High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy

Sharma, Dayananda Shamurailatpam; Gupta, Tejpal; Jalali, Rakesh; Master, Zubin; Phurailatpam, Reena; Sarin, Rajiv

doi:10.1259/bjr/13776022

Cited by 109 publications

(109 citation statements)

References 28 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%

“…Sharma et al [15] dosimetrically compared 3DCRT, linac-based IMRT, and tomotherapy techniques for the treatment of CSI for pediatric and adolescent patients. The conclusion of the study was that tomotherapy was technically easier and potentially dosimetrically favorable, when compared to the other techniques.…”

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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“…The classical approach is to use parallel-opposed lateral cranial fields matched to a direct posterior field. The subsequent development of threedimensional (3D) conformal and intensity-modulated RT has seen these solutions increasingly used to deliver CSI and boost the posterior fossa, [14][15][16][17] and there is increasing interest in proton RT for both conditions, not least as reduced integral doses to normal structures may improve toxicity and second malignancy rates.…”

Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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Objective: There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. Methods: 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42,45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. Results: IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was 20.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Conclusion: Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

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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: 45%

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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High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy

Cited by 109 publications

References 28 publications

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

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

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