Critical appraisal of a conformal head and neck cancer irradiation avoiding electron beams and field matching

Purpose: In head and neck cancer patients, spinal chains are usually irradiated by a combination of photon and electron beams, requiring high precision in held matching. This study compares a conventional treatment approach where two lateral photon beams are combined to direct electron fields, to a conformal radiotherapy based on five photon fields, covering the whole neck. Methods and Materials: A comparative analysis of dose distributions and dose-volume histograms was carried out in patients with locally advanced head and neck tumors, for which planning target volumes (PTV) were outlined from the base of the skull down to the supraclavicular region. The prescribed dose to PTV (excluding booster irradiation) was 54 Gy, with spinal dose constraint not exceeding 75% of the total dose, whatever the technique. Results: For the new five-field technique, minimum and maximum point doses showed mean deviations, on five patients entered in the study, of 84% and 113% from the ICRU prescription point. In the conventional treatment, the corresponding figures were 73% and 112%, respectively. A positioning error analysis (isocenter displacement of 2 mm, in all directions) did not elicit any systematic difference in five-field treatment plans while hot spots were found with electron fields. Conclusions: The five-field technique appears routinely feasible and compares favorably with the conventional mixed photon- and electron-therapy approach, especially in regard to its better compliance with dose homogeneity requirements and a reduced risk in dose inhomogeneity related to field matching and patient positioning. (C) 1999 Elsevier Science Inc.