Abstract

BackgroundThe ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via different treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by different TPS and RT techniques.MethodsCT data sets of the first six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95% = 77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids.ResultsAll RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT.ConclusionDifferent TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT.Trial registration ClinicalTrials.gov Identifier: NCT 01212354, EudraCT-No.: 2010-021139-15. ARO: ARO 14-01

Highlights

  • The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer

  • Head and neck cancer patients are treated by intensity modulated radiotherapy (IMRT) as standard of care in radiation oncology

  • Concerning coverage (CVF) of helical tomotherapy (HT) for SIB77Gy, there was a small gap between HT and Columetric Modulated Arc Therapy (VMAT) and IMRT, which seems clinically irrelevant

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Summary

Introduction

The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Head and neck cancer patients are treated by intensity modulated radiotherapy (IMRT) as standard of care in radiation oncology. In the era of IMRT application, Pigorsch et al Radiat Oncol (2020) 15:253 modulated arc therapy (VMAT), and helical tomotherapy (HT) are routinely used to treat patients with head and neck cancer. In multicenter prospective trials with IMRT, quality assurance (QA) of RT planning is mandatory [10, 11]. The second step is the proof of dose specification with different TPS, followed by a dummy run of all participating trial centers including a dummy run for target volume and OAR contouring

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