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. 2011 Dec;10(6):575–583. doi: 10.1177/153303461101000607

Improved Normal Tissue Sparing in Head and Neck Radiotherapy Using Biological Cost Function Based-IMRT

N Anderson 1,*, C Lawford 1, V Khoo 1,2,3, M Rolfo 1, D Lim Joon 1, M Wada 1
PMCID: PMC4509883  PMID: 22066597

Abstract

Intensity-modulated radiotherapy (IMRT) has reduced the impact of acute and late toxicities associated with head and neck radiotherapy. Treatment planning system (TPS) advances in biological cost function based optimization (BBO) and improved segmentation techniques have increased organ at risk (OAR) sparing compared to conventional dose-based optimization (DBO). A planning study was undertaken to compare OAR avoidance in DBO and BBO treatment planning. Simultaneous integrated boost treatment plans were produced for 10 head and neck patients using both planning systems. Plans were compared for tar get coverage and OAR avoidance. Comparisons were made using the BBO TPS Monte Carlo dose engine to eliminate differences due to inherent algorithms. Target coverage (V95%) was maintained for both solutions. BBO produced lower OAR doses, with statistically significant improvement to left (12.3%, p = 0.005) and right parotid mean dose (16.9%, p = 0.004), larynx V50 Gy (71.0%, p = 0.005), spinal cord (21.9%, p < 0.001) and brain stem dose maximums (31.5%, p = 0.002). This study observed improved OAR avoidance with BBO planning. Further investigations will be undertaken to review any clinical benefit of this improved planned dosimetry.

Keywords: Biological cost functions, Dose avoidance, Head and neck cancer, Intensity-modulated radiotherapy (IMRT), Monte Carlo algorithms.

Abbreviations:

TPS:

Treatment Planning System

IMRT:

Intensity Modulated Radiation Therapy

OAR:

Organ at Risk

EUD:

Equivalent Uniform Dose

SIB:

Simultaneous Integrated Boost

GTV:

Gross Tumor Volume

CTV:

Clinical Target Volume

PTV:

Planning Target Volume

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