Constraining the brachial plexus does not compromise regional control in oropharyngeal carcinoma

Radiation Oncology

Nancy Y Lee²  Suzanne L Wolden²  Shyam S Rao²  Zhigang Zhang⁴  Anuj Goenka¹  Sean L Berry³  Jeremy Setton¹  Nadeem Riaz¹  Pinaki R Dutta¹  Benjamin H Lok¹  Robert W Mutter² 

[1] Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA;Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA;Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA;Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA

关键词: Cetuximab;    Cisplatin;    Oropharyngeal carcinoma;    Intensity-modulated radiation therapy;    Brachial plexopathy;   

Others  :  1153490
DOI  :  10.1186/1748-717X-8-173

 received in 2012-12-11, accepted in 2013-03-17,  发布年份 2013

【 摘 要 】

Background

Accumulating evidence suggests that brachial plexopathy following head and neck cancer radiotherapy may be underreported and that this toxicity is associated with a dose–response. Our purpose was to determine whether the dose to the brachial plexus (BP) can be constrained, without compromising regional control.

Methods

The radiation plans of 324 patients with oropharyngeal carcinoma (OPC) treated with intensity-modulated radiation therapy (IMRT) were reviewed. We identified 42 patients (13%) with gross nodal disease <1 cm from the BP. Normal tissue constraints included a maximum dose of 66 Gy and a D₀₅ of 60 Gy for the BP. These criteria took precedence over planning target volume (PTV) coverage of nodal disease near the BP.

Results

There was only one regional failure in the vicinity of the BP, salvaged with neck dissection (ND) and regional re-irradiation. There have been no reported episodes of brachial plexopathy to date.

Conclusions

In combined-modality therapy, including ND as salvage, regional control did not appear to be compromised by constraining the dose to the BP. This approach may improve the therapeutic ratio by reducing the long-term risk of brachial plexopathy.

【 授权许可】

   
2013 Robert et al.; licensee BioMed Central Ltd.

【 图 表 】

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