Treatment planning software to protect dental structure, salivary glands, and nontarget tissue in head and neck cancer patients: a scoping review

OBJECTIVE: to identify the treatment planning systems (TPS) used in radiotherapy for head and neck cancer patients and evaluate their impact in reducing toxicities to teeth, salivary glands, and nontarget tissues. METHODS: A comprehensive search was conducted in 6 databases and gray literature sources. Eligible studies involved patients with head and neck cancer undergoing radiotherapy and evaluated dosimetric strategies or planning software to protect critical structures. TPS impact was categorized as low, moderate, or high based on dose reduction and clinical benefit reported in each study. RESULTS: A total of 26 studies were included, covering 8 different TPS. Of these, 23 studies assessed dose reduction to the salivary glands or nontarget tissues and 3 studies focused on dental structures. Overall, 51% of TPS assessments (n = 19) reported a high impact on dose reduction, 35% showed a moderate impact, and 14% demonstrated a low impact in minimizing radiation exposure to critical structures. Eclipse was the most frequently assessed TPS, showing predominantly high or moderate impact across all structure types. These findings indicate a predominance of evidence supporting Eclipse's dosimetric performance, whereas variability among other systems (Pinnacle, Monaco, KonRad, XiO, and CORVUS) suggests differences in optimization algorithms and clinical implementation. CONCLUSION: TPS show heterogeneous results regarding the sparing of nontarget tissues. Eclipse demonstrated the most consistent positive outcomes, but dental structures remain underexplored concerning TPS approaches.