Dosimetric analytic comparison of inverse and forward planned IMRT techniques in the treatment of head and neck...

Our aim was to investigate if, and to what degree, improvements of IMRT treatment plans generated by forward planning can be achieved with an inverse planning strategy for treatments of head and neck cancer.

Between June 2007 and April 2008, 19 patients with head-and-neck cancers were treated at KAAH and Oncology Center Jeddah, using forward planning intensity modulated radiation therapy (FP-IMRT). They received thirty fractions over six weeks, to simultaneously deliver 66 Gy to the gross tumor (CTV1), 60 Gy to the soft tissue and nodes adjacent to the previous volume (CTV2), and 54 Gy to elective nodes (CTV3). These are biologically equivalent to 70, 60, and 50 Gy, if given 2 Gy per fraction. These were retrospectively re-planned with an inverse planning algorithm (IP-IMRT). The main objective of the optimization process was sparing of the parotid glands, spinal cord, and brainstem beside adequate treatment of the planning target volume.

Having 95% and 98% of CTV1 to receive at least 95% and 90% of prescribed dose respectively was fulfilled in all cases in both groups with higher figures in group B (IP-IMRT) than in group A (FR-IMRT), more obvious in CTV2 and CTV3. The average maximum dose to the spinal cord was 45.1 Gy in group A, and 41.6 Gy in group B. The mean dose of both parotid glands was kept below 26 Gy in four patients in group A, but in all cases in group B.

IP-IMRT selectively spared critical organs to greater degree with better target coverage and should be considered the standard of treatment in head and neck tumors.