Selective omission of level V nodal coverage for patients with oropharyngeal cancer: Clinical validation of intensity‐modulated radiotherapy experience and dosimetric significance. Issue 4 (16th June 2015)

• Record Type: Journal Article
• Authors: Mohindra, Pranshu; Urban, Erich; Pagan, Jonathan D.; Geye, Heather M.; Patel, Vatsal B.; Bayliss, R. Adam A.; Bender, Edward T.; Harari, Paul M.
• Is Part Of: Head & neck. Volume 38:Issue 4(2016)
• Page Start: 499
• Page End: 505
• Publication Date: 2015-06-16
• Subjects: intensity‐modulated radiotherapy (IMRT) -- oropharyngeal cancer -- neck lymph nodes -- level V -- patterns of failure; Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.23924
• Languages: English
• ISSNs: 1043-3074

Abstract

ABSTRACT: Background: We sought to validate the consensus recommendation and assess dosimetric significance of selective omission of nodal level V from intensity‐modulated radiotherapy (IMRT) clinical target volume (CTV) for oropharyngeal cancer. Methods: IMRT plans and clinical outcomes for 112 patients with oropharyngeal cancer (nodal classification N0–N2b) were analyzed for coverage of ipsilateral and contralateral nodal level V. Additionally, new IMRT plans were generated in 6 randomly selected patients to assess its dosimetric impact. Results: With median follow‐up of 3.4 years, there were no failures identified in nodal level V with or without nodal level V omission. Upon dosimetric evaluation, significant reduction in integral dose, V10 Gy, V20 Gy, V30 Gy, V40 Gy, and V50 Gy was observed by excluding unilateral and bilateral level V from the CTV. Conclusion: We clinically validate the consensus recommendation for selective omission of level V nodal coverage in IMRT planning of patients with oropharyngeal cancer and demonstrate significant dosimetric advantages. © 2016 Wiley Periodicals, Inc. Head Neck 38: 499–505, 2016