Craniospinal Irradiation With Spinal IMRT to Improve Target Homogeneity

Panandiker, Atmaram Pai; Ning, Holly; Likhacheva, Anna; Ullman, Karen; Arora, Barbara; Ondos, John; Karimpour, Shervin; Packer, Roger; Miller, Robert W.; Citrin, Deborah E.

doi:10.1016/j.ijrobp.2007.02.037

Cited by 66 publications

(40 citation statements)

References 20 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the dosimetric outcome of this work is in favor of proton therapy and to a lesser extent of modern photon techniques, significant range in mean doses (up to 20 Gy) to the OARs are found between centers using a similar technique. This inter-center variation in mean doses to the OARs is larger than the differences in OARs doses reported by other published studies comparing irradiation techniques [12,14,35,36]. On the one hand, the large dose range points towards an effect of mastering a technique to a different extent, as already observed for VMAT dose distributions by Fogliata et al [43].…”

Section: Discussionmentioning

confidence: 50%

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 50%

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

View full text Add to dashboard Cite

show abstract

“…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%

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

Chen¹,

Chen²,

Atwood³

et al. 2012

J Radiat Oncol

View full text Add to dashboard Cite

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.

show abstract

“…Contemporary state-of-art technology available for radiotherapy planning and delivery has also been investigated for designing sophisticated and novel treatment strategies to reduce the dose to nontarget tissues. Forward planned segmented field IMRT and inverse planned IMRT have been proposed for the spinal component of CSI [22,23]. As these techniques were mainly aimed at improving the target coverage and dose homogeneity, the dose-volume relationship to the underlying normal tissues was not addressed.…”

Section: Discussionmentioning

confidence: 99%

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

Sharma¹,

Gupta²,

Jalali³

et al. 2009

BJR

109

View full text Add to dashboard Cite

ABSTRACT. This study aimed to establish the feasibility of intensity-modulated radiation therapy (IMRT) in craniospinal irradiation (CSI) using conventional linear accelerator (IMRT_LA) and compare it dosimetrically with helical TomoTherapy (IMRT_ Tomo) and three-dimensional conformal radiotherapy (3DCRT). CT datasets of four previously treated patients with medulloblastoma were used to generate 3DCRT, IMRT_ LA and IMRT_Tomo plans. A CSI dose of 35 Gy was prescribed to the planning target volume (PTV). IMRT_LA plans for tall patients were generated using an intensity feathering technique. All plans were compared dosimetrically using standardised parameters. The mean volume of each PTV receiving at least 95% of the prescribed dose (V 95% ) was .98% for all plans. All plans resulted in a comparable dose homogeneity index (DHI) for PTV_brain. For PTV_spine, IMRT_Tomo achieved the highest mean DHI of 0.96, compared with 0.91 for IMRT_LA and 0.84 for 3DCRT. The best dose conformity index was achieved by IMRT_Tomo for PTV_brain (0.96) and IMRT_LA for PTV_spine (0.83). The IMRT_Tomo plan was superior in terms of reduction of the maximum, mean and integral doses to almost all organs at risk (OARs). It also reduced the volume of each OAR irradiated to various dose levels, except for the lowest dose volume. The beam-on time was significantly longer in IMRT_Tomo. In conclusion, IMRT_Tomo for CSI is technically easier and potentially dosimetrically favourable compared with IMRT_LA and 3DCRT. IMRT for CSI can also be realised on a conventional linear accelerator even for spinal lengths exceeding maximum allowable field sizes. The longer beam-on time in IMRT_Tomo raises concerns about intrafraction motion and whole-body integral doses.

show abstract

Craniospinal Irradiation With Spinal IMRT to Improve Target Homogeneity

Abstract: A new technique of spine IMRT is presented in combination with a quality assurance method. This method improves target dose uniformity compared to the conventional CSI technique. Longer follow-up will be required to determine any benefit with regard to toxicity and disease control.

Cited by 66 publications

References 20 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)

Volumetric modulated arc therapy planning method for supine craniospinal irradiation

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

Contact Info

Product

Resources

About