Simultaneous integrated vs. sequential boost in VMAT radiotherapy of high-grade gliomas

Farzin, Mostafa; Molls, M.; Astner, Sabrina T.; Rondak, Ina-Christine; Oechsner, Markus

doi:10.1007/s00066-015-0888-1

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…Farzin et al compared SIB vs SEB in 20 patients with high-grade gliomas. In the SIB method, the PTV received 54 Gy in 30 fractions with 1.8Gy dose per fraction, while the tumor bed received 60 Gy in 2 Gy per fraction [22]. There results demonstrated that the SIB and SEB were equivalent in target coverage, but the SIB was significantly superior to the SEB for almost all the OARs sparing.…”

Section: Discussionmentioning

confidence: 98%

“…Thus, in addition to "physical sparing" of OARs, the simultaneous integrated boost (SIB) method can also offer the possibility of a "biological sparing" as in SIB method, the single dose per fraction to the PTV not boost tumor volume (BTV) was lower when compared with the SIB. That might be of interest in patients with brain tumors with longer life expectancies and when considering that in the PTV there is a comparatively high probability of irradiation of subvolumes of relatively sensitive OARs [19]. The Primary Objective of the study was to compare the dosimetric coverage of the Planning target volumes (PTV) and sparing the critical structures and organs at risk (OARs) using different delivery methods of radiation to Boost Tumor volume (BTV) for high grade Glioma, using sequential boost (SEB) vs. simultaneous integrated boost (SIB) using VMAT.…”

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confidence: 99%

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Dosimetric Comparison of Simultaneous Integrated vs. Sequential Boost in Radiotherapy for High Grade Gliomas

Nageeti¹

2019

CTOIJ

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Objective: To compare the dosimetric coverage of the Planning target volumes (PTV) and sparing organs at risk (OARs) in volumetric modulated arc therapy (VMAT) technique for high grade glioma using different methods to Boost the tumor bed by sequential boost (SEB) vs. simultaneous integrated boost (SIB).Methods: Non-interventional dosimetric study of seven consecuti7e cases with pathologically proven high-grade gliomas who attended KAMC radiotherapy were included in the study. We delineated PTVs and the boost volumes (BVs) on the planning CTs with image fusion with MRIs. Delineation of the target volumes was based on the gross target volume (GTV) which is defined as the contrast enhancing visible tumor on the T1 with gadolinium (Gd) images. The clinical target volume (CTV1), representing the subclinical tumor involvement, is defined as GTV1 + 15.0-mm expansion including the edema visible on the T2-weighted images. The planning target volume (PTV1) is defined as CTV1 + 5.0-mm margin. The CTV2 is defined as the GTV + 5.0-mm expansion including the contrast-enhancing tumor visible on the T1-Gd images. The PTV2 is defined as the CTV2 + 5.0mm margin. We planned each case by three VMAT plans of the (SB) technique and two (SIB) techniques of two dose regimens utilizing equivalent biologically effective doses for all plans. The first Plan using of the SB, PTV1 received 46 Gy over 23 fractions in 2Gy as dose per fraction and PTV2 received 14 Gy in seven fractions with 2Gy as dose per fraction. The second Plan) using SIB planning (SIB1) , the PTV1 received 54 Gy over 30 fractions with 1.8 Gy as a dose per fraction, while the PTV2 received 60 Gy over 30 fractions but with 2 Gy as a dose per fraction. The third plan was carried out using SIB (SIB2) with different biologically equivalent dose to deliver to PTV-1 dose of 48.6 Gy over 27 fractions in 1.8 Gy as dose per fraction while the PTV-2 will receive 59.4 Gy over 27 fractions but with 2.2 Gy as a dose per fraction. Results:We compared the dose distributions and DVH for OAR constrains for all three plans. We found that the mean percentage coverage of 95% of PTV1 volume (109% , 96.49% and 96.23& ) for (SB, SIB1 and SIB2) respectively. The mean percentage coverage of 95% of PTV2 volume were (98%, 96.8% and 94.26%) for (SB, SIB1 and SIB2) respectively. The mean maximum dose to optic nerve is (19.7 Gy, 20 Gy, 18.23 GY) for (SB, SIB1 and SIB2) respectively which is statistically non-significate with (P-value 0.94). The mean maximum dose to optic chiasm (40.3 GY, 41.76 GY, 38 GY) for (SB, SIB1 and SIB2) respectively which is also statistically non-significate with P-value <0.9. We found no statistical difference into the mean maximum dose to brainstem (55.6 GY, 54 GY, 50.2 GY) for (SB, SIB1 and SIB2), respectively (P-value= 0.057). Conclusion:We found no significant difference in the mean maximum dose to organs at risk in utilizing VMAT for planning SB vs SIB in highgrade glioma. Based on our data we recommend that utilization of SIB with a smaller number of fractions of biolo...

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Dosimetric Comparison of Simultaneous Integrated vs. Sequential Boost in Radiotherapy for High Grade Gliomas

Nageeti¹

2019

CTOIJ

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“…Before the arrival of IMRT, the SeqB method was mostly used, within the 3D conformal irradiation technique to treat high-grade gliomas. With the SIB method, the dose per fraction to the PTV is lower when compared with the SEB, delivers an enhanced dose to the gross tumor volume and has a greater potential of sparing of organs at risk (Figure 8) [33][34][35][36][37]. Whole brain radiotherapy is the most common palliative treatment and has always been considered the standard treatment for patients with brain metastases.…”

Section: Radiotherapymentioning

confidence: 99%

Radiation Therapy with a Simultaneous Integrated Boost

Katsochi¹

2017

Radiotherapy

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Radiotherapy has an established role in the treatment of cancer and represents a definitive, less invasive approach for various cancer types. Its main aim is to deliver the maximum dose to the tumor with minimal toxicity on neighboring healthy tissues. Therefore, the precise determination of the target and its spatial relation to critical surrounding organs is of main importance. New imaging modalities such as the CT, MRI, and PET/CT offer more anatomical detail and facilitate the accurate delineation of the target volume and the organs at risk. The recent advances in 3D-CRT and IMRT radiation techniques offer high accuracy in tumor targeting and ensure safe dose escalation. Moreover, the introduction of IGRT offers the opportunity to safely apply a supplementary dose to the macroscopic tumor. In trials conducted, a simultaneous integrated boost (SIB) has proved to be feasible in various cancer localizations, to safely increase the total delivered dose, shorten the total treatment time and results in increased tumor control while keeping the side effects low at the same time. However, more trials need to be conducted to establish an acceptable protocol.

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“…In humans, SIB protocols have been investigated for different tumor types and anatomical regions, including brain tumors. 14 , 15 , 16 , 17 , 18 , 19 …”

Section: Introductionmentioning

confidence: 99%

Treatment of intracranial neoplasia in dogs using higher doses: A randomized controlled trial comparing a boosted to a conventional radiation protocol

Staudinger

Meier

Beckmann

et al. 2022

Veterinary Internal Medicne

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Background: Local progression of intracranial tumors can be the consequence of insufficient radiation dose delivered. Dose increases in the brain must be made carefully so as not to risk debilitating adverse effects such as radiation necrosis.Hypothesis: A new protocol with 10 Â 4 Gy + 11% physical dose increase limited to the macroscopic tumor volume results in a clinically better outcome compared to a 10 Â 4 Gy protocol.Animals: Fifty-seven client-owned dogs with primary intracranial neoplasia.Methods: Randomized controlled trial. Twenty-eight dogs were assigned to the control protocol (10 Â 4 Gy) and 29 to the simultaneous integrated boost (SIB) protocol with 4.45 Gy dose increase. Treatment groups were compared for outcome and signs of toxicity.Results: Mild, transient acute or early-delayed adverse radiation effects were observed in 5 dogs. Severe late adverse effects were not seen. Between the protocols, no significant differences were found for outcome (intention-to-treat analysis): overall time to progression (TTP) was 708 days (95% confidence interval (95% CI) [545,872]), in the control group it was 828 days (95% CI [401,1256]), and in the SIB group 627 days (95% CI [282,973]; P = .07). Median overall survival (OS) was 684 days (95% CI [516,853]), in the control group it was 724 days (95% CI [623,826]), and in the SIB group 557 days (95% CI [95,1020]; P = .47). None of the tested variables was prognostic in terms of outcome. Conclusion and Clinical Importance:The dose escalation used with an 11% physical dose increase did not result in better outcome.

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Simultaneous integrated vs. sequential boost in VMAT radiotherapy of high-grade gliomas

Abstract: Our analysis shows that the SIB method offers advantages over the SEB method in terms of sparing OARs.

Cited by 11 publications

References 31 publications

Dosimetric Comparison of Simultaneous Integrated vs. Sequential Boost in Radiotherapy for High Grade Gliomas

Dosimetric Comparison of Simultaneous Integrated vs. Sequential Boost in Radiotherapy for High Grade Gliomas

Radiation Therapy with a Simultaneous Integrated Boost

Treatment of intracranial neoplasia in dogs using higher doses: A randomized controlled trial comparing a boosted to a conventional radiation protocol

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