Changes in target volume during irradiation of canine intranasal tumors can significantly impact radiation dosimetry.

Abstract

Nasal tumor size can change during radiation therapy (RT). The amount of peritumoral fluid (eg, mucohemorrhagic effusions) can also fluctuate. How often this occurs and the magnitude of change are unknown. Likewise, there are no data which describe dosimetric effects of these changing volumes during a course of RT in veterinary medicine. This study addresses that gap in knowledge. Using pet dogs with nasal tumors, three CT image sets were created. Different Hounsfield units were applied to the gross tumor volume (GTV) of each image set: unchanged, -1000 (AIR), -1000 (to the portion of the GTV that actually underwent volume reduction during clinical RT; REAL). Two plans were created: 18-fraction three-dimensional conformal RT (3DCRT) and three-fraction intensity-modulated stereotactic RT (IM-SRT). For nearby normal tissues and GTV, near-maximum doses (Dand D) and volumes receiving clinically significant doses were recorded. To verify "AIR" results, thermoluminescent dosimeters recorded dose in cadavers that were irradiated using both 3DCRT and IM-SRT plans. "AIR" scenario had ≤1.5 Gray (Gy) increases in Dand ≤3.2 cc increases of volume. "REAL" scenario had ≤0.97 Gy increases in Dand ≤0.55 cc increases of volume at clinically relevant doses. Both were statistical significant. Results suggest that near-complete resolution of GTV warrants plan revision.