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IMRT1

Rx: 66Gy/30fx to PTV66, also PTV60 and PTV56 (simultaneous integrated boost)

RTOG 0920

2:31 IMRT treatment field delivery time

Beams
DVH
Metrics

Name (ID): UniLateral_HN, (UniLateral_HN)
Plan or PlanSum ID: 7fld1bSX1norm

Structure IDStructure CodePatient StructureDVH ObjectiveEvaluatorVariationPriorityMetAchieved
PTV66PTV_High 66D95.0%[Gy]>=6664Goal66.283 Gy
PTV66EVAL-08PTV66Eval-08Min[Gy]>=6260Goal63.585 Gy
PTV60PTV_Int 60D95.0%[Gy]>=6460Variation60.764 Gy
PTV60 (GREATER THAN 8MM FROM SKIN)PTV60 Eval-08Min[Gy]>=6056Not met55.937 Gy
PTV60PTV_Int 60Max[Gy]<7072Goal68.150 Gy
PTV56PTV_Low 54D95.0%[Gy]>=5654Goal56.478 Gy
PTV56EVAL-08PTV56Eval-08Min[Gy]>=5250Variation50.013 Gy
SPINAL_CORD_PRVSpinalCord_05D0.03cc[Gy]<4850Goal46.062 Gy
SPINAL_CORD_PRVSpinalCord_05D0.01cc[Gy]<5052Goal46.527 Gy
BRAINSTEM_PRVBRAINSTEM_PRVD0.03cc[Gy]<=52Goal50.992 Gy
LIPSLIPSMean[Gy]<20Goal14.717 Gy
LIPS (NON ORAL CAVITY CANCER)LIPSMax[Gy]<50Goal30.039 Gy
ORAL CAVITYORALCAVITYMax[Gy]<60Not met67.919 Gy
ORAL CAVITY (NON ORAL CAVITY CANCER)ORALCAVITYMean[Gy]<50Goal47.692 Gy
RIGHT PAROTIDPAROTID_RMean[Gy]<26Goal7.586 Gy
RIGHT PAROTIDPAROTID_RD50.0%[Gy]<30Goal6.500 Gy
TOTAL PAROTIDPAROTID_TOTAL_RD20.0cc[Gy]<20Goal0.000 Gy
OARPHARYNXPharynxConstTtlD33.0%[Gy]<=50Not met56.171 Gy
OARPHARYNXPharynxConstTtlMean[Gy]<45Goal44.623 Gy
OARPHARYNXPharynxConstTtlD15.0%[Gy]<=60Goal57.830 Gy
CERVICAL ESOPHAGUSESOPHAGUS_UPPERD33.0%[Gy]>=4535Variation41.572 Gy
CERVICAL ESOPHAGUSESOPHAGUS_UPPERMean[Gy]<35Goal33.124 Gy
CERVICAL ESOPHAGUSESOPHAGUS_UPPERD15.0%[Gy]<=54Goal53.987 Gy
GLOTTIC AND SUPRAGLOTTIC LARYNXLARYNXMax[Gy]<45Not met58.575 Gy
MANDIBLEMANDIBLEMax[Gy]<66Not met70.019 Gy
UNSPECIFIED TISSUE OUTSIDE TARGETS (WITH BOOST)NS_NormalTissueD1.0%[Gy]<=72.6Goal56.684 Gy
UNSPECIFIED TISSUE OUTSIDE TARGETSNS_NormalTissueD5.0%[Gy]<=66Goal39.777 Gy
UNSPECIFIED TISSUE OUTSIDE TARGETSNS_NormalTissueD1.0cc[Gy]<=72.6Goal69.706 Gy
Technical Plan Comments

Unilateral head and neck treated SIB following RTOG 0920.  This seven (7) field IMRT plan was created with custom gantry positions to mimic the irregular volume target shape of the lowest dose target on the transverse planes.  Also, consideration was given to place beam edges so that a sharp gradient could be achieved against the highest value OARs (oral cavity, pharynx, larynx, and esophagus).  From a beam's eye view, unique collimator rotations were selected per field to match the general angle of the target volume.

The challenge was achieving the minimum PTV coverage constraint for targets that were overlapping or abutting OARs which could not be adequately spared due to the target size, location and overlap.  When a protocol enforces a minimum dose to the target, the temptation is to simply perform a uniform expansion on the target and optimize on the expanded target.  However, in this case, an optimization PTV was created and stretched outward only along the edges of the real PTV where the minimum dose was not met.  Careful attention was paid to minimize stretching where the target interfaced/overlapped with an OAR.

Physician Comments

This is clearly a more challenging case. The plan is overall adequate. Some remarkable dose gradients and dose falloffs are achieved. The problematic areas are in the overall zones with the oral cavity mostly, but also the larynx, pharynx and mandible. However, these are expected given the overlap with the PTV. If the PTV is corrected, then the overdose areas these OARs are clinically acceptable since the overlaps are very clear. This is a clinically acceptable plan.

Links

Review 3rd party software generated full treatment plan report

PDF

                              

Download full DICOM CT, struct, plan and dose file         

ZIP        

Any reference to a "plan study" are simply what the organizers call each case and may not be a "study" in the FDA sense as they may not have been published in a peer reviewed journal.
Varian does not provide medical advice and these are illustrative examples only.
Leading plans by expert planner. Your results may vary.

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