Craniospinal Irradiation in Medulloblastoma using High Energy Medical Linear Accelerator: an Innovative Approach to Planning Technique

Abstract

Background: Craniospinal irradiation (CSI) of medulloblastoma poses technological challenges due to the involvement of large treatment volume. Commonly, the whole treatment length is covered with two different isocentric plans in which the junction is shifted after every five fractions to overcome the possibility of hot and cold spot.Objective: This study aims to evaluate dosimetrically and clinically the innovative planning technique for the CSI which doesn’t need re-planning and re-setup of patients after every five fractions.Material and Methods: Computed tomography was done for fifteen (ten children and five adults) patients diagnosed with medulloblastoma. Treatment planning for 36 Gray (Gy) in 20 fractions (#) at the rate of 1.8Gy/# was done on the treatment planning system. A single plan for children was created with two bilateral fields of 6 Mega Voltage (MV) energy for cranium and one posterior field of 6 MV for spinal cord (C1-S2). Two plans for adult patients were created, first plan was with two bilateral fields of 6 MV for cranium and two posterior oblique fields of 6 MV for cervical and the part of thoracic spinal cord (up to T8-T9). The second plan was with a single posterior field of 15 MV covering remaining thoracic (T8-T9 to T12), lumbar and sacrum (up to lower border of S2) spine. After careful evaluation of all the plans, treatment was delivered; acute toxicities were recorded.Results: 95% of prescribed dose was received by more than 95% of planning target volume in all the plans with the acceptable hot spot and good homogeneity index. All the patients reported common radiation induced acute toxicities (headache, vomiting, weakness) during radiotherapy.Conclusion: The new planning technique for CSI has acceptable dosimetric and acute clinical possibilities; therefore it can be used for CSI for improved homogeneous dose delivery.

Dosimetric comparison of three different techniques for craniospinal irradiation

“…[6] The liver is a lateral structure away from the field of radiation. We found no statistically significant difference between the three plans and remained less than its dose constraint as this was the same as Gurgaret al [7] Also, both kidneys' mean dose in all plans is minimal as they are lateral structures with no statistically significant difference; however, it is a bit higher in the IMRT plan but still low compared to its dose constraint.…”

Analisis Isodosis Teknik Tiga Dimensi Dengan Lapangan Kraniospinal Pada Pasien Anak

“…Telah dilakukan penelitian oleh Op Gurjar [1] mengenai metode penyinaran Medulloblastoma yang bertujuan untuk mengevaluasi teknik perencanaan secara dosimetri dan klinis yang tidak memerlukan perencanaan ulang dan pengaturan ulang pasien setelah setiap lima fraksi. Dari hasil penelitian tersebut, target volume menerima dosis melebihi 95% dosis radiasi yang telah ditentukan serta pasien melaporkan toksisitas akut yang diinduksi radiasi selama radioterapi.…”