PMC5766653_01
Midline sagittal and axial views on positron emission tomography-computerized tomography. There are foci of hyperavidity in the supraglottic larynx, level II cervical lymph nodes, and the upper thoracic esophagus.
fonc-07-00307-g001.jpg
PMC5766653_01_fonc-07-00307-g001.jpg
F1
Staging positron emission tomography scan demonstrated activity in the supraglottic mass, bilateral level II cervical lymph nodes (LNs), and unexpectedly within the upper esophagus (Figure 1).
Planning target volumes and respective dose-volume histogram. Coronal and sagittal 3D volume renderings (top) by color: orange = esophageal primary, green = elective esophageal lymph nodes (LNs), yellow = bilateral low-risk elective cervical LNs, cyan = bilateral intermediate-risk elective cervical LNs, and red = supraglottic primary and gross nodal disease. Solid blue = esophagus contour. Each color is represented as a structure on the dose-volume histogram (bottom).
fonc-07-00307-g002.jpg
PMC5766653_01_fonc-07-00307-g002.jpg
F2
Radiation treatment plan. (A) Axial view of all 11 fields with the 3D-conformal AP/PA fields highlighted in cyan. (B) Sagittal views of the nine intensity-modulated radiation (IMRT) fields:five coplanar beams and four additional non-coplanar beams which have been angled to reduce entrance and exit dose in normal tissue. (C) AP view showing the AP 3D-conformal (cyan) and IMRT (yellow) fields and their body surface projections. The 3D-conformal field is contained within the AP IMRT field's fluence and is specifically targeting the esophageal primary (red contour) and elective esophageal nodes (green contour). Solid blue = esophagus contour.
fonc-07-00307-g003.jpg
PMC5766653_01_fonc-07-00307-g003.jpg
F3
Table 1) using a monoisocentric, hybrid 3D-conformal/IMRT technique (Figure 3), including nine static IMRT beams and opposed low 3D-conformal AP/PA beams. The AP/PA beams were used as a base plan, allowing those beams to be fully taken into account by the optimizer during subsequent IMRT beam planning to avoid field junction heterogeneity. Doses were prescribed to the following planning target volumes: elective esophageal LNs (52.5 Gy), low-risk elective neck (54.0 Gy), esophageal primary and intermediate-risk elective neck (59.5 Gy), and supraglottic primary/high-risk gross nodal disease (70 Gy) (Figure 3).
Radiation isodose distributions. (Top) Axial view at the level of the subglottic larynx. (Bottom left) Coronal view. (Bottom right) Midline sagittal view.
fonc-07-00307-g004.jpg
PMC5766653_01_fonc-07-00307-g004.jpg
F4
Isodose distributions are shown in Figure 4.