Optimal Normal Tissue Sparing in Craniospinal Axis Irradiation Using IMRT With Daily Intrafractionally Modulated Junction(s)

Kusters, J.M.A.M.; Louwe, R.; Kollenburg, P.G.M. Van; Kunze-Busch, Martina; Gidding, Corrie; Lindert, Erik J. van; Kaanders, Johannes H.A.M.; Janssens, Geert O.

doi:10.1016/j.ijrobp.2010.07.1987

Cited by 33 publications

(33 citation statements)

References 37 publications

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“…For example, the mean thyroid dose can range between 5.6 and 24.6 Gy with VMAT and between 0.3 and 10.1 Gy with PBS, depending on the treatment center. In the literature, several reports demonstrate improved CI and HI for the PTV and field-junctions by the use of modern radiotherapy techniques compared with 3D-CRT [11,13,17,35,36]. However, it should be mentioned that knowledge on the uncertainties related to possible motion of the target and correct target volume delineation are pre-requisites for highly-conformal techniques.…”

Section: Discussionmentioning

confidence: 99%

“…This approach results in dose inhomogeneity, especially at the beam junction(s), and a significant dose anterior to the spinal target volume. Over the last decade, other techniques for CSI have been investigated in order to decrease the dose to the organs outside the target volume, in particular the thyroid, heart and intestines [11][12][13][14][15]. Intensity-Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT) and TomoTherapy V R are highly conformal techniques, which can reduce the dose to the structures anterior to the vertebrae at the expense of a larger volume of low-dose irradiation to the entire body.…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

et al. 2018

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Purpose: Conventional techniques (3D-CRT) for craniospinal irradiation (CSI) are still widely used. Modern techniques (IMRT, VMAT, TomoTherapy V R , proton pencil beam scanning [PBS]) are applied in a limited number of centers. For a 14-year-old patient, we aimed to compare dose distributions of five CSI techniques applied across Europe and generated according to the participating institute protocols, therefore representing daily practice. Material and methods: A multicenter (n ¼ 15) dosimetric analysis of five different techniques for CSI (3D-CRT, IMRT, VMAT, TomoTherapy V R , PBS; 3 centers per technique) was performed using the same patient data, set of delineations and dose prescription (36.0/1.8 Gy). Different treatment plans were optimized based on the same planning target volume margin. All participating institutes returned their best treatment plan applicable in clinic. Results: The modern radiotherapy techniques investigated resulted in superior conformity/homogeneity-indices (CI/HI), particularly in the spinal part of the target (CI: 3D-CRT:0.3 vs. modern:0.6; HI: 3D-CRT:0.2 vs. modern:0.1), and demonstrated a decreased dose to the thyroid, heart, esophagus and pancreas. Dose reductions of >10.0 Gy were observed with PBS compared to modern photon techniques for parotid glands, thyroid and pancreas. Following this technique, a wide range in dosimetry among centers using the same technique was observed (e.g., thyroid mean dose: VMAT: 5.6-24.6 Gy; PBS: 0.3-10.1 Gy). Conclusions: The investigated modern radiotherapy techniques demonstrate superior dosimetric results compared to 3D-CRT. The lowest mean dose for organs at risk is obtained with proton therapy. However, for a large number of organs ranges in mean doses were wide and overlapping between techniques making it difficult to recommend one radiotherapy technique over another. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

et al. 2018

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“…[12,13] It is reported that heart, inner and middle ear, temporal lobe doses are lower in proton treatment which is known to be a more advanced technique, compared to treatments with photons and electrons. [14,15] Germanwala et al reported that boost dose at posterior fossa in the presence of residual tumor could be administered in one patient with supratentorial tumor.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgery and Craniospinal Radiotherapy for Adult Patients with Medulloblastoma

Güzelöz¹

2017

TJ Oncol

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OBJECTIVEThe aim of the present study was to evaluate treatment outcomes for adult patients with medulloblastoma who received craniospinal irradiation following surgery at Dokuz Eylül University Radiation Oncology Department. METHODSTwelve patients were evaluated retrospectively. Median age was 31 years (range: 18-55 years). According to Chang staging system, 3 (25%) of the patients were T1, 2 (17%) were T2, 5 (42%) were T3, and 1 (8%) was T4; 1 patient could not be staged due to inadequate preoperative imaging. Tumor location, stage, presence of residual disease, duration between surgery and radiotherapy (RT), age, and sex were evaluated as prognostic factors. Statistical analyses were conducted using Kaplan-Meier method and SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTSMedian dose was 36 Gy (range: 32-44 Gy) to craniospinal field and 54 Gy (range: 50-56 Gy) to primary tumor location. Median follow-up time was 62 months (range: 4-212 months). Five-, 10-, and 15-year overall survival rates were 79%, 63%, and 63%, and 5-, 10-and 15-year progression-free survival rates were 63%, 63%, and 63%, respectively. No statistically significant prognostic factor was found for survival rate. Three (25%) patients developed serious hematological toxicity during RT course. No grade 3 or 4 late side effect was observed. CONCLUSIONDespite the limited number of cases, results are consistent with the literature. Evaluation of features of this rare disease requires studies with larger number of.

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“…Since TV PIV and V PIV could not obtained directly from HT treatment planning station, the patient contours and doses were then transferred to MIM software (MIM Software Inc, Cleveland, Ohio), and these parameters were obtained from the dose-volume histogram calculated by MIM software. Homogeneity index was defined by the following equation 3 :…”

Section: Methodsmentioning

confidence: 99%

“…1,2 The conventional treatment technique used for CSI patients has been 3-dimensional conformal treatment technique (3DCRT) using a linear accelerator; however, issues with junction doses between the cranial and spinal fields still pose a problem. 3 Proton therapy has the potential advantage of decreased integral dose to pediatric patients, but the degree of clinically meaningful benefit from proton CSI from a toxicity standpoint is subject to uncertainty because of the absence of convincing clinical evidence with appropriate follow-up to determine both tumor control and toxicity. 4,5 Helical tomotherapy (HT) allows treatment of large volumes (40 Â 160 cm 2 ) and also offers clear advantages for CSI patients over treatment with conventional 3DCRT, in particular the superior dose deposition patterns in the avoidance of organs at risk (OARs) and minimization of the junction problems that are inherent to conventional 3DCRT.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Craniospinal Irradiation Using Different Tomotherapy Techniques

Zhang

Peñagarícano

Han

et al. 2014

Technol Cancer Res Treat

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The objective of this study is to compare the new and conventional tomotherapy treatment techniques and to evaluate dosimetric differences between them. A dosimetric analysis was performed by comparing planning target volume (PTV) median dose, 95% of PTV dose coverage, Paddick conformity index (CI), homogeneity index (HI), whole-body integral dose, and OAR median doses. The beam on time (BOT) and the effect of different jaw sizes and pitch values was studied. The study results indicated that the PTV dose coverage for all the techniques was comparable. Treatment plans using dynamic jaw reduced OAR doses to structures located at the treatment field edge compared to fixed jaw plans. The HT-3DCRT plans resulted in higher OAR doses to kidney, liver, and lung compared to the other techniques, and TD-IMRT provided the best dose sparing to liver compared to other techniques. Whole-body integral dose differences were found to be insignificant among the techniques. BOT was found to be higher for fixed jaw treatment plan compared to dynamic jaw plan and comparable between all treatment techniques with 5-cm dynamic jaw. In studying effect of jaw size, better OAR sparing and HI were found for 2.5-cm jaw but at the expense of doubling of BOT as compared to 5-cm jaw. There was no significant improvement found in OAR sparing when the pitch value was increased. Increasing the pitch from 0.2 to 0.43, the CI was improved, HI improved only for 5-cm jaw size, and BOT decreased to approximately half of its original time.

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Optimal Normal Tissue Sparing in Craniospinal Axis Irradiation Using IMRT With Daily Intrafractionally Modulated Junction(s)

Cited by 33 publications

References 37 publications

Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

Outcomes of Surgery and Craniospinal Radiotherapy for Adult Patients with Medulloblastoma

Dosimetric Comparison of Craniospinal Irradiation Using Different Tomotherapy Techniques

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