{Reference Type}: Journal Article
{Title}: Selective omission of level V nodal coverage for patients with oropharyngeal cancer: Clinical validation of intensity-modulated radiotherapy experience and dosimetric significance.
{Author}: Mohindra P;Urban E;Pagan JD;Geye HM;Patel VB;Bayliss RA;Bender ET;Harari PM;
{Journal}: Head Neck
{Volume}: 38
{Issue}: 4
{Year}: Apr 2016
{Factor}: 3.821
{DOI}: 10.1002/hed.23924
{Abstract}: <B>BACKGROUND: </B>We sought to validate the consensus recommendation and assess dosimetric significance of selective omission of nodal level V from intensity-modulated radiotherapy (IMRT) clinical target volume (CTV) for oropharyngeal cancer.<BR><B>METHODS: </B>IMRT plans and clinical outcomes for 112 patients with oropharyngeal cancer (nodal classification N0-N2b) were analyzed for coverage of ipsilateral and contralateral nodal level V. Additionally, new IMRT plans were generated in 6 randomly selected patients to assess its dosimetric impact.<BR><B>RESULTS: </B>With median follow-up of 3.4 years, there were no failures identified in nodal level V with or without nodal level V omission. Upon dosimetric evaluation, significant reduction in integral dose, V10 Gy , V20 Gy , V30 Gy , V40 Gy , and V50 Gy was observed by excluding unilateral and bilateral level V from the CTV.<BR><B>CONCLUSIONS: </B>We clinically validate the consensus recommendation for selective omission of level V nodal coverage in IMRT planning of patients with oropharyngeal cancer and demonstrate significant dosimetric advantages.