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Clinical use of intensity-modulated radiotherapy: part I

Radiotherapy Department and Head and Neck Unit, Institute of Cancer Research and Royal Marsden NHS Trust, London and Surrey, UK

View larger version (51K): [in a new window]   Figure 1. SMART boost technique used in PARSPORT trial showing a higher total dose (65 Gy) and dose per fraction (2.17 Gy) delivered to the primary tumour and involved nodes (red in 3D reconstruction and green colour wash) and lower total (54 Gy) dose and dose per fraction (1.8 Gy) to the elective nodes (purple in 3D reconstruction and orange colour wash).

View larger version (98K): [in a new window]   Figure 2. Parotid gland sparing intensity-modulated radiotherapy (IMRT): a dose distribution to deliver a high dose to the target volume (blue contour and red colour wash) whilst sparing the parotid gland (pink contours) can be achieved with IMRT.

View larger version (107K): [in a new window]   Figure 3. The primary planning target volume (PTV) (in red) is shown encompassed by the 95% (green) isodose curve (63 Gy in 28 fractions). The elective PTV (neck nodes in pink) is treated to a lower dose (78% isodose curve in orange; 51.8 Gy in 28 fractions), whilst the spinal cord is kept below 40 Gy (60% isodose curve in pale blue).

View larger version (67K): [in a new window]   Figure 4. The left parapharyngeal space is shown within the high dose planning target volume (PTV), in close proximity to the left parotid gland, treated beyond tolerance (mean dose above 24 Gy). On the right side, where the parapharyngeal space is not part of the high dose PTV, sparing can be more readily achieved.

View larger version (62K): [in a new window]   Figure 5. Primary planning target volume (PTV) (thyroid bed and high risk nodal areas) encompassed by the 95% isodose curve (green), elective nodes by the 78% isodose and the spinal cord is kept below 40 Gy (60% isodose curve). Dose prescribed 58.8 Gy in 28 fractions to the primary PTV and 50 Gy in 28 fractions to the elective neck nodes.

View larger version (61K): [in a new window]   Figure 6. Intensity-modulated radiotherapy planned dose distribution for treatment of right pleura (reproduced with permission of Dr C Scrace).