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Choi HS, Jeong BK, Jeong H, Ha IB, Choi BH, Kang KM. Target movement according to cervical lymph node level in head and neck cancer and its clinical significance. Radiat Oncol J 2023; 41:283-291. [PMID: 38185933 PMCID: PMC10772595 DOI: 10.3857/roj.2023.00787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To evaluate set-up error for head and neck cancer (HNC) patients according to each neck lymph node (LN) level. And clinical factors affecting set-up error were analyzed. MATERIALS AND METHODS Reference points (RP1, RP2, RP3, and RP4) representing neck LN levels I to IV were designated. These RP were contoured on simulation computed tomography (CT) and cone-beam CT of 89 HNC patients with the same standard. After image registration was performed, movement of each RP was measured. Univariable logistic regression analyses were performed to analyze clinical factors related to measured movements. RESULTS The mean value of deviation of all axes was 1.6 mm, 1.3 mm, 1.8 mm, and 1.5 mm for RP1, RP2, RP3, and RP4, respectively. Deviation was over 3 mm in 24 patients. Movement of more than 3 mm was observed only in RP1 and RP3. In RP1, it was related to bite block use. Movement exceeding 3 mm was most frequently observed in RP3. Primary tumor and metastatic LN volume change were clinical factors related to the RP3 movement. CONCLUSION Planning target volume margin of 4 mm for neck LN level I, 3 mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.
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Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Bae Kwon Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hojin Jeong
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Bong Ha
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Bong-Hoi Choi
- Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
- Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Sakamoto M, Konishi K, Ohira K, Hirata M, Wakabayashi K, Aramaki S, Kokubo R, Nakamura K. A newly developed patient fixation system using a dedicated mouthpiece and dental impression materials for head and neck radiotherapy: a preliminary study. JOURNAL OF RADIATION RESEARCH 2022; 63:749-757. [PMID: 35818301 PMCID: PMC9494543 DOI: 10.1093/jrr/rrac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Indexed: 06/15/2023]
Abstract
We evaluated the basic characteristics and efficacy of our newly developed patient fixation system for head and neck radiotherapy that uses a dedicated mouthpiece and dental impression materials. The present investigation demonstrated that with this system, the changes in the absorbed dose to water depending on the material of the mouthpiece were small, with a maximum of 0.32% for a 10-MV photon beam. For the dental impression material, we selected a silicone material with the lowest Hounsfield unit (HU) value that had little effect on the generation of artifacts and the quality of the X-ray beam. Multiphase magnetic resonance imaging (MRI) revealed that the head-up and -down motions in the thermoplastic shell without the mouthpiece were 5.76 ± 1.54 mm, whereas the motion with the mouthpiece decreased significantly to 1.72 ± 0.92 mm (P = 0.006). Similarly, the head-left and -right motion displacement decreased from 6.32 ± 1.86 mm without the mouthpiece to 1.80 ± 0.42 mm with the mouthpiece (P = 0.003). Regarding the tongue depressor function of the mouthpiece, the median distance from the hard palate to the surface of the tongue was 28.42 mm. The present results indicate that the new immobilization device developed herein that uses a mouthpiece and a thermoplastic shell is useful for suppressing patients' head motions and tongue positions.
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Affiliation(s)
- Masataka Sakamoto
- Corresponding author. Department of Radiology, Hamamatsu University Hospital, Handayama 120-1, Higashi-ku, Hamamatsu 431-3192, JAPAN. Tel: +81-053-435-2111; E-mail:
| | - Kenta Konishi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Keiichi Ohira
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Masanori Hirata
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kohei Wakabayashi
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shuhei Aramaki
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Ryo Kokubo
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsumasa Nakamura
- Department of Radiology, Hamamatsu University Hospital, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Radiotherapy of tongue cancer using an intraoral stent: a pilot study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396921000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:The aim was to evaluate the feasibility of an intraoral stent (10 and 20 mm thickness) in radiotherapy of tongue cancer, and to measure the reduction in acute mucositis in the palate.Materials and method:There were six patients in the intervention group, and seven patients in the control group. Target coverage was measured by the minimum dose covering 98% of the clinical target volume (CTV). Data were collected from the planning CT and daily cone-beam computer tomography (CBCT).Results:The 10 and 20 mm stent yielded a mean distance of 26 and 36 mm, respectively, between the tongue and the hard palate. We found comparable dose coverage of the CTV in the treatment plan, and on the CBCT. The stent reduced mean dose to the hard palate by 61.0% (p = 0.002). Dose to the soft palate was not reduced (p = 0.18). Average Common Terminology Criteria for Adverse Events (CTCAE) mucositis scores of the hard palate were 0 and 0.8 in the intervention and control group, respectively. The mucositis scores of the soft palate were 1.2 and 1.8.Findings:Use of an intraoral stent substantially reduced the dose to the hard palate. CTV coverage was maintained. We did not find any significant reduction in visually scored radiation-induced mucositis.
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Anderson G, Ebadi M, Vo K, Novak J, Govindarajan A, Amini A. An Updated Review on Head and Neck Cancer Treatment with Radiation Therapy. Cancers (Basel) 2021; 13:4912. [PMID: 34638398 PMCID: PMC8508236 DOI: 10.3390/cancers13194912] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022] Open
Abstract
The complexity of head and neck cancers (HNC) mandates a multidisciplinary approach and radiation therapy (RT) plays a critical role in the optimal management of patients with HNC, either as frontline or adjuvant treatment postoperatively. The advent of both definitive and post-operative RT has significantly improved the outcomes of patients with HNC. Herein, we discuss the role of postoperative RT in different subtypes of HNC, its side effects, and the importance of surveillance. The treatment regions discussed in this paper are the oral cavity, nasopharynx, paranasal sinus cavity, oropharynx, larynx and hypopharynx. Multiple studies that demonstrate the importance of definitive and/or postoperative RT, which led to an improved outlook of survival for HNC patients will be discussed.
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Affiliation(s)
- Garrett Anderson
- Division of Nuclear Medicine, Department of Radiology, Loma Linda University, Loma Linda, CA 92350, USA
| | - Maryam Ebadi
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL 60640, USA
| | - Kim Vo
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Jennifer Novak
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Ameish Govindarajan
- Department of Internal Medicine, UCLA-Kern Medical Center, Bakersfield, CA 93306, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
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Ju SG, Ahn YC, Kim YB, Park SG, Choi YM, Na CH, Hong CS, Oh D, Kwon DY, Kim CC, Kim DH. Development of a Tongue Immobilization Device Using a 3D Printer for Intensity Modulated Radiation Therapy of Nasopharyngeal Cancer Patients. Cancer Res Treat 2020; 53:45-54. [PMID: 32972044 PMCID: PMC7812000 DOI: 10.4143/crt.2020.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose This study aimed to reduce radiation doses to the tongue, a patient-specific semi-customized tongue immobilization device (SCTID) was developed using a 3D printer for helical tomotherapy (HT) of nasopharyngeal cancer (NPCa). Dosimetric characteristics and setup stability of the SCTID were compared with those of a standard mouthpiece (SMP). Materials and Methods For displacement and robust immobilization of the tongue, the SCTID consists of four parts: upper and lower tooth stoppers, tongue guider, tongue-tip position guide bar, and connectors. With the SCTID and SMP, two sets of planning computed tomography and HT plans were obtained for 10 NPCa patients. Dosimetric and geometric characteristics were compared. Position reproducibility of the tongue with SCTID was evaluated by comparing with planned dose and adaptive accumulated dose of the tongue and base of the tongue based on daily setup mega-voltage computed tomography. Results Using the SCTID, the tongue was effectively displaced from the planning target volume compared to the SMP. The median mucosa of the tongue (M-tongue) dose was significantly reduced (20.7 Gy vs. 27.8 Gy). The volumes of the M-tongue receiving a dose of 15 Gy, 30 Gy, and 45 Gy and the volumes of the mucosa of oral cavity and oropharynx (M-OC/OP) receiving a dose of 45 Gy and 60 Gy were significantly lower than using the SMP. No significant differences was observed between the planned dose and the accumulated adaptive dose in any dosimetric characteristics of the tongue and base of tongue. Conclusion SCTID can not only reduce the dose to the M-tongue and M-OC/OP dramatically, when compared to SMP, but also provide excellent reproducibility and easy visual verification.
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Affiliation(s)
- Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yeong-Bi Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Gyu Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Mi Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Cho Hee Na
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Yeol Kwon
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Chong Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyeon Kim
- Institute of Advanced Convergence Technology, Kyungpook National University, Daegu, Korea
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Stieb S, Perez-Martinez I, Mohamed AS, Rock S, Bajaj N, Deshpande TS, Zaid M, Garden AS, Goepfert RP, Cardoso R, Ferrarotto R, Reddy JP, Phan J, Morrison WH, Rosenthal DI, Koay EJ, Frank SJ, Fuller CD, Gunn GB. The impact of tongue-deviating and tongue-depressing oral stents on long-term radiation-associated symptoms in oropharyngeal cancer survivors. Clin Transl Radiat Oncol 2020; 24:71-78. [PMID: 32642562 PMCID: PMC7334797 DOI: 10.1016/j.ctro.2020.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES To evaluate whether the use of oral stents during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC) is associated with long-term patient reported symptoms. MATERIALS AND METHODS Data was obtained from a prospective observational study of disease-free head and neck cancer survivors. Radiation-associated patient reported symptoms were assessed using the MD Anderson Symptom Inventory Head and Neck module (MDASI-HN). Scores of ≥5 (11-point Likert scale, 0-10) were considered moderate/severe. Stratification was performed regarding IMRT volume (uni- versus bilateral neck) and stent utilization, with non-parametric analyses between groups. RESULTS 462 OPC survivors formed the cohort (54% tonsil, 46% base of tongue primaries). A tongue-deviating stent was used in 17%, tongue-depressing stent in 46%, and no stent in 37%. Median prescribed dose to the high dose clinical target volume was 66.0 Gy. Median follow-up from RT to MDASI-HN assessment was 68 months. Twenty percent had received unilateral neck RT (all had tonsil primaries), in whom a significant improvement in the proportion of patients with moderate/severe taste impairment (2% vs. 15%, p = 0.047) and lack of appetite (0% vs. 9%, p = 0.019) was associated with the use of tongue-deviating stents compared to no oral stent. In those who had received bilateral neck RT, a significant improvement in the proportion of patients with moderate/severe difficulty swallowing/chewing was associated with use of a tongue-depressing stent (21% vs. 31% without oral stent, p = 0.013). CONCLUSION Disease-site specific select use of oral stents during IMRT was associated with reduced long-term patient reported symptoms in OPC survivors.
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Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Ismael Perez-Martinez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Stockton Rock
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Nimit Bajaj
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Tanaya S. Deshpande
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Mohamed Zaid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Adam S. Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Ryan P. Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Richard Cardoso
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - William H. Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - C. David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - G. Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - MD Anderson Head and Neck Cancer Symptom Working Group
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Three-Dimensional Printed Silicone Bite Blocks for Radiotherapy of Head and Neck Cancer—A Preliminary Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10051688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Conventional methods that have been developed to immobilize the mouth and tongue for radiotherapy (RT) in head and neck cancer (HNC) treatment have been unsatisfactory. We, therefore, developed three-dimensional (3D), customizable, silicone bite blocks and examined their clinical feasibility. For HNC patients, before RT, the 3D printed bite blocks were fabricated based on primary computed tomography (CT) simulation images. The placement of the 3D bite blocks was followed by a secondary CT simulation before RT planning was finalized. Dosimetric parameters and positioning verification achieved with the propose bite blocks were compared with conventional universal oral corks. The 3D printed bite blocks were conformal to the occlusal surface, ensuring immobilization of the tongue without eliciting a gag reflex, and an elastic and firm texture that supports opening of the mouth, with a smooth surface with tolerable intraoral tactility. The dosimetry of patients using the proposed bite blocks showed better coverage of the planning target volume and surface of a tumour bed along with reduction in normal tissue doses. Good concordance of positioning by 3D printed bite blocks during the RT course was verified. The 3D printed bite blocks with silicone might be a customizable, safe, and practical advanced technology in RT for HNC.
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8
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Hong CS, Oh D, Ju SG, Ahn YC, Na CH, Kwon DY, Kim CC. Development of a semi-customized tongue displacement device using a 3D printer for head and neck IMRT. Radiat Oncol 2019; 14:79. [PMID: 31088472 PMCID: PMC6515618 DOI: 10.1186/s13014-019-1289-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
Purpose To reduce radiation doses to the tongue, a patient-specific semi-customized tongue displacement device (SCTDD) was developed using a 3D printer (3DP) for head and neck (H&N) radiation therapy (RT). Dosimetric characteristics of the SCTDD were compared with those of a standard mouthpiece (SMP). Materials and methods The SCTDD consists of three parts: a mouthpiece, connector with an immobilization mask, and tongue displacer, which can displace the tongue to the contralateral side of the planning target volume. Semi-customization was enabled by changing the thickness and length of the SCTDD. The instrument was printed using a 3DP with a biocompatible material. With the SCTDD and SMP, two sets of planning computed tomography (CT) and tomotherapy plans were obtained for seven H&N cancer patients. Dosimetric and geometric characteristics were compared. Results Using the SCTDD, the tongue was effectively displaced from the planning target volume without significant tongue volume change compared to the SMP. The median tongue dose was significantly reduced (29.6 Gy vs. 34.3 Gy). The volumes of the tongue receiving a dose of 15 Gy, 30 Gy, 35 Gy, 45 Gy, and 60 Gy were significantly lower than using the SMP. Conclusion The SCTDD significantly decreased the radiation dose to the tongue compared to the SMP, which may potentially reduce RT-related tongue toxicity.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Sang Gyu Ju
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Cho Hee Na
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Yeol Kwon
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Cheol Chong Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81 ,Gangnam-Gu, Seoul, 06351, Republic of Korea
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9
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Kil WJ, Kulasekere C, Hatch C, Bugno J, Derrwaldt R. Tongue-out versus tongue-in position during intensity-modulated radiotherapy for base of tongue cancer: Clinical implications for minimizing post-radiotherapy swallowing dysfunction. Head Neck 2017; 39:E85-E91. [PMID: 28475284 DOI: 10.1002/hed.24809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/23/2017] [Accepted: 03/14/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess whether different tongue positions change the radiation doses to swallowing organs at risks: the pharyngeal constrictor, oral cavity, and larynx during intensity-modulated radiotherapy (IMRT) for base of tongue (BOT) cancer. METHODS IMRT plans with Tongue-out (IMRT-TO) and tongue-in position (IMRT-TI) was compared in 3 cases. RESULTS Distance from BOT to pharyngeal constrictor was increased to 1.8 ± 0.8 cm with IMRT-TO from 0.9 ± 0.6 cm with IMRT-TI (P < .01). Compared to IMRT-TI, IMRT-TO significantly decreased the radiation dose to the anterior oral cavity, oral tongue, superior pharyngeal constrictor, middle pharyngeal constrictor, and supraglottic larynx (all P ≤ .04). IMRT-TO also had a smaller volume irradiated than IMRT-TI to the anterior oral cavity and the oral tongue receiving ≥30 Gy (V30) and V35, and superior pharyngeal constrictor and middle pharyngeal constrictor for V55 and V65 (all P ≤ .04). CONCLUSION Dosimetric advantage with IMRT-TO over IMRT-TI may potentially reduce post-IMRT swallowing dysfunction in selected patients with BOT cancer.
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Affiliation(s)
- Whoon Jong Kil
- Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Medicine Service-Radiation Oncology Section, Oklahoma City Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | | | - Craig Hatch
- Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Jacob Bugno
- Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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