Evaluation of gross target volumes in CECT vs MRI in head and neck cancer and its implication on concordance indices and dose-volume parameters of IMRT treatment plan.

Background: Although radiotherapy treatment planning (RTP) for head and neck cancers (HNCs) is based on contrast enhanced computed tomography (CECT), soft tissue contrasts are better evident on magnetic resonance imaging (MRI). We therefore evaluated dose-volume histogram (DVH) parameters along with concordance index (ConI), conformity index (CI), and homogeneity index (HI) of planning target volume (PTV) of GTV delineated on CECT vs MRI in HNCs enrolled for intensity modulated radiotherapy (IMRT).

Methodology: Forty consecutive HNCs were enrolled in this study. All underwent CECT and MRI simulations with immobilization devices. GTVp and GTVn were delineated independently on CECT and MRI images. Corresponding MRI volumes were then copied to CECT. IMRT plans were generated on the CECT incorporating PTV margins. DVH parameters of PTVpn for both CECT and MRI were compared. In addition, mean (±SD) percentage difference of GTVp, GTVn, GTVpn, ConI, CI, and HI were evaluated using paired t-test.

Results: The GTVp (P = 0.005), GTVn (P = 0.009), and GTVpn (P < 0.001) delineated on MRI were found to be significantly larger than GTV delineated on CECT. In eight patients, GTV outlined on CECT were larger than MRI. Significant mean differences in CECT vs MRI of CI (P < 0.001), HI (P < 0.001), ConI (P < 0.001), and DVH parameters (D2, D95, D98, V95, and V100 all P < 0.001; D50: P = 0.009) were noted.

Conclusion: The GTVs and corresponding PTVs were significantly larger on MRI compared to CECT. This resulted in significant differences in DVH parameters, CI, ConI, and HI. This could be improved by co-registered MRI-CECT volumes during routine IMRT treatment planning for HNCs.