Definitive radiotherapy for a head and neck Merkel cell carcinoma and comprehensive nodal volumes

A case for using a computer-designed variable-thickness compensator to reduce risk and severity of mucositis

Anesa Ahamad, Donald Weed, Darel D. Pruett, Daniel Saulpaugh, Womah Neeranjun, Eduardo Fernandez

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

When contemplating how to treat head and neck primary cancers and regional lymph nodes with radiotherapy, we often select the contemporary intensity-modulated radiotherapy (IMRT) without much consideration of older methods that may give fewer side effects and be more cost-effective. For an 87-year-old female with a 1.5-cm Merkel cell carcinoma (MCC) located 1.5 cm lateral to the orbital rim, we were challenged to deliver 50 Gy to comprehensive elective nodal regions and 70 Gy to the primary. We were particularly concerned about the potential adverse acute effects of radiotherapy to mucosal structures in this elderly female. Acute mucositis could impair nutrition, quality of life, and treatment intensity especially given her age. We compared 3 techniques that are appropriate for this target: step-and-shoot IMRT, matched electron fields (MEF), and electron conformal therapy (BolusECT™). We selected and treated her with BolusECT™ because of better sparing of larynx, pharynx, oral cavity and lips, and shortest treatment time. This is a reasonable option for treating ipsilateral head and neck target volumes at centers where only these 3 techniques are available.

Original languageEnglish (US)
JournalMedical Dosimetry
DOIs
StateAccepted/In press - 2017

Fingerprint

Merkel Cell Carcinoma
Mucositis
Intensity-Modulated Radiotherapy
Neck
Radiotherapy
Head
Electrons
Head and Neck Neoplasms
Larynx
Lip
Pharynx
Mouth
Therapeutics
Lymph Nodes
Quality of Life
Costs and Cost Analysis

Keywords

  • Comparative dosimetry
  • Electron beam
  • Merkel cell carcinoma
  • Quality of life
  • Variable thickness compensator

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Definitive radiotherapy for a head and neck Merkel cell carcinoma and comprehensive nodal volumes: A case for using a computer-designed variable-thickness compensator to reduce risk and severity of mucositis",
abstract = "When contemplating how to treat head and neck primary cancers and regional lymph nodes with radiotherapy, we often select the contemporary intensity-modulated radiotherapy (IMRT) without much consideration of older methods that may give fewer side effects and be more cost-effective. For an 87-year-old female with a 1.5-cm Merkel cell carcinoma (MCC) located 1.5 cm lateral to the orbital rim, we were challenged to deliver 50 Gy to comprehensive elective nodal regions and 70 Gy to the primary. We were particularly concerned about the potential adverse acute effects of radiotherapy to mucosal structures in this elderly female. Acute mucositis could impair nutrition, quality of life, and treatment intensity especially given her age. We compared 3 techniques that are appropriate for this target: step-and-shoot IMRT, matched electron fields (MEF), and electron conformal therapy (BolusECT™). We selected and treated her with BolusECT™ because of better sparing of larynx, pharynx, oral cavity and lips, and shortest treatment time. This is a reasonable option for treating ipsilateral head and neck target volumes at centers where only these 3 techniques are available.",
keywords = "Comparative dosimetry, Electron beam, Merkel cell carcinoma, Quality of life, Variable thickness compensator",
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T2 - A case for using a computer-designed variable-thickness compensator to reduce risk and severity of mucositis

AU - Ahamad, Anesa

AU - Weed, Donald

AU - Pruett, Darel D.

AU - Saulpaugh, Daniel

AU - Neeranjun, Womah

AU - Fernandez, Eduardo

PY - 2017

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N2 - When contemplating how to treat head and neck primary cancers and regional lymph nodes with radiotherapy, we often select the contemporary intensity-modulated radiotherapy (IMRT) without much consideration of older methods that may give fewer side effects and be more cost-effective. For an 87-year-old female with a 1.5-cm Merkel cell carcinoma (MCC) located 1.5 cm lateral to the orbital rim, we were challenged to deliver 50 Gy to comprehensive elective nodal regions and 70 Gy to the primary. We were particularly concerned about the potential adverse acute effects of radiotherapy to mucosal structures in this elderly female. Acute mucositis could impair nutrition, quality of life, and treatment intensity especially given her age. We compared 3 techniques that are appropriate for this target: step-and-shoot IMRT, matched electron fields (MEF), and electron conformal therapy (BolusECT™). We selected and treated her with BolusECT™ because of better sparing of larynx, pharynx, oral cavity and lips, and shortest treatment time. This is a reasonable option for treating ipsilateral head and neck target volumes at centers where only these 3 techniques are available.

AB - When contemplating how to treat head and neck primary cancers and regional lymph nodes with radiotherapy, we often select the contemporary intensity-modulated radiotherapy (IMRT) without much consideration of older methods that may give fewer side effects and be more cost-effective. For an 87-year-old female with a 1.5-cm Merkel cell carcinoma (MCC) located 1.5 cm lateral to the orbital rim, we were challenged to deliver 50 Gy to comprehensive elective nodal regions and 70 Gy to the primary. We were particularly concerned about the potential adverse acute effects of radiotherapy to mucosal structures in this elderly female. Acute mucositis could impair nutrition, quality of life, and treatment intensity especially given her age. We compared 3 techniques that are appropriate for this target: step-and-shoot IMRT, matched electron fields (MEF), and electron conformal therapy (BolusECT™). We selected and treated her with BolusECT™ because of better sparing of larynx, pharynx, oral cavity and lips, and shortest treatment time. This is a reasonable option for treating ipsilateral head and neck target volumes at centers where only these 3 techniques are available.

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