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• W2132390385 abstract "Due to concerns for the development of brachial plexopathy, the dose to the brachial plexus (BP) is routinely constrained in intensity modulated radiation therapy (IMRT) treatment planning for head and neck cancer at our medical center. Our purpose was to determine whether compromise of target coverage, in order to meet BP normal tissue toxicity constraints, impacts regional control. The records of 442 patients with oropharyngeal carcinoma (OPC) treated with IMRT at our institution between 1998 and 2009 were reviewed. From this group, we identified 42 patients (10%) with gross nodal disease <1 cm from the BP who were the subjects of this study. Seven of the 42 patients had bilateral gross nodal disease <1 cm from the BP. Platinum-based chemotherapy was administered to 31 (74%); 11 (26.2%) received cetuximab. For IMRT, a dose-painting technique with daily fractionation was used, delivering 70Gy to the gross disease. The BP was contoured for all patients prior to treatment according to published guidelines. Normal tissue constraints adhered to include a maximum point dose of 65Gy and a D05 of 60Gy for the BP. These criteria routinely took precedence over planning target volume (PTV) coverage near the BP. Neck dissection (ND) was reserved for patients with less than a complete response on imaging or clinical examination. We defined PTVBP70 as the portion of the PTV prescribed 70 Gy from 6mm inferior to 6mm superior of the ipsilateral BP. Dose-volume parameters for the BP and PTVBP70 were analyzed. Kaplan-Meier method was used to calculate regional control (RC). The median follow-up time in living patients was 21 months (range, 1 - 51). For the PTVBP70, the median D95 was 66.7Gy (range, 39.4 - 72.5Gy) and the median Dmin was 58.7Gy (range, 18.9 - 70.2Gy). For the BP, the median Dmax was 63.3Gy (range, 46.4 - 75.7Gy) and the median D05 was 59.1Gy (range, 40.5 - 73.8Gy). There was only one regional failure in proximity of the BP, salvaged successfully with ND and regional re-irradiation to 60Gy (performed due to concern for possible residual disease at the carotid bulb). The D95 and Dmin of PTVBP70 for that patient were 62.3 and 51.6Gy, respectively. The 3-year RC rate in the vicinity of the BP was 98%. There were 5 other regional failures distant from the BP. One was a contralateral out-of-field level 5 neck failure in a previously node negative hemi-neck. The other four RFs occurred in the ipsilateral high neck. There have been no reported episodes of brachial plexopathy to date. In the context of combined modality therapy, including ND as salvage, RC was not compromised by constraining the dose to the BP, thereby reducing the risk of brachial plexopathy. Our findings justify constraining the BP in future IMRT protocols for OPC." @default.
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• W2132390385 date "2011-10-01" @default.
• W2132390385 modified "2023-09-27" @default.
• W2132390385 title "Constraining the Brachial Plexus Does Not Compromise Regional Control in Oropharyngeal Carcinoma" @default.
• W2132390385 doi "https://doi.org/10.1016/j.ijrobp.2011.06.785" @default.
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