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Review

IMRT in the treatment of head and neck cancer: is the present already the future?

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Pages 297-308 | Published online: 10 Jan 2014

References

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  • ••Reference publication about the so-calleddynamic modulation technique or sliding window, to realize IMRT.
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  • ••One of the key articles about IMRTfundamentals. A must for people approaching the subject.
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  • ••Comparative study at planning level onpotentialities of IMRT and proton therapy for head and neck for five patients affected by advanced (stage III and IV) squamous cell carcinoma of the head and neck The study indicates that organs at risk sparing can be highly improved with IMRT (and even better with protons) leaving wide space for dose-escalation and/or concomitant boost.
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  • ••Treatment acceleration study carried outwith intensity modulation beam design (SIB) to escalate dose to the primary tumor site keeping acceptable treatment morbidity, in particular parotid functionality. Together with the Mohan paper, this constitues one of the fundamental papers regarding the new era of concomitant boost techniques open by IMRT.
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  • ••Reference publication of the so-called'Bortfeld technique' for intensity modultated beam segmentation, origin of the step and shoot IMRT technique.
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  • ••The idea and implementation of the concomitant boost scheme known as SMART were modulation and acceleration are combined to produce, in the aims of the study, a significant gain in local control without any unacceptable increase of side effects.
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  • •Quality assurance in IMRT is deeply investigated in this paper in terms of dosimetric verification of the chain planning-delivery by one of the most active groups in head and neck.
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  • ••Fundamental and largely uniquepublication on normal tissue tolerance. The majority of the ongoing studies and protocols are based on values reported by this publication. In our opinion, some of the numbers given needs updating and careful verification. The large research groups should invest time in publishing similarly comprehensive data collections.
  • van Dieren EB, Nowak PJ, Wijers OB et al. Beam intensity modulation using tissue compensators or dynamic rnultileaf collimation in three-dimensional conformal radiotherapy of primary cancers of the oropharynx and larynx, including the elective neck Int. J. Radiat. Oncol Biol. Phys. 47,1299–1309 (2000).
  • •Comparative study at planning level addresses the potential of IMRT in sparing parotids. As for similar studies the expected reduction of complications (NTCP reduced of about 7-49%) encouraged the group to start clinical treatment of patients in 1998.
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  • •One of the most recent updates about side effect in head and neck treatment with IMRT published by the University of Michigan group who firstly started clinical treatments.
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  • ••Report of the initial experience of theMallinckrodt group on IMRT applied to head and neck cancer patients. In this study, data about 41 patients treated between 1997–1999 are reported. Twenty-seven were treated with IMRT. Authors found a correlation between saliva flow and mean dose delivered to the parotids with a decrease rate of about 4% per Gy.
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  • ••Treatment acceleration with comcomitantboost can be used to escalate dose to the primary tumor site keeping acceptable treatment morbidity, in particular parotid functionality. Together with the Wo paper, this study focused on radiobiological equivalences and constitues one of the fundamental papers regarding the new era of concomitant boost techniques open by IMRT.
  • Wu Q, Mohan R, Morris M, Tong S, Schmidt-Ullrich R Simultaneous integrated boost IMRT of advanced head and neck squamous cell carcinomas using dynamic multi-leaf collimators. Int. J. Radiat. Oncol. Bia Phys. 51, 180 (2001).
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  • ••One of the most interesting comparisonstudies at planning level published recently. Conventional 3-DCRT, IMRT and proton techniques were compared for several tumor sites indicating advantages of protons and IMRT with respect to other treatment techniques unable to generate concave dose distributions.
  • Lomax AJ, Boehringer T, Coray A et al. Intensity modulated proton therapy: a clinical example. Med. Phys. 28, 317–324 (2001).
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