Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa
Identifieur interne : 006023 ( Ncbi/Merge ); précédent : 006022; suivant : 006024Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa
Auteurs : Vicky Koh [Singapour] ; Johann I. Tang [Singapour] ; Bok Ai Choo [Singapour] ; Chek Wee Tan [Singapour] ; Boon Keat Lim [Singapour] ; Liang Shen [Singapour] ; Jiade Jay Lu [Singapour]Source :
- OncoTargets and therapy [ 1178-6930 ] ; 2013.
Abstract
Irradiation of the supraclavicular fossa is commonly used as part of adjuvant breast radiotherapy. Intensity-modulated radiotherapy (IMRT) may be used to target this region accurately, and there are subgroups of patients that may benefit more from IMRT than others. We identify the benefit of IMRT over fixed-depth dose prescription to the supraclavicular fossa in patients of different builds in a clinical setting.
Fifteen patients who received radiotherapy to the left breast and supraclavicular fossa were selected. Computed tomographic planning was used to generate plans for supraclavicular fossa coverage. Dose prescription to 1.5 cm and 3.0 cm depths was compared with IMRT plans. Coverage of the planning target volume and dose to the organs at risk were compared and correlated with patient body mass index (BMI) and computed tomography measurements.
Within the IMRT group, increasing depth of the supraclavicular fossa produced significantly better coverage of the planning target volume with IMRT. IMRT resulted in lower mean doses to the brachial plexus (
IMRT of the supraclavicular fossa results in lower brachial plexus doses for patients with low BMI while patients with higher BMI benefit from lower mean cord doses. IMRT provides superior coverage of the planning target volume, especially in patients with a deeper supraclavicular fossa.
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DOI: 10.2147/OTT.S49864
PubMed: 24294004
PubMed Central: 3839797
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa</title><author><name sortKey="Koh, Vicky" sort="Koh, Vicky" uniqKey="Koh V" first="Vicky" last="Koh">Vicky Koh</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Tang, Johann I" sort="Tang, Johann I" uniqKey="Tang J" first="Johann I" last="Tang">Johann I. Tang</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Choo, Bok Ai" sort="Choo, Bok Ai" uniqKey="Choo B" first="Bok Ai" last="Choo">Bok Ai Choo</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Tan, Chek Wee" sort="Tan, Chek Wee" uniqKey="Tan C" first="Chek Wee" last="Tan">Chek Wee Tan</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Lim, Boon Keat" sort="Lim, Boon Keat" uniqKey="Lim B" first="Boon Keat" last="Lim">Boon Keat Lim</name><affiliation wicri:level="1"><nlm:aff id="af2-ott-6-1701">Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Diagnostic Radiology, Khoo Teck Puat Hospital</wicri:regionArea><wicri:noRegion>Khoo Teck Puat Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Shen, Liang" sort="Shen, Liang" uniqKey="Shen L" first="Liang" last="Shen">Liang Shen</name><affiliation wicri:level="4"><nlm:aff id="af3-ott-6-1701">Department of Biostatistics, National University of Singapore, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Biostatistics, National University of Singapore</wicri:regionArea><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Lu, Jiade Jay" sort="Lu, Jiade Jay" uniqKey="Lu J" first="Jiade Jay" last="Lu">Jiade Jay Lu</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24294004</idno><idno type="pmc">3839797</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839797</idno><idno type="RBID">PMC:3839797</idno><idno type="doi">10.2147/OTT.S49864</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">004237</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004237</idno><idno type="wicri:Area/Pmc/Curation">004236</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004236</idno><idno type="wicri:Area/Pmc/Checkpoint">002479</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002479</idno><idno type="wicri:Area/Ncbi/Merge">006023</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa</title><author><name sortKey="Koh, Vicky" sort="Koh, Vicky" uniqKey="Koh V" first="Vicky" last="Koh">Vicky Koh</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Tang, Johann I" sort="Tang, Johann I" uniqKey="Tang J" first="Johann I" last="Tang">Johann I. Tang</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Choo, Bok Ai" sort="Choo, Bok Ai" uniqKey="Choo B" first="Bok Ai" last="Choo">Bok Ai Choo</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Tan, Chek Wee" sort="Tan, Chek Wee" uniqKey="Tan C" first="Chek Wee" last="Tan">Chek Wee Tan</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author><author><name sortKey="Lim, Boon Keat" sort="Lim, Boon Keat" uniqKey="Lim B" first="Boon Keat" last="Lim">Boon Keat Lim</name><affiliation wicri:level="1"><nlm:aff id="af2-ott-6-1701">Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Diagnostic Radiology, Khoo Teck Puat Hospital</wicri:regionArea><wicri:noRegion>Khoo Teck Puat Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Shen, Liang" sort="Shen, Liang" uniqKey="Shen L" first="Liang" last="Shen">Liang Shen</name><affiliation wicri:level="4"><nlm:aff id="af3-ott-6-1701">Department of Biostatistics, National University of Singapore, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Biostatistics, National University of Singapore</wicri:regionArea><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Lu, Jiade Jay" sort="Lu, Jiade Jay" uniqKey="Lu J" first="Jiade Jay" last="Lu">Jiade Jay Lu</name><affiliation wicri:level="1"><nlm:aff id="af1-ott-6-1701">Department of Radiation Oncology, National University Cancer Institute, Singapore</nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Radiation Oncology, National University Cancer Institute</wicri:regionArea><wicri:noRegion>National University Cancer Institute</wicri:noRegion></affiliation></author></analytic><series><title level="j">OncoTargets and therapy</title><idno type="eISSN">1178-6930</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Irradiation of the supraclavicular fossa is commonly used as part of adjuvant breast radiotherapy. Intensity-modulated radiotherapy (IMRT) may be used to target this region accurately, and there are subgroups of patients that may benefit more from IMRT than others. We identify the benefit of IMRT over fixed-depth dose prescription to the supraclavicular fossa in patients of different builds in a clinical setting.</p></sec><sec><title>Methods</title><p>Fifteen patients who received radiotherapy to the left breast and supraclavicular fossa were selected. Computed tomographic planning was used to generate plans for supraclavicular fossa coverage. Dose prescription to 1.5 cm and 3.0 cm depths was compared with IMRT plans. Coverage of the planning target volume and dose to the organs at risk were compared and correlated with patient body mass index (BMI) and computed tomography measurements.</p></sec><sec><title>Results</title><p>Within the IMRT group, increasing depth of the supraclavicular fossa produced significantly better coverage of the planning target volume with IMRT. IMRT resulted in lower mean doses to the brachial plexus (<italic>P</italic> = 0.00) when compared with 1.5 cm and 3 cm depth dose prescriptions, but higher maximum brachial plexus doses. IMRT was more beneficial in patients with lower BMI because this resulted in a decreased maximum brachial plexus dose (<italic>P</italic>-values of 0.03 and 0.001 when compared with 1.5 cm and 3.0 cm depth dose prescriptions, respectively). Higher patient BMI resulted in a lower dose contribution of IMRT to the cord (<italic>P</italic>-values 0.066 and 0.034 when compared with 1.5 cm and 3.0 cm depth dose prescriptions respectively).</p></sec><sec><title>Conclusion</title><p>IMRT of the supraclavicular fossa results in lower brachial plexus doses for patients with low BMI while patients with higher BMI benefit from lower mean cord doses. IMRT provides superior coverage of the planning target volume, especially in patients with a deeper supraclavicular fossa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Whelan, Tj" uniqKey="Whelan T">TJ Whelan</name></author><author><name sortKey="Olivotto, I" uniqKey="Olivotto I">I Olivotto</name></author><author><name sortKey="Ackerman, J" uniqKey="Ackerman J">J Ackerman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Truong, Pt" uniqKey="Truong P">PT Truong</name></author><author><name sortKey="Jones, So" uniqKey="Jones S">SO Jones</name></author><author><name sortKey="Kader, Ha" uniqKey="Kader H">HA Kader</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pierce, Lj" uniqKey="Pierce L">LJ Pierce</name></author><author><name sortKey="Moughan, J" uniqKey="Moughan J">J Moughan</name></author><author><name sortKey="White, J" uniqKey="White J">J White</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liengsawangwong, R" uniqKey="Liengsawangwong R">R Liengsawangwong</name></author><author><name sortKey="Yu, Tk" uniqKey="Yu T">TK Yu</name></author><author><name sortKey="Tzouh Liang, S" uniqKey="Tzouh Liang S">S Tzouh-Liang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bentel, Gc" uniqKey="Bentel G">GC Bentel</name></author><author><name sortKey="Marks, Lb" uniqKey="Marks L">LB Marks</name></author><author><name sortKey="Hardenbergh, Ph" uniqKey="Hardenbergh P">PH Hardenbergh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sethi, Ra" uniqKey="Sethi R">RA Sethi</name></author><author><name sortKey="Hyun, Sn" uniqKey="Hyun S">SN Hyun</name></author><author><name sortKey="Gabor, J" uniqKey="Gabor J">J Gabor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lomax, A" uniqKey="Lomax A">A Lomax</name></author><author><name sortKey="Cella, L" uniqKey="Cella L">L Cella</name></author><author><name sortKey="Weber, D" uniqKey="Weber D">D Weber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cavey, Ml" uniqKey="Cavey M">ML Cavey</name></author><author><name sortKey="Bayouth, Je" uniqKey="Bayouth J">JE Bayouth</name></author><author><name sortKey="Endres, Ej" uniqKey="Endres E">EJ Endres</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dogan, N" uniqKey="Dogan N">N Dogan</name></author><author><name sortKey="Cuttino, L" uniqKey="Cuttino L">L Cuttino</name></author><author><name sortKey="Lloyd, R" uniqKey="Lloyd R">R Lloyd</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Emami, B" uniqKey="Emami B">B Emami</name></author><author><name sortKey="Lyman, J" uniqKey="Lyman J">J Lyman</name></author><author><name sortKey="Brown, A" uniqKey="Brown A">A Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Basso Ricci, S" uniqKey="Basso Ricci S">S Basso-Ricci</name></author><author><name sortKey="Della Costa, C" uniqKey="Della Costa C">C della Costa</name></author><author><name sortKey="Viganotti, G" uniqKey="Viganotti G">G Viganotti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johansson, S" uniqKey="Johansson S">S Johansson</name></author><author><name sortKey="Svensson, H" uniqKey="Svensson H">H Svensson</name></author><author><name sortKey="Denekamp, J" uniqKey="Denekamp J">J Denekamp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Powell, S" uniqKey="Powell S">S Powell</name></author><author><name sortKey="Crooke, J" uniqKey="Crooke J">J Crooke</name></author><author><name sortKey="Parsons, C" uniqKey="Parsons C">C Parsons</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Giuliano, A" uniqKey="Giuliano A">A Giuliano</name></author><author><name sortKey="Hunt, K" uniqKey="Hunt K">K Hunt</name></author><author><name sortKey="Ballman, K" uniqKey="Ballman K">K Ballman</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Onco Targets Ther</journal-id><journal-id journal-id-type="iso-abbrev">Onco Targets Ther</journal-id><journal-id journal-id-type="publisher-id">OncoTargets and Therapy</journal-id><journal-title-group><journal-title>OncoTargets and therapy</journal-title></journal-title-group><issn pub-type="epub">1178-6930</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24294004</article-id><article-id pub-id-type="pmc">3839797</article-id><article-id pub-id-type="doi">10.2147/OTT.S49864</article-id><article-id pub-id-type="publisher-id">ott-6-1701</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Koh</surname><given-names>Vicky</given-names></name><xref ref-type="aff" rid="af1-ott-6-1701">1</xref></contrib><contrib contrib-type="author"><name><surname>Tang</surname><given-names>Johann I</given-names></name><xref ref-type="aff" rid="af1-ott-6-1701">1</xref></contrib><contrib contrib-type="author"><name><surname>Choo</surname><given-names>Bok Ai</given-names></name><xref ref-type="aff" rid="af1-ott-6-1701">1</xref></contrib><contrib contrib-type="author"><name><surname>Tan</surname><given-names>Chek Wee</given-names></name><xref ref-type="aff" rid="af1-ott-6-1701">1</xref></contrib><contrib contrib-type="author"><name><surname>Lim</surname><given-names>Boon Keat</given-names></name><xref ref-type="aff" rid="af2-ott-6-1701">2</xref></contrib><contrib contrib-type="author"><name><surname>Shen</surname><given-names>Liang</given-names></name><xref ref-type="aff" rid="af3-ott-6-1701">3</xref></contrib><contrib contrib-type="author"><name><surname>Lu</surname><given-names>Jiade Jay</given-names></name><xref ref-type="aff" rid="af1-ott-6-1701">1</xref><xref ref-type="corresp" rid="c1-ott-6-1701"></xref></contrib></contrib-group><aff id="af1-ott-6-1701"><label>1</label>Department of Radiation Oncology, National University Cancer Institute, Singapore</aff><aff id="af2-ott-6-1701"><label>2</label>Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore</aff><aff id="af3-ott-6-1701"><label>3</label>Department of Biostatistics, National University of Singapore, Singapore</aff><author-notes><corresp id="c1-ott-6-1701">Correspondence: Jiade Jay Lu, Department of Radiation Oncology, National University Cancer Institute, Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228, Tel +65 9818 6358, Email <email>mdcljj@nus.edu.sg</email></corresp></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>21</day><month>11</month><year>2013</year></pub-date><volume>6</volume><fpage>1701</fpage><lpage>1706</lpage><permissions><copyright-statement>© 2013 Koh et al. This work is published by Dove Medical Press Ltd, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement><copyright-year>2013</copyright-year><license><license-p>The full terms of the License are available at <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>Irradiation of the supraclavicular fossa is commonly used as part of adjuvant breast radiotherapy. Intensity-modulated radiotherapy (IMRT) may be used to target this region accurately, and there are subgroups of patients that may benefit more from IMRT than others. We identify the benefit of IMRT over fixed-depth dose prescription to the supraclavicular fossa in patients of different builds in a clinical setting.</p></sec><sec><title>Methods</title><p>Fifteen patients who received radiotherapy to the left breast and supraclavicular fossa were selected. Computed tomographic planning was used to generate plans for supraclavicular fossa coverage. Dose prescription to 1.5 cm and 3.0 cm depths was compared with IMRT plans. Coverage of the planning target volume and dose to the organs at risk were compared and correlated with patient body mass index (BMI) and computed tomography measurements.</p></sec><sec><title>Results</title><p>Within the IMRT group, increasing depth of the supraclavicular fossa produced significantly better coverage of the planning target volume with IMRT. IMRT resulted in lower mean doses to the brachial plexus (<italic>P</italic> = 0.00) when compared with 1.5 cm and 3 cm depth dose prescriptions, but higher maximum brachial plexus doses. IMRT was more beneficial in patients with lower BMI because this resulted in a decreased maximum brachial plexus dose (<italic>P</italic>-values of 0.03 and 0.001 when compared with 1.5 cm and 3.0 cm depth dose prescriptions, respectively). Higher patient BMI resulted in a lower dose contribution of IMRT to the cord (<italic>P</italic>-values 0.066 and 0.034 when compared with 1.5 cm and 3.0 cm depth dose prescriptions respectively).</p></sec><sec><title>Conclusion</title><p>IMRT of the supraclavicular fossa results in lower brachial plexus doses for patients with low BMI while patients with higher BMI benefit from lower mean cord doses. IMRT provides superior coverage of the planning target volume, especially in patients with a deeper supraclavicular fossa.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>intensity-modulated radiotherapy</kwd><kwd>radiotherapy</kwd><kwd>breast cancer</kwd><kwd>supraclavicular fossa</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-ott-6-1701" position="float"><label>Figure 1</label><caption><p>Dose distribution of 1.5 cm and 3.0 cm depth dose prescriptions and intensity modulated radiotherapy.</p></caption><graphic xlink:href="ott-6-1701Fig1"></graphic></fig><fig id="f2-ott-6-1701" position="float"><label>Figure 2</label><caption><p>Coverage of the supraclavicular fossa planning target volume by intensity-modulated radiotherapy compared with fixed-depth dose prescription.</p><p><bold>Abbreviations:</bold> IMRT, intensity-modulated radiotherapy; PTV, planning target volume.</p></caption><graphic xlink:href="ott-6-1701Fig2"></graphic></fig><table-wrap id="t1-ott-6-1701" position="float"><label>Table 1</label><caption><p>Comparison of results for each of the techniques used</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="2" colspan="1"></th><th colspan="3" align="left" valign="top" rowspan="1">Mean in cGray (standard deviation)
<hr></hr></th><th colspan="2" align="left" valign="top" rowspan="1"><italic>P</italic>-value (comparison with IMRT)
<hr></hr></th></tr><tr><th align="left" valign="top" rowspan="1" colspan="1">1.5 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">3 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">IMRT</th><th align="left" valign="top" rowspan="1" colspan="1">1.5 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">3 cm depth</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">PTV 95%</td><td align="left" valign="top" rowspan="1" colspan="1">1,620 (789)</td><td align="left" valign="top" rowspan="1" colspan="1">1,403 (728)</td><td align="left" valign="top" rowspan="1" colspan="1">4,974 (92)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Brachial plexus (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">3,678 (325)</td><td align="left" valign="top" rowspan="1" colspan="1">3,876 (303)</td><td align="left" valign="top" rowspan="1" colspan="1">2,774 (400)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Brachial plexus (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">4,910 (179)</td><td align="left" valign="top" rowspan="1" colspan="1">5,148 (230)</td><td align="left" valign="top" rowspan="1" colspan="1">5,383 (132)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1">0.002</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Heart (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">3.80 (1.82)</td><td align="left" valign="top" rowspan="1" colspan="1">4.60 (3.96)</td><td align="left" valign="top" rowspan="1" colspan="1">4.00 (3.05)</td><td align="left" valign="top" rowspan="1" colspan="1">0.715</td><td align="left" valign="top" rowspan="1" colspan="1">0.508</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Heart (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">22.6 (8.68)</td><td align="left" valign="top" rowspan="1" colspan="1">25.1 (15.2)</td><td align="left" valign="top" rowspan="1" colspan="1">23.4 (13.1)</td><td align="left" valign="top" rowspan="1" colspan="1">0.695</td><td align="left" valign="top" rowspan="1" colspan="1">0.668</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Cord (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">102 (58.3)</td><td align="left" valign="top" rowspan="1" colspan="1">120 (81.4)</td><td align="left" valign="top" rowspan="1" colspan="1">806 (440)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Cord (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">1,320 (506)</td><td align="left" valign="top" rowspan="1" colspan="1">1,430 (504)</td><td align="left" valign="top" rowspan="1" colspan="1">3,846 (299)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Left lung (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">443 (84.8)</td><td align="left" valign="top" rowspan="1" colspan="1">469 (95.2)</td><td align="left" valign="top" rowspan="1" colspan="1">400 (111)</td><td align="left" valign="top" rowspan="1" colspan="1">0.11</td><td align="left" valign="top" rowspan="1" colspan="1">0.014</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Left lung (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">4,814 (192)</td><td align="left" valign="top" rowspan="1" colspan="1">5,059 (259)</td><td align="left" valign="top" rowspan="1" colspan="1">5,421 (113)</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td><td align="left" valign="top" rowspan="1" colspan="1"><0.001</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-ott-6-1701"><p><bold>Note:</bold> The Bonferroni technique was used for multiple comparisons.</p></fn><fn id="tfn2-ott-6-1701"><p><bold>Abbreviations:</bold> IMRT, intensity-modulated radiotherapy; PTV, planning target volume.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-ott-6-1701" position="float"><label>Table 2</label><caption><p><italic>P</italic>-values when fixed-depth dose prescription is compared with IMRT across increasing AP diameter, SCF depth, and BMI</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="2" colspan="1"></th><th colspan="2" align="left" valign="top" rowspan="1">AP diameter
<hr></hr></th><th colspan="2" align="left" valign="top" rowspan="1">SCF depth
<hr></hr></th><th colspan="2" align="left" valign="top" rowspan="1">BMI
<hr></hr></th></tr><tr><th align="left" valign="top" rowspan="1" colspan="1">1.5 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">3.0 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">1.5 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">3.0 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">1.5 cm depth</th><th align="left" valign="top" rowspan="1" colspan="1">3.0 cm depth</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">PTV 95%</td><td align="left" valign="top" rowspan="1" colspan="1">0.685</td><td align="left" valign="top" rowspan="1" colspan="1">0.062</td><td align="left" valign="top" rowspan="1" colspan="1">0.879</td><td align="left" valign="top" rowspan="1" colspan="1">0.196</td><td align="left" valign="top" rowspan="1" colspan="1">0.817</td><td align="left" valign="top" rowspan="1" colspan="1">0.302</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Brachial plexus (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.742</td><td align="left" valign="top" rowspan="1" colspan="1">0.800</td><td align="left" valign="top" rowspan="1" colspan="1">0.125</td><td align="left" valign="top" rowspan="1" colspan="1">0.114</td><td align="left" valign="top" rowspan="1" colspan="1">0.508</td><td align="left" valign="top" rowspan="1" colspan="1">0.438</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Brachial plexus (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.004<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.001<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.044<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.012<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.030<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.001<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Heart (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.817</td><td align="left" valign="top" rowspan="1" colspan="1">0.939</td><td align="left" valign="top" rowspan="1" colspan="1">0.898</td><td align="left" valign="top" rowspan="1" colspan="1">0.842</td><td align="left" valign="top" rowspan="1" colspan="1">0.780</td><td align="left" valign="top" rowspan="1" colspan="1">0.875</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Heart (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.960</td><td align="left" valign="top" rowspan="1" colspan="1">0.340</td><td align="left" valign="top" rowspan="1" colspan="1">0.270</td><td align="left" valign="top" rowspan="1" colspan="1">0.914</td><td align="left" valign="top" rowspan="1" colspan="1">0.844</td><td align="left" valign="top" rowspan="1" colspan="1">0.406</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Cord (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.046<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.028<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.383</td><td align="left" valign="top" rowspan="1" colspan="1">0.341</td><td align="left" valign="top" rowspan="1" colspan="1">0.066</td><td align="left" valign="top" rowspan="1" colspan="1">0.034<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Cord (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.830</td><td align="left" valign="top" rowspan="1" colspan="1">0.945</td><td align="left" valign="top" rowspan="1" colspan="1">0.960</td><td align="left" valign="top" rowspan="1" colspan="1">0.924</td><td align="left" valign="top" rowspan="1" colspan="1">0.345</td><td align="left" valign="top" rowspan="1" colspan="1">0.440</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Left lung (mean dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.668</td><td align="left" valign="top" rowspan="1" colspan="1">0.578</td><td align="left" valign="top" rowspan="1" colspan="1">0.067</td><td align="left" valign="top" rowspan="1" colspan="1">0.090</td><td align="left" valign="top" rowspan="1" colspan="1">0.898</td><td align="left" valign="top" rowspan="1" colspan="1">0.678</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Left lung (maximum dose)</td><td align="left" valign="top" rowspan="1" colspan="1">0.029<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.132</td><td align="left" valign="top" rowspan="1" colspan="1">0.017<xref ref-type="table-fn" rid="tfn3-ott-6-1701">*</xref></td><td align="left" valign="top" rowspan="1" colspan="1">0.105</td><td align="left" valign="top" rowspan="1" colspan="1">0.201</td><td align="left" valign="top" rowspan="1" colspan="1">0.336</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn3-ott-6-1701"><label>*</label><p>Significant <italic>P</italic>-values.</p></fn><fn id="tfn4-ott-6-1701"><p><bold>Abbreviations:</bold> AP, anterior-posterior; BMI, body mass index; SCF, supraclavicular fossa; IMRT, intensity-modulated radiotherapy; PTV, planning target volume.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Singapour</li></country><orgName><li>Université nationale de Singapour</li></orgName></list><tree><country name="Singapour"><noRegion><name sortKey="Koh, Vicky" sort="Koh, Vicky" uniqKey="Koh V" first="Vicky" last="Koh">Vicky Koh</name></noRegion><name sortKey="Choo, Bok Ai" sort="Choo, Bok Ai" uniqKey="Choo B" first="Bok Ai" last="Choo">Bok Ai Choo</name><name sortKey="Lim, Boon Keat" sort="Lim, Boon Keat" uniqKey="Lim B" first="Boon Keat" last="Lim">Boon Keat Lim</name><name sortKey="Lu, Jiade Jay" sort="Lu, Jiade Jay" uniqKey="Lu J" first="Jiade Jay" last="Lu">Jiade Jay Lu</name><name sortKey="Shen, Liang" sort="Shen, Liang" uniqKey="Shen L" first="Liang" last="Shen">Liang Shen</name><name sortKey="Tan, Chek Wee" sort="Tan, Chek Wee" uniqKey="Tan C" first="Chek Wee" last="Tan">Chek Wee Tan</name><name sortKey="Tang, Johann I" sort="Tang, Johann I" uniqKey="Tang J" first="Johann I" last="Tang">Johann I. 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