Development of a biological at-risk volume using apparent diffusion coefficient for parotid-sparing radiation therapy planning

Objectives Xerostomia toxicity continues to contribute toward a decrease in quality of life in head and neck cancer patients. Diffusion weighted MRI and the associated apparent diffusion coefficient (ADC) may identify the radiosensitive region within the parotid gland (PG). This study retrospectively assesses the feasibility of using percentile threshold values from the ADC map to generate a biological at-risk volume (BRV). The location and distribution of BRV is evaluated across the PG. Methods Image registration between the planning CT and MRI-Simulation images were performed and reviewed to ensure accurate translation of ADC data when contouring the PG. Histogram analysis was undertaken using the 20th, 30th and 50th percentile ADC values of each contoured PG to form the BRV. The whole PG was split into eight anatomical sectors at a common intersection point to evaluate the distribution of BRV throughout. Results The BRV distribution for each percentile was mapped across the whole contoured PG and each anatomical sector contour. The largest distribution was predominantly found in the Superolateral sectors. Conclusions The 20th and 30th percentile ADC values can be used to form a BRV of the PG. The location of the BRV distribution indicates a potential relationship between ADC thresholds and the functional region of the PG. Advances in Knowledge The BRV is located in a favourable position within the PG and could be used to further spare this salivary gland during dose optimisation. The feasibility of this approach will be explored in a future retrospective dosimetry study.