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Dosimetric analysis and clinical outcomes of brachial plexus as an organ-at-risk in head-and-neck cancer patients treated with intensity-modulated radiotherapy


1 Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Medical Physics, Manipal University, Manipal, Karnataka, India

Correspondence Address:
Prahlad H Yathiraj,
Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal University, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_959_17

 > Abstract 


Objectives: To document the dose received by brachial plexus (BP) in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck squamous cell carcinoma (HNSCC) and report the incidence of brachial plexopathy.
Methods: Newly diagnosed patients of HNSCC treated with radical or adjuvant IMRT were included in this retrospective study. No dosimetric constraints were applied for BP maximum dose equivalent dose (EQD2 α/β = 3). Patients with minimum 6-month follow-up were included and patients with suspicion of plexopathy were evaluated further.
Results: Sixty-seven patients were eligible and 127 BP were analyzed. The mean BP maximum dose (BPmax) was 62.4 Gy (+6.9), while mean BP volume was 28.1 cc (+4.1). Proportion of patients receiving BPmax >66 and >70 Gy were 34.7% and 14.2%. The mean BPmax for T4 tumors was significantly higher than T1 tumors (65 vs. 57.5 Gy, P = 0.005) but when adjusted for N-category, T-category was not independently significant in accounting for BPmax >66 or >70 Gy. Mean BPmax for N0 versus N2+ was 59.8 versus 65.6 Gy (P = 0.0001) and N1 versus N2+ was 61.6 versus 65.6 Gy (P = 0.018). After adjusting for T-category, patients with N2+ had a mean 4.2 Gy higher BPmax than N0-N1 (P = 0.0001). Stage III–IV patients had a mean six Gy higher BPmax doses than Stage I–II disease (P = 0.0001). With a median follow-up of 28 months (interquartile range 16–42), no patient had brachial plexopathy.
Conclusion: Clinically significant plexopathy was not seen in spite of majority having over 2-years follow-up and a third of patients having dose above the recommended tolerance. Only nodal category independently influenced dose to the brachial plexii.

Keywords: Brachial plexopathy, clinical outcome, dosimetric analysis, head-and-neck squamous cell carcinoma, intensity-modulated radiotherapy



How to cite this URL:
Prakash BB, Yathiraj PH, Sharan T K, Singh A, Reddy AS, Chandraguthi SG, Balasubramanian R, Nagesh J, Nair SS, Fernandes DJ, Mamidipudi VS. Dosimetric analysis and clinical outcomes of brachial plexus as an organ-at-risk in head-and-neck cancer patients treated with intensity-modulated radiotherapy. J Can Res Ther [Epub ahead of print] [cited 2019 Jan 21]. Available from: http://www.cancerjournal.net/preprintarticle.asp?id=244488

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    -  Prakash BB
    -  Yathiraj PH
    -  Sharan T K
    -  Singh A
    -  Reddy AS
    -  Chandraguthi SG
    -  Balasubramanian R
    -  Nagesh J
    -  Nair SS
    -  Fernandes DJ
    -  Mamidipudi VS
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