Volumetric Modulated Arc Therapy (VMAT) Craniospinal Irradiation (CSI) for Children and Adults: A Practical Guide for Implementation

Dosimetry and efficiency comparison of knowledge-based and manual planning using volumetric modulated arc therapy for craniospinal irradiation

“…VMAT with 360-degree beams can achieve higher conformity and better dispersion of normal organs compared to conventional 3D-CRT. 5 , 6 The VMAT technique with large field overlaps for low-dose gradient junction could tolerate greater positional shifts while maintaining homogeneous dose. 7 , 8 However, planning CSI using the high-precision VMAT technique is challenging and time-consuming for medical physicists due to the long treatment field from the brain to the lumbosacral region, which significantly exceeds the treatment field size of a linear accelerator and involves more than ten organs at risk.…”

Existing and Evolving Landscape of Medulloblastoma: Towards Optimization and Personalization

“…The planning and delivery of CSI remains one of the most difficult and challenging processes in RT due to the target volume being large, irregularly shaped, complex, and surrounded by normal critical structures that need to be spared the detrimental impact of irradiation. The advent of intensity-modulated radiation therapy (IMRT), particularly rotational IMRT techniques, due to advances in physics and technology have vastly improved the process of the photon-based treatment planning, delivery, and verification of CSI in contemporary neuro-oncologic practice [ 22 , 23 ]. The emergence of proton-beam therapy with superior depth–dose characteristics (compared to photons) and resultant improvements in dosimetry provides an opportunity to further sculpt the dose away from surrounding normal structures conforming to the defined target volumes, thereby further reducing the incidence and severity of treatment-related toxicity in clinical practice [ 24 ].…”