</enddate><creator>Orton, Andrew</creator><creator>Gordon, John</creator><creator>Vigh, Tyler</creator><creator>Tonkin, Allison</creator><creator>Cannon, George</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170503</creationdate><title>Differences in Parotid Dosimetry and Expected Normal Tissue Complication Probabilities in Whole Brain Radiation Plans Covering C1 Versus C2</title><author>Orton, Andrew ; Gordon, John ; Vigh, Tyler ; Tonkin, Allison ; Cannon, George</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c297t-4a3e6792d7581090f987ea3dbb60f079b528541ab57161059f95ccaa128a6c9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Exocrine glands</topic><topic>Oral diseases</topic><topic>Palliative care</topic><topic>Radiation Oncology</topic><topic>Radiation therapy</topic><topic>Tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Orton, Andrew</creatorcontrib><creatorcontrib>Gordon, John</creatorcontrib><creatorcontrib>Vigh, Tyler</creatorcontrib><creatorcontrib>Tonkin, Allison</creatorcontrib><creatorcontrib>Cannon, George</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Orton, Andrew</au><au>Gordon, John</au><au>Vigh, Tyler</au><au>Tonkin, Allison</au><au>Cannon, George</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differences in Parotid Dosimetry and Expected Normal Tissue Complication Probabilities in Whole Brain Radiation Plans Covering C1 Versus C2</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2017-05-03</date><risdate>2017</risdate><volume>9</volume><issue>5</issue><spage>e1217</spage><epage>e1217</epage><pages>e1217-e1217</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract><![CDATA[There is no consensus standard regarding the placement of the inferior field border in whole brain radiation therapy (WBRT) plans, with most providers choosing to cover the first versus (vs.) second cervical vertebrae (C1 vs. C2). We hypothesize that extending coverage to C2 may increase predicted rates of xerostomia.
Fifteen patients underwent computed tomography (CT) simulation; two WBRT plans were then produced, one covering C2 and the other covering C1. The plans were otherwise standard, and patients were prescribed doses of 25, 30 and 37.5 gray (Gy). Dose-volume statistics were obtained and normal tissue complication probabilities (NTCPs) were estimated using the Lyman-Burman-Kutcher model. Mean parotid dose and predicted xerostomia rates were compared for plans covering C2 vs. C1 using a two-sided patient-matched t-test. Plans were also evaluated to determine whether extending the lower field border to cover C2 would result in a violation of commonly accepted dosimetric planning constraints.
The mean dose to both parotid glands was significantly higher in WBRT plans covering C2 compared to plans covering C1 for all dose prescriptions (p<0.01). Normal tissue complication probabilities were also significantly higher when covering C2 vs. C1, for all prescribed doses (p<0.01). Predicted median rates of xerostomia ranged from <0.03%-21% for plans covering C2 vs. <0.001%-12% for patients treated with plans covering C1 (p<0.01), dependent on the treatment dose and NTCP model. Plans covering C2 were unable to constrain at least one parotid to <20 Gy in 31% of plans vs. 9% of plans when C1 was covered. A total parotid dose constraint of <25 Gy was violated in 13% of plans covering C2 vs. 0% of plans covering C1.
Coverage of C2 significantly increases the mean parotid dose and predicted NTCPs and results in more frequent violation of commonly accepted dosimetric planning constraints.]]></abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>28589066</pmid><doi>10.7759/cureus.1217</doi><oa>free_for_read</oa></addata></record> |
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subjects | Exocrine glands Oral diseases Palliative care Radiation Oncology Radiation therapy Tomography |
title | Differences in Parotid Dosimetry and Expected Normal Tissue Complication Probabilities in Whole Brain Radiation Plans Covering C1 Versus C2 |
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