Development of a standardized method for contouring the larynx and its substructures

Radiation Oncology

Bharat B Mittal⁵  Alfred W Rademaker⁴  Ian Bacchus⁵  Malisa S Lester¹  Tamer Refaat³  Mehee Choi² 

[1] Department of Radiology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA;Department of Radiation Oncology, Stritch School of Medicine Loyola University Chicago, Cardinal Bernardin Cancer Center, Chicago, Illinois, USA;Department of Clinical Oncology, Faculty of medicine, Alexandria University, Alexandria, Egypt;Preventive Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA;Department of Radiation Oncology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, 251 E Huron, LC-178, Chicago 60611, IL, USA

关键词: Organs at risk;    Intensity-modulated radiotherapy;    Swallowing dysfunction;    Larynx anatomy;    Head-and-neck cancer;   

Others  :  1150592
DOI  :  10.1186/s13014-014-0285-4

 received in 2014-10-02, accepted in 2014-12-03,  发布年份 2014

【 摘 要 】

Objectives

Limiting radiation dose to the larynx can diminish effects of laryngeal dysfunction. However, no clear guidelines exist for defining the larynx and its substructures consistently on cross-sectional imaging. This study presents computed tomography (CT)- and magnetic resonance imaging (MRI)-based guidelines for contouring laryngeal organs-at-risk (OARs).

Materials and Methods

Standardized guidelines for delineating laryngeal OARs were devised and used to delineate on CT and MRI for head-and-neck cancer patients. Volumetric comparisons were performed to evaluate consistency and reproducibility of guideline-based contours.

Results

For the initial 5 patients the mean CT and MRI based larynx volume did not differ significantly between imaging modalities; 34.39 ± 9.85 vs. 35.01 ± 9.47 (p = .09). There was no statistical difference between the CT based mean laryngeal volume in the subsequent 44 patients compared to the initial 5 patients outlined on CT and the MRI scan (p = 0.53 and 0.62). The OAR volume for laryngeal substructures were not statistically different among patients or between imaging modalities. Once established, the guidelines were easy to follow.

Conclusion

The guidelines developed provide a precise method for delineating laryngeal OARs. These guidelines need to be validated and clinical significance of outlining laryngeal substructures and dose-volume constraints should be investigated before routine implementation in clinic practice.

【 授权许可】

   
2014 Choi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Mittal B, Eisbruch A, et al.: Post-radiation dysphagia. In Cured II - LENT Cancer Survivorship Research and Education. 1st edition. Edited by Rubin P, Constine LS, Marks LB. Springer, Berlin Heidelberg; 2008:67-79.
• [2]Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, Dutta S, Midyett A, Barloon J, Sallah S: Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2005, 61:772-778.
• [3]Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, Newman L, MacCracken E, Santa D, Mittal B: Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 2008, 30:148-158.
• [4]Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, Gagne A, Sullivan CA, Sammartino DE, Haddad RI: Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg 2006, 134:916-922.
• [5]List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K, Vokes EE: Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol 1999, 17:1020-1028.
• [6]Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, Marsh R, Pameijer FA, Balm AJ: Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 2004, 60:1425-1439.
• [7]Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, Wirth LJ, Haddad RI, Norris CM, Court LE, Aninno DJ, Posner MR, Allen AM: Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72:1110-1118.
• [8]Jensen K, Lambertsen K, Grau C: Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: Frequency, intensity and correlation with dose and volume parameters. Radiother Oncol 2007, 85:74-82.
• [9]Christianen E, Schilstra C, Beetz I, Muijs CT, Chouvalova O, Burlage FR, Doornaert P, Koken PW, Leemans CR, Rinkel RN, de Bruijn MJ, de Bock GH, Roodenburg JL, van der Laan BF, Slotman BJ, Verdonck-de Leeuw IM, Bijl HP, Langendijk JA: Predictive modeling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational study. Radiother Oncol 2012, 105(1):107-14.
• [10]Salzman KL: Hypopharynx-Larynx, Diagnostic and Surgical Imaging Anatomy: Brain, Head & Neck, Spine. Amirsys, Inc, Salt Lake City; 2009.
• [11]Becker M: Larynx and hypopharynx. In Valvassori’s Imaging of the Head and Neck. 2nd edition. Edited by Mafee MF, Valbasson GE, Becker M. Thieme, Stuttgart; 2005:731-779.
• [12]Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, Chepeha DB, Eisbruch A: Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2007, 68:1289-1298.
• [13]Dornfeld K, Simmons JR, Karnell L, Karnell M, Funk G, Yao M, Wacha J, Zimmerman B, Buatti JM: Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Int J Radiat Oncol Biol Phys 2007, 68:750-757.
• [14]Caudell JJ, Schaner PE, Desmond RA, Meredith RF, Spencer SA, Bonner JA: Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2010, 76:403-409.
• [15]Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S: Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2009, 75:385-392.
• [16]Christianen M, Langendijk JA, Westerlaan HE, van de Water TA, Bijl HP: Delineation of organs at risk involved in swallowing for radiotherapy treatment planning. Radiother Oncol 2011, 101:394-402.
• [17]Raaijmakers AJ, Raaymakers BW, Lagendijk JJ: Magnetic-field-induced dose effects in MR-guided radiotherapy systems: dependence on magnetic field strength. Phys Med Biol 2008, 53:909-923.
• [18]Amdur R, Li J, Liu C, Hinerman RW, Mendenhall WM: Unnecessary laryngeal irradiation in the IMRT era. Head and Neck 2004, 26:257-264.
• [19]Dabaja B, Salehpour MR, Rosen I, Tung S, Morrison WH, Ang KK, Garden AS: Intensity modulated radiation therapy (IMRT) of cancer of the head and neck: comparison between split-field and whole-field techniques. Int J Radiat Oncol Biol Phys 2005, 63:1000-1005.
• [20]Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92:111-117.
• [21]van der Laan HP, Christianen M, Bijl HP, Schilstra C, Langendijk JA: The potential benefit of swallowing sparing intensity modulated radiotherapy to reduce swallowing dysfunction: An in silico planning comparative study. Radiother Oncol 2012, 103:76-81.
• [22]Fiorino C, Dell'Oca I, Pierelli A, Broggi S, De Martin E, Di Muzio N, Longobardi B, Fazio F, Calandrino R: Significant improvement in normal tissue sparing and target coverage for head and neck cancer by means of helical tomotherapy. Radiother Oncol 2006, 78:276-282.
• [23]Chao K, Ozyigit G, Tran B, Cengiz M, Dempsey JF, Low DA: Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2003, 55:312-321.
• [24]Millender LE, Li JG, Liu C, Hinerman RW, Mendenhall WM: Evaluation of larynx dose with extended field IMRT for head and neck cancer. Int J Radiat Oncol Biol Phys 2007, 69:S455.
• [25]Hollien H: Some laryngeal correlates of vocal pitch. J Speech Hear Res 1960, 3:52-58.
• [26]Brouwer CL, Steenbakkers RJ, van den Heuvel E, Duppen JC, Navran A, Bijl HP, Chouvalova O, Burlage FR, Meertens H, Langendijk JA, van 't Veld AA: 3D variation in delineation of head and neck organs at risk. Radiat Oncol 2012, 7:32. BioMed Central Full Text