ArticleJournal of applied clinical medical physics2026
Segmented jaw-locking in IMRT for upper thoracic esophageal cancer: A plan complexity-driven approach to lung dose reduction.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Segmented jaw-locking in IMRT for upper thoracic esophageal cancer: A plan complexity-driven approach to lung dose reduction.Journal of applied clinical medical physics · 2026Article
- Effect of Multi-Leaf Collimator Angle Optimization on the Planning Parameters in Intensity-Modulated Radiotherapy for Thoracic Tumors.Technology in cancer research & treatmentArticle
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Abstract
objectiveExtended-field intensity-modulated radiotherapy (EF-IMRT) used for elective nodal irradiation (ENI) in upper thoracic esophageal cancer frequently results in excessive intermediate-to-low-dose pulmonary irradiation. This study presented a practical and reproducible planning strategy (segmented Jaw-locking IMRT, SJL-IMRT) for optimizing dose distributions to ENI target volumes, and assessed its impact on plan complexity and lung parenchyma sparing.
methodsIn a paired planning study (n = 40), EF-IMRT and SJL-IMRT plans were generated per patient under identical target coverage objectives. SJL-IMRT partitioned the longitudinal ENI volume into cervical-supraclavicular and upper-mediastinal segments via coordinated orthogonal collimators, and multi-leaf collimator (MLC)-defined apertures locked within each segment. The evaluation was based on multifaceted criteria, including metrics for: (i) plan complexity: the aperture-based edge-area metric (EAM) and the sequence-level modulation complexity score (MCS); (ii) dosimetry: conformity index (CI), homogeneity index (HI), gradient measure (GM), pulmonary parameters (mean lung dose [MLD], V
resultsBoth SJL-IMRT and EF-IMRT satisfied prescription dose objectives for planning target volume (PTV). No significant differences were observed in CI and HI (p = 0.347 and p = 0.173, respectively). SJL-IMRT demonstrated lower geometric complexity and simpler sequencing: EAM 8.610 ± 2.951 vs. 20.824 ± 4.944 (paired Δ = -12.214; p = 0.00195) and MCS 0.243 ± 0.015 vs. 0.203 ± 0.036 (paired Δ = +0.040; p = 0.0193), respectively. Compared with EF-IMRT, SJL-IMRT (i) reduced gradient measures (GM) by 0.215 cm (p < 0.01), indicating a steeper dose fall-off; (ii) decreased MLD by 1.62 Gy (left) and 2.64 Gy (right); (iii) lowered left lung V
conclusionSJL-IMRT reduces plan complexity (EAM↓, MCS↑) and lowers intermediate-to-low lung dose compared with EF-IMRT for ENI in upper thoracic esophageal cancer, without compromising target coverage, supporting SJL-IMRT as a pragmatic approach to improving dosimetric quality and delivery simplicity. Confirmation in larger cohorts is warranted.
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