A method to improve target dose homogeneity of craniospinal irradiation using dynamic split field IMRT

Seppälä, Jan; Kulmala, Jarmo; Lindholm, Paula; Minn, Heikki

doi:10.1016/j.radonc.2010.05.018

Cited by 39 publications

(39 citation statements)

References 23 publications

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“…Conventional IMRT and tomotherapy have also been investigated in CSI [14][15][16][17]. Seppälä et al have developed a method to improve target dose homogeneity for craniospinal irradiation using a single plan with dynamic split-field IMRT [14].…”

Section: Discussionmentioning

confidence: 99%

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Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Chen¹,

Chen²,

Atwood³

et al. 2012

J Radiat Oncol

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Background The purpose of this study is to propose a volumetric modulated arc therapy (VMAT) treatment planning technique for supine craniospinal irradiation (CSI) in order to improve dose conformity and homogeneity, as well as the reliability of the matching of abutting fields. Methods and materials CT datasets of a 9-year-old child and a 24-year-old adult treated with supine CSI were identified. The planning target volume (PTV) was contoured to include the whole contents of the brain and spinal canal with a uniform margin of 5 mm. RapidArc plans were generated with two partial arcs covering the brain and the superior portion of the spinal cord and a single partial arc covering the remaining inferior portion of the spinal cord. Conformity and heterogeneity indexes (CI and HI) and organs at risk (OAR) dose-volume histograms were evaluated. The effect of treatment inaccuracy was simulated with intentional patient shifts of ±3 mm. Results The CI for the pediatric and adult cases was 1.0 and 0.99, respectively, and the HI for the two cases was 12.7 and 11.8 %, respectively. The mean dose to the PTV was 102.5 and 102.1 %, respectively, while the mean doses to the OARs were all low. The simulated ±3-mm shift in patient position generated an error of less than ±10 % of the calculated dose in the spinal cord. Conclusions VMAT CSI was able to achieve highly conformal and homogeneous dose distributions, with minor doses to the surrounding normal tissues. Setup errors of ±3 mm were shown to have little effect on the intended dose distribution.

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Section: Discussionmentioning

confidence: 99%

“…Seppälä et al have developed a method to improve target dose homogeneity for craniospinal irradiation using a single plan with dynamic split-field IMRT [14]. The results showed that improved dose homogeneity in the target volume was achieved with the split-field IMRT, when compared to that of conventional 3DCRT.…”

Section: Discussionmentioning

confidence: 99%

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Chen¹,

Chen²,

Atwood³

et al. 2012

J Radiat Oncol

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“…7,8 The mean V 95% and V 107% of the brain of 26 patients in our study were 98.2% and 0.4%, respectively. Furthermore, the mean V 95% and V 107% of the spinal cord of 26 patients were 98.4% and 24.1%, respectively.…”

Section: Resultsmentioning

confidence: 47%

A novel supine isocentric approach for craniospinal irradiation and its clinical outcome

Cheng

Zeng

et al. 2016

BJR

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The authors Yi-Kan Cheng, Lei Zeng and Shu-Biao Ye contributed equally to this article.Objective: To report a novel approach for craniospinal irradiation (CSI) using a supine isocentric technique. Methods: Patients were treated in the supine position using CT simulation. Half-beam-blocked lateral cranial fields and superior spinal fields have the same isocentre, and their beam divergences match. Tangential irradiation provides a non-divergent junction for the other two fullbeam spinal fields. Shielding for cranial fields was generated, and dose distribution was calculated using a three-dimensional planning system. When sacral spinal fields were required, two lateral opposite fields were designed to protect the urogenital organs. All treatment portals were filmed once per week. Results: At a median follow-up of 49.8 months, 5 relapses and no cases of radiation myelitis developed in 26 consecutive patients. In the junctions of the brain-spine or spine-spine field, no failure occurred. Three failures occurred in the primary site alone, two in the spinal axis alone. Conclusion:The results of our study have shown that our novel approach for CSI was not associated with increased failures at the field junction and deaths. In addition, no radiation myelitis, pneumonia, severe damage to the heart and gastrointestinal tract, and second cancers occurred in our study. Advances in knowledge: This new approach is an optimal alternative in cancer centre without tomotherapy because of its convenience for immobilization, repeatability, optimal dose distribution and satisfactory clinical outcome.

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“…The role of new techniques, for example IMRT (Intensity Modulated Radiation Therapy), tomotherapy, protontherapy, and carbon ion radiation in the reduction of doses to OARs during the irradiation of brain malignancies is under investigation [63][64][65], as well as the role of new imaging techniques [66]. Results also seem promising for medulloblastoma patients, although they should be prospectively evaluated and some reports are not completely satisfactory [63][64][65][67][68][69][70][71][72], indicating that particular attention should be given to the volumes of treatment and to the toxic effects of concomitant chemotherapy [73,74]. Despite the small number of analysed patients, our results seem to show that radiation therapy results in a good outcome without a significant negative late impact on neuropsychological abilities.…”

Section: Discussionmentioning

confidence: 99%

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

Boccadoro¹,

Chiesa²,

Chieffo

et al. 2011

J Neurooncol

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Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990-2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101 months (64-218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62 months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.

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A method to improve target dose homogeneity of craniospinal irradiation using dynamic split field IMRT

Cited by 39 publications

References 23 publications

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

A novel supine isocentric approach for craniospinal irradiation and its clinical outcome

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

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