Elective nodal irradiation of lower neck lymphatics

[lazers]

In my institution our attendings use IMRT for elective low neck irradiation. In the Ang textbook it recommends using an anterior field for low neck irradiation. Which technique is more correct?

---

Members don't see this ad.

 

[Seldon1985]

Matching to a low anterior neck field with larynx block supposedly reduces larynx dose (and possibly pharyngeal constrictor dose) vs IMRT - see an original paper by Dabaja which has subsequently been updated with other MDACC data too. Just depends on where you train and philosophy of treatment. What are other people's experiences with this?

 

[Reaganite]

Matching to a low anterior neck field with larynx block supposedly reduces larynx dose (and possibly pharyngeal constrictor dose) vs IMRT - see an original paper by Dabaja which has subsequently been updated with other MDACC data too. Just depends on where you train and philosophy of treatment. What are other people's experiences with this?

As a resident, we did LAN gradient match which the planners absolutely hated. I did a lot of locums in the community I'm now working, and I asked all the planners what they were doing, and they all said whole field. I know U of F group was pretty adamant about larynx blocks back in the day, but I thought (I may be wrong on this) they recently had a paper where they argued that with modern IMRT and an emphasis on larynx constraints that whole field IMRT is perfectly acceptable.

 

[Palex80]

Next to better larynx/pharynx sparing, our physicists also claim that the mixed technique also increases dose homogenity in the IMRT region.
Perhaps because the volume gets smaller and is less irregular?

 

[Seldon1985]

As a resident, we did LAN gradient match which the planners absolutely hated. I did a lot of locums in the community I'm now working, and I asked all the planners what they were doing, and they all said whole field. I know U of F group was pretty adamant about larynx blocks back in the day, but I thought (I may be wrong on this) they recently had a paper where they argued that with modern IMRT and an emphasis on larynx constraints that whole field IMRT is perfectly acceptable.

Yea, Million of U of F learned it at MDACC I believe....

 

[medgator]

Matching to a low anterior neck field with larynx block supposedly reduces larynx dose (and possibly pharyngeal constrictor dose) vs IMRT - see an original paper by Dabaja which has subsequently been updated with other MDACC data too. Just depends on where you train and philosophy of treatment. What are other people's experiences with this?

UF initially advocated a split field technique, but on a more recent paper found that whole neck IMRT is fine provided you contour the larynx (and pharyngeal constrictors when appropriate) and control the dose stringently to those structures.


http://www.sciencedirect.com/science/article/pii/S1879850010000056

I use whole neck personally. Just easier to plan IMO and not a problem if you contour appropriately and keep the doses low

 

[deleted4401]

I swear there was a post about this not too long ago. When GFunk was on his game, he would told this guy to use the search function... Now, he's busy private practice guy, no time for the peons

 

[Gfunk6]

I SWEAR I was going to post the link!

But then the conversation got going and I figured, "eh . . . why bother?"

Also, I like lazers' original question, "which is more correct?" -- quite diplomatic.