International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 4 , Pages 1026-1036 , 15 March 2010

Clinical Utility of the Modified Segmental Boost Technique for Treatment of the Pelvis and Inguinal Nodes

  • M.S. Moran, M.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
    • Yale New Haven Hospital, New Haven, Connecticut and William W. Backus Hospital, Norwich, Connecticut
    • Corresponding Author InformationReprint requests to: Meena S. Moran, M.D., Yale University School of Medicine, 333 Cedar Street, P.O. Box 208040, New Haven, CT 06520-8040. Tel: (203) 785-6384; Fax: (203) 785-4622
  • ,
  • W.A. Castrucci, M.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
  • ,
  • M. Ahmad, Ph.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
    • Yale New Haven Hospital, New Haven, Connecticut and William W. Backus Hospital, Norwich, Connecticut
  • ,
  • H. Song, Ph.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
  • ,
  • M.W. Lund, M.A., C.M.D.

      Affiliations

    • Yale New Haven Hospital, New Haven, Connecticut and William W. Backus Hospital, Norwich, Connecticut
  • ,
  • S. Mani, M.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
    • Yale New Haven Hospital, New Haven, Connecticut and William W. Backus Hospital, Norwich, Connecticut
  • ,
  • Daniel Chamberlain, M.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut
  • ,
  • S.A. Higgins, M.D.

      Affiliations

    • Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut

Received 1 October 2008 ,Revised 19 February 2009 ,Accepted 27 February 2009.

References 

  1. Milano MT, Jani AB, Farrey KJ, Rash C, Heimann R, Chmura SJ. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: toxicity and clinical outcome. Int J Radiat Oncol Biol Phys. 2005;63(2):354–361
  2. Menkarios C, Azria D, Laliberte B, et al. Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regimen for the treatment of locally advanced anal canal carcinoma: A comparison of conventional and IMRT plans. Radiat Oncol. 2007;2(1):41
  3. Moran M, Lund MW, Ahmad M, Trumpore HS, Haffty B, Nath R. Improved treatment of pelvis and inguinal nodes using modified segmental boost technique: Dosimetric evaluation. Int J Radiat Oncol Biol Phys. 2004;59(5):1523–1530
  4. Chen YJ, Liu A, Tsai PT, et al. Organ sparing by conformal avoidance intensity-modulated radiation therapy for anal cancer: dosimetric evaluation of coverage of pelvis and inguinal/femoral nodes. Int J Radiat Oncol Biol Phys. 2005;63(1):274–281
  5. Gunderson LL, Tepper JE. Clinical radiation oncology. In Vulvar and vaginal carcinoma. 2nd ed.. Philadelphia: Elsevier; 2007;p. 1403–1405
  6. Kalend AM, Park TL, Wu A, et al. Clinical use of a wing field with transmission block for the treatment of the pelvis including the inguinal node. Int J Radiat Oncol Biol Phys. 1990;19(1):153–158
  7. King GC, Sonnik DA, Kalend AM, Wu A, Kalnicki S. Transmission block technique for the treatment of the pelvis and perineum including the inguinal lymph nodes: Dosimetric considerations. Med Dosim. 1993;18(1):7–12
  8. Digel CA, Lastner GM, Zinreich ES. The use of transmission block in the radiation therapy portal treatment of the inguinal nodes in late stage pelvic malignancies. Radiol Technol. 1987;58(3):227–231
  9. Ma L, Chang W, Lau-Chin M, Tate EM, Boyer AL. Using static MLC fields to replace partial transmission cerrobend blocks in treatment planning of rectal carcinoma cases. Med Dosim. 1998;23(4):264–266
  10. Watson BA, Ten Haken RK, Schewe JE, Possert PW, Sullivan MA. Use of segmental boost fields in the irradiation of inguinal lymphatic nodes. Med Dosim. 1999;24(1):27–32
  11. Dittmer PH, Randall ME. A technique for inguinal node boost using photon fields defined by asymmetric collimator jaws. Radiat Oncol. 2001;59:61–64
  12. Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–2593
  13. Brown PD, Kline RW, Petersen IA, Haddock MG. Irradiation of the inguinal lymph nodes in patients of differing body habitus: A comparison of techniques and resulting normal tissue complication probabilities. Med Dosim. 2004;29(3):217–222
  14. Gilroy JS, Amdur RJ, Louis DA, Li JG, Mendenhall WM. Irradiating the groin without breaking a leg: A comparison of techniques for groin node irradiation. Med Dosim. 2004;29(4):258–264
  15. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109–122
  16. Grigsby PW, Roberts HL, Perez CP. Femoral neck fracture following groin radiation. Int J Radiat Oncol Biol Phys. 1995;32(1):63–67
  17. Mell LK, Schomas DA, Salama JK, et al. Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2007;1431–1437
  18. Lin A, Ben-Josef E. Intensity-modulated radiation therapy for the treatment of anal cancer. Clin Colorectal Cancer. 2007;6(10):716–719
  19. Stehman FB, Bundy BN, Thomas G, et al. Groin dissection versus groin radiation in carcinoma of the vulva: A Gynecologic Oncology Group study. Int J Radiat Oncol Biol Phys. 1992;24(2):389–396
  20. McCall AR, Olson MC, Potkul RK. The variation of inguinal lymph node depth in adult women and its importance in planning elective irradiation for vulvar cancer. Cancer. 1995;75(9):2286–2288
  21. Kalidas H. Influence of inguinal node anatomy on radiation therapy techniques. Med Dosim. 1995;20:295–300
  22. Koh WJ, Chiu M, Stelzer KJ. Femoral vessel depth and the implications for groin node radiation. Int J Radiat Oncol Biol Phys. 1993;35:969–974
  23. Tsai HK, Hong TS, Willins J, et al. Dosimetric comparison of dose-painted intensity modulated radiation therapy vs. conventional radiation therapy for anal cancer. San Francisco, CA: Presented at the American Society of Clinical Oncology Gastrointestinal Cancer Symposium; Jan 2006;
  24. Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: A multicenter experience. J Clin Oncol. 2007;25(29):4581–4586
  25. Radiation Therapy Oncology Group protocol 0529: A phase II evaluation of dose-painted IMRT in combination with 5-fluorouracil and mitomycin-C for reduction of acute morbidity in carcinoma of the anal canal. Available at: http://www.rtog.org/members/protocols/0529/0529.pdf.
  26. Myerson R, Garofalo M, Naqa I, et al. Elective clinical target volumes in anorectal cancer: An RTOG consensus panel contouring atlas. Available at: http://www.rtog.org/pdf_document/AnorectalContouringGuidelines.pdf.
  27. Jhingran A, Winter K, Portelance L, et al. A phase II study of intensity modulated radiation therapy to the pelvis for postoperative patients with endometrial carcinoma (RTOG 0418). Int J Radiat Oncol Biol Phys. 2008;72(Suppl 1):516–517
  28. Wright JL, Patil SM, Temple LK, Minsky BD, Saltz LB, Goodman KA. Squamous cell carcinoma of the anal canal: Patterns and predictors of failure and implications for intensity modulated radiation (IMRT) planning. Int J Radiat Oncol Biol Phys. 2008;72(Suppl 1):571
  29. Guol S, Bhatia S, Trichter F, Bashist B, Ennis RD. Rethinking the radiotherapeutic GYN pelvis: Assessment of nodal target definition and its dosimetric and treatment technique implications. Int J Radiat Oncol Biol Phys. 2008;72(Suppl 1):5371–5372
  30. Mell LK, Tiryaki H, Ahn KH, Mundt AJ, Roeske JC, Avdogan B. Dosimetric comparison of bone marrow-sparing intensity modulated radiotherapy versus conventional techniques for treatment of cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71(5):1504–1510

 Conflict of interest: none.

PII: S0360-3016(09)00453-2

doi: 10.1016/j.ijrobp.2009.02.066

International Journal of Radiation Oncology * Biology * Physics
Volume 76, Issue 4 , Pages 1026-1036 , 15 March 2010