Comparison of cervical esophagus dose-volumes for three radiotherapy techniques for head and neck cancer

Abstract: Purpose: This study compares the radiation dose-volume of the cervical esophagus during head and neck radiotherapy using three different techniques. Methods: Treatment plans of 58 patients from 3/04 to 1/06 treated with bilateral head and neck radiotherapy were analyzed retrospectively. A comparison of the cervical esophagus dose with three-field 3D conformal RT (3DRT, n =34), whole-field IMRT (WF-IMRT, n =12), and half-beam IMRT (HB-IMRT, n =12) was performed. The volumes of esophagus receiving ⩾50Gy (V50), ⩾54Gy (V54) and ⩾60Gy (V60) and lengths receiving circumferential dose ⩾50Gy (L50) and ⩾54Gy (L54) were evaluated. Results: Maximum dose, V54 and L54 were greater for the first 2cm and entire cervical esophagus with WF-IMRT than HB-IMRT or 3DRT. In patients requiring a high match, WF-IMRT was associated with a greater maximum dose, V54 and L54 than HB-IMRT and 3DRT (p <0.05). In the low match group, WF-IMRT was associated with a greater V54 and L54 (p <0.05). Low neck disease, low primary site, and definitive radiotherapy were associated with increased irradiation of the esophagus. Conclusion: Treatment of the lower neck with IMRT is associated with increased irradiation to the cervical esophagus, and dose constraints should be included to reduce toxicity. [Copyright &y& Elsevier]