Is uniform target dose possible in IMRT plans in the head and neck?

PURPOSE: Various published reports involving intensity-modulated radiotherapy (IMRT) plans developed using automated optimization (inverse planning) have demonstrated highly conformal plans. These reported conformal IMRT plans involve significant target dose inhomogeneity, including both overdosage and underdosage within the target volume. In this study, we demonstrate the development of optimized beamlet IMRT plans that satisfy rigorous dose homogeneity requirements for all target volumes (e.g., +/-5%), while also sparing the parotids and other normal structures. METHODS AND MATERIALS: The treatment plans of 15 patients with oropharyngeal cancer who were previously treated with forward-planned multisegmental IMRT were planned again using an automated optimization system developed in-house. The optimization system allows for variable sized beamlets computed using a three-dimensional convolution/superposition dose calculation and flexible cost functions derived from combinations of clinically relevant factors (costlets) that can include dose, dose-volume, and biologic model-based costlets. The current study compared optimized IMRT plans designed to treat the various planning target volumes to doses of 66, 60, and 54 Gy with varying target dose homogeneity while using a flexible optimization cost function to minimize the dose to the parotids, spinal cord, oral cavity, brainstem, submandibular nodes, and other structures. RESULTS: In all cases, target dose uniformity was achieved through steeply varying dose-based costs. Differences in clinical plan evaluation metrics were evaluated for individual cases (eight different target homogeneity costlets), and for the entire cohort of plans. Highly conformal plans were achieved, with significant sparing of both the contralateral and ipsilateral parotid glands. As the homogeneity of the target dose distributions was allowed to decrease, increased sparing of the parotids (and other normal tissues) may be achieved. However, it was shown that relatively few patients would benefit from the use of increased target inhomogeneity, because the range of improvement in the parotid dose is relatively limited. Hot spots in the target volumes are shown to be unnecessary and do not assist in normal tissue sparing. CONCLUSION: Sparing of both parotids in patients receiving bilateral neck radiation can be achieved without compromising strict target dose homogeneity criteria. The geometry of the normal tissue and target anatomy are shown to be the major factor necessary to predict the parotid sparing that will be possible for any particular case.

Ultraviolet light photosensitivity in Ge-doped silica fibers: wavelength dependence of the light-induced index change.

A novel technique is reported for detecting permanent and transient light-induced refractive-index changes (photosensitivity) in optical fibers. The index change is detected by irradiating one arm of an unbalanced Mach-Zehnder fiber interferometer with UV light, thereby changing its optical path length. From a measurement of the change in the spectral response of the Mach-Zehnder interferometer, the change in the fiber core index as a function of wavelength can be determined. The equilibrium change in the core index is found to have an almost constant value of approximately 2.3 x 10(-5) over the measured wavelength range of 700 to 1400 nm.

Ultraviolet-light photosensitivity in Er(3+)-Ge-doped optical fiber.

Light-induced refractive-index change in Er(3+)-Ge-doped optical fiber is reported for the first time to the authors' knowledge. Evidence of the change is observed when UV light (lambda = 249 nm) irradiates one arm of an unbalanced Mach-Zehnder interferometer made from Er(3+)-Ge-doped fiber. From a measurement of the change in the spectral response of the interferometer with UV exposure, the change in fiber core index as a function of wavelength is determined. The equilibrium change in core index is found to vary between 2.3 x 10(-5) and 3.7 x 10(-5) over the measured wavelength region of 800 to 1700 nm. Also for the first time to our knowledge, fused couplers made of Er(3+)-doped fiber are reported. These identical fiber couplers are used in a novel all-fiber unbalanced Mach-Zehnder interferometer.