Delineation of various target volumes using contrast-enhanced magnetic resonance imaging (MRI) and/or computed tomography (CT) constitutes the primary step for radiation therapy planning (RTP) in brain tumors. This study presents a quantification and comparative evaluation of the various clinical target volumes (CTV) and gross target volumes (GTV) as outlined by contrast-enhanced CT and MRI, along with its implications for postoperative radiotherapy of brain tumors. Twenty-one patients of gliomas were considered for this prospective study. Peritumoral edema as CTV and residual tumor as GTV were delineated separately in postoperative contrast-enhanced CT and MRI. These volumes were estimated separately and their congruence studied for contrast-enhanced CT and MRI. Compared to MRI, CT underestimated the volumes, with significant differences seen in the mean CTV (mean +/- SD: -62.92 +/- 93.99 cc; P = 0.006) and GTV (mean +/- SD: -21.08 +/- 36.04 cc; P = 0.014). These differences were found to be significant for high-grade gliomas (CTV: P = 0.045; GTV: P = 0.044), while they were statistically insignificant for low-grade gliomas (CTV: P = 0.080; GTV: P = 0.117). The mean differences in the volumes for CTV and GTV were estimated to be -106.7% and -62.6%, respectively, taking the CT volumes as the baseline. Thus, even though, electron density information from CT is essential for RTP, target delineation during postoperative radiotherapy of brain tumors, especially for high-grade tumors, should be based on MRI so as to avoid inadvertent geographical misses, especially in the regions of peritumoral edema.
Electron‐beam therapy is used to treat superficial tumors at a standard 100 cm source‐to‐surface distance (SSD). However, certain clinical situations require the use of an extended SSD. In the present study, Monte Carlo methods were used to investigate clinical electron beams, at standard and non‐standard SSDs, from a Siemens Oncor Avant Garde (Siemens Healthcare, Erlangen, Germany) linear accelerator (LINAC). The LINAC treatment head was modeled in BEAMnrc for electron fields 5 cm in diameter and 10×10 cm, 15×15 cm, and 20×20 cm; for 6 MeV, 9 MeV, and 12 MeV; and for 100 cm, 110 cm, and 120 cm SSD. The DOSXYZnrc code was used to calculate extended SSD factors and dose contributions from various parts of the treatment head.The main effects of extended SSD on water phantom dose distributions were verified by Monte Carlo methods. Monte Carlo–calculated and measured extended SSD factors showed an average difference of ±1.8%. For the field 5 cm in diameter, the relative output at extended SSD declined more rapidly than it did for the larger fields. An investigation of output contributions showed this decline was mainly a result of a rapid loss of scatter dose reaching the dmax point from the lower scrapers of the electron applicator. The field 5 cm in diameter showed a reduction in dose contributions; the larger fields generally showed an increased contribution from the scrapers with increase in SSD. Angular distributions of applicator‐scattered electrons have shown a large number of acute‐angle electron tracks contributing to the output for larger field sizes, explaining the shallow output reduction.PACS numbers: 87.53.Wz, 87.53.Vb, 87.53.Hv
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