Radiation dose to the brachial plexus in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: An increased risk of an excessive dose to the brachial plexus adjacent to gross nodal disease

Feng,Guosheng; Lu,Heming; Liang,Yuan; Chen,Huasheng; Shu,Liuyang; Lu,Shui; Zhu,Jianfang; Gao,Weiwei

doi:10.3892/etm.2012.592

August 2012 Volume 4 Issue 2

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August 2012 Volume 4 Issue 2

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Article

Radiation dose to the brachial plexus in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: An increased risk of an excessive dose to the brachial plexus adjacent to gross nodal disease

Authors:
- Guosheng Feng
- Heming Lu
- Yuan Liang
- Huasheng Chen
- Liuyang Shu
- Shui Lu
- Jianfang Zhu
- Weiwei Gao
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Affiliations: Department of Medical Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guanxi 530021, P.R. China, Department of Radiation Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guanxi 530021, P.R. China, Department of Public Health, Guangxi Zhuang Autonomous Region, Nanning, Guanxi 530021, P.R. China, Department of Clinical Medicine, Guangxi Medical University, Nanning, Guanxi 530021, P.R. China, Department of Integrated Traditional and Western Medicine, Guangxi Traditional Chinese Medical University, Nanning, Guanxi 530021, P.R. China
Pages: 216-220
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Published online on: May 28, 2012

https://doi.org/10.3892/etm.2012.592
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Abstract

This retrospective study aimed to evaluate the dose to the brachial plexus in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Twenty-eight patients were selected and the brachial plexus was delineated retrospectively. Brachial plexus adjacent/not adjacent to nodes were defined and abbreviated as BPAN and BPNAN, respectively. Dose distribution was recalculated and a dose-volume histogram was generated based on the original treatment plan. The maximum dose to the left brachial plexus was 59.12-78.47 Gy, and the percentage of patients receiving the maximum dose exceeding 60, 66 and 70 Gy was 96.4, 57.1 and 25.0%, respectively; the maximum dose to the right brachial plexus was 59.74-80.31 Gy, and the percentage of patients exposed to a maximum dose exceeding 60, 66 and 70 Gy was 96.4, 64.3 and 39.3%, respectively. For the left brachial plexus, the maximum doses to the BPANs and the BPNANs were 72.84±3.91 and 64.81±3.47 Gy, respectively (p<0.001). For the right brachial plexus, the maximum doses to the BPANs and the BPNANs were 72.91±4.74 and 64.91±3.52 Gy, respectively (p<0.001). The difference between the left BPANs and the left BPNANs was statistically significant not only for V60 (3.60 vs. 1.01 cm3, p=0.028) but also for V66 (1.26 vs. 0.11 cm3, p=0.046). There were significant differences in V60 (3.68 vs. 1.16 cm3, p<0.001) and V66 (1.83 vs. 1.23 cm3, p=0.012) between the right BPANs and the right BPNANs. In conclusion, a large proportion of patients were exposed to the maximum dose to the brachial plexus exceeding the Radiation Therapy Oncology Group-recommended restraints when the brachial plexus was not outlined. The BPANs are at a significantly higher risk of receiving an excessive radiation dose when compared to the BPNANs. A further study is underway to test whether brachial plexus contouring assists in the dose reduction to the brachial plexus for IMRT optimization.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Radiation dose to the brachial plexus in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: An increased risk of an excessive dose to the brachial plexus adjacent to gross nodal disease

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