Development and Validation of a Standardized Method for Contouring the Brachial Plexus: Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer

William H. Hall, Michael Guiou, Nancy Y. Lee, Arthur Dublin, Samir Narayan, Srinivasan Vijayakumar, James A. Purdy, Allen M. Chen

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Purpose: Although Radiation Therapy Oncology Group protocols have proposed a limiting dose to the brachial plexus for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, essentially no recommendations exist for the delineation of this structure for treatment planning. Methods and Materials: Using anatomic texts, radiologic data, and magnetic resonance imaging, a standardized method for delineating the brachial plexus on 3-mm axial computed tomography images was devised. A neuroradiologist assisted with identification of the brachial plexus and adjacent structures. This organ at risk was then contoured on 10 consecutive patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. Dose-volume histogram curves were generated by applying the proposed brachial plexus contour to the initial treatment plan. Results: The total dose to the planning target volume ranged from 60 to 70 Gy (median, 70). The mean brachial plexus volume was 33 ± 4 cm3 (range, 25.1-39.4). The mean irradiated volumes of the brachial plexus were 50 Gy (17 ± 3 cm3), 60 Gy (6 ± 3 cm3), 66 Gy (2 ± 1 cm3), 70 Gy (0 ± 1 cm3). The maximal dose to the brachial plexus was 69.9 Gy (range, 62.3-76.9) and was ≥60 Gy, ≥66 Gy, and ≥70 Gy in 100%, 70%, and 30% of patients, respectively. Conclusions: This technique provides a precise and accurate method for delineating the brachial plexus organ at risk on treatment planning computed tomography scans. Our dosimetric analysis suggest that for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, brachial plexus routinely receives doses in excess of historic and Radiation Therapy Oncology Group limits.

Original languageEnglish (US)
Pages (from-to)1362-1367
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume72
Issue number5
DOIs
StatePublished - Dec 1 2008

Fingerprint

Brachial Plexus
Head and Neck Neoplasms
radiation therapy
cancer
dosage
planning
Intensity-Modulated Radiotherapy
organs
tomography
Organs at Risk
Radiation Oncology
delineation
recommendations
histograms
magnetic resonance
Radiotherapy
therapy
Tomography
curves
Therapeutics

Keywords

  • Brachial plexus
  • Contouring
  • Head-and-neck cancer
  • Intensity-modulated radiotherapy
  • Radiotherapy planning

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Development and Validation of a Standardized Method for Contouring the Brachial Plexus : Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer. / Hall, William H.; Guiou, Michael; Lee, Nancy Y.; Dublin, Arthur; Narayan, Samir; Vijayakumar, Srinivasan; Purdy, James A.; Chen, Allen M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 72, No. 5, 01.12.2008, p. 1362-1367.

Research output: Contribution to journalArticle

Hall, William H. ; Guiou, Michael ; Lee, Nancy Y. ; Dublin, Arthur ; Narayan, Samir ; Vijayakumar, Srinivasan ; Purdy, James A. ; Chen, Allen M. / Development and Validation of a Standardized Method for Contouring the Brachial Plexus : Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 72, No. 5. pp. 1362-1367.
@article{657c10ef39e44495bd5762d253eae6cf,
title = "Development and Validation of a Standardized Method for Contouring the Brachial Plexus: Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer",
abstract = "Purpose: Although Radiation Therapy Oncology Group protocols have proposed a limiting dose to the brachial plexus for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, essentially no recommendations exist for the delineation of this structure for treatment planning. Methods and Materials: Using anatomic texts, radiologic data, and magnetic resonance imaging, a standardized method for delineating the brachial plexus on 3-mm axial computed tomography images was devised. A neuroradiologist assisted with identification of the brachial plexus and adjacent structures. This organ at risk was then contoured on 10 consecutive patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. Dose-volume histogram curves were generated by applying the proposed brachial plexus contour to the initial treatment plan. Results: The total dose to the planning target volume ranged from 60 to 70 Gy (median, 70). The mean brachial plexus volume was 33 ± 4 cm3 (range, 25.1-39.4). The mean irradiated volumes of the brachial plexus were 50 Gy (17 ± 3 cm3), 60 Gy (6 ± 3 cm3), 66 Gy (2 ± 1 cm3), 70 Gy (0 ± 1 cm3). The maximal dose to the brachial plexus was 69.9 Gy (range, 62.3-76.9) and was ≥60 Gy, ≥66 Gy, and ≥70 Gy in 100{\%}, 70{\%}, and 30{\%} of patients, respectively. Conclusions: This technique provides a precise and accurate method for delineating the brachial plexus organ at risk on treatment planning computed tomography scans. Our dosimetric analysis suggest that for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, brachial plexus routinely receives doses in excess of historic and Radiation Therapy Oncology Group limits.",
keywords = "Brachial plexus, Contouring, Head-and-neck cancer, Intensity-modulated radiotherapy, Radiotherapy planning",
author = "Hall, {William H.} and Michael Guiou and Lee, {Nancy Y.} and Arthur Dublin and Samir Narayan and Srinivasan Vijayakumar and Purdy, {James A.} and Chen, {Allen M.}",
year = "2008",
month = "12",
day = "1",
doi = "10.1016/j.ijrobp.2008.03.004",
language = "English (US)",
volume = "72",
pages = "1362--1367",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Development and Validation of a Standardized Method for Contouring the Brachial Plexus

T2 - Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer

AU - Hall, William H.

AU - Guiou, Michael

AU - Lee, Nancy Y.

AU - Dublin, Arthur

AU - Narayan, Samir

AU - Vijayakumar, Srinivasan

AU - Purdy, James A.

AU - Chen, Allen M.

PY - 2008/12/1

Y1 - 2008/12/1

N2 - Purpose: Although Radiation Therapy Oncology Group protocols have proposed a limiting dose to the brachial plexus for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, essentially no recommendations exist for the delineation of this structure for treatment planning. Methods and Materials: Using anatomic texts, radiologic data, and magnetic resonance imaging, a standardized method for delineating the brachial plexus on 3-mm axial computed tomography images was devised. A neuroradiologist assisted with identification of the brachial plexus and adjacent structures. This organ at risk was then contoured on 10 consecutive patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. Dose-volume histogram curves were generated by applying the proposed brachial plexus contour to the initial treatment plan. Results: The total dose to the planning target volume ranged from 60 to 70 Gy (median, 70). The mean brachial plexus volume was 33 ± 4 cm3 (range, 25.1-39.4). The mean irradiated volumes of the brachial plexus were 50 Gy (17 ± 3 cm3), 60 Gy (6 ± 3 cm3), 66 Gy (2 ± 1 cm3), 70 Gy (0 ± 1 cm3). The maximal dose to the brachial plexus was 69.9 Gy (range, 62.3-76.9) and was ≥60 Gy, ≥66 Gy, and ≥70 Gy in 100%, 70%, and 30% of patients, respectively. Conclusions: This technique provides a precise and accurate method for delineating the brachial plexus organ at risk on treatment planning computed tomography scans. Our dosimetric analysis suggest that for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, brachial plexus routinely receives doses in excess of historic and Radiation Therapy Oncology Group limits.

AB - Purpose: Although Radiation Therapy Oncology Group protocols have proposed a limiting dose to the brachial plexus for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, essentially no recommendations exist for the delineation of this structure for treatment planning. Methods and Materials: Using anatomic texts, radiologic data, and magnetic resonance imaging, a standardized method for delineating the brachial plexus on 3-mm axial computed tomography images was devised. A neuroradiologist assisted with identification of the brachial plexus and adjacent structures. This organ at risk was then contoured on 10 consecutive patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. Dose-volume histogram curves were generated by applying the proposed brachial plexus contour to the initial treatment plan. Results: The total dose to the planning target volume ranged from 60 to 70 Gy (median, 70). The mean brachial plexus volume was 33 ± 4 cm3 (range, 25.1-39.4). The mean irradiated volumes of the brachial plexus were 50 Gy (17 ± 3 cm3), 60 Gy (6 ± 3 cm3), 66 Gy (2 ± 1 cm3), 70 Gy (0 ± 1 cm3). The maximal dose to the brachial plexus was 69.9 Gy (range, 62.3-76.9) and was ≥60 Gy, ≥66 Gy, and ≥70 Gy in 100%, 70%, and 30% of patients, respectively. Conclusions: This technique provides a precise and accurate method for delineating the brachial plexus organ at risk on treatment planning computed tomography scans. Our dosimetric analysis suggest that for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, brachial plexus routinely receives doses in excess of historic and Radiation Therapy Oncology Group limits.

KW - Brachial plexus

KW - Contouring

KW - Head-and-neck cancer

KW - Intensity-modulated radiotherapy

KW - Radiotherapy planning

UR - http://www.scopus.com/inward/record.url?scp=56349162665&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=56349162665&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2008.03.004

DO - 10.1016/j.ijrobp.2008.03.004

M3 - Article

C2 - 18448267

AN - SCOPUS:56349162665

VL - 72

SP - 1362

EP - 1367

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -