Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp

Mizuno, Toshihiko; Tomita, Natsuo; Takaoka, Taiki; Tomida, Masashi; Fukuma, Hiroshi; Shibamoto, Yuta

doi:10.1177/1533033820985866

Cited by 9 publications

(9 citation statements)

References 45 publications

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“…Previous studies suggested that total scalp irradiation was a more effective treatment than local irradiation [37,39,40]. Mizuno et al [41] compared PTV coverage and doses to OAR among helical tomotherapy, volumetric-modulated arc therapy, and intensity-modulated proton therapy (IMPT) and showed that all three techniques achieved sufficient coverage and satisfactory homogeneity for PTV. The present study appears to be the first to examine the clinical efficacy of IMRT for ASF patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study

Niwa

Tomita

Takaoka

et al. 2023

Cancers

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Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60–70 Gy in 28–35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan–Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71–80 years), with a median follow-up of 17 months (IQR 11–42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03–5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08–5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03–5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study

Niwa

Tomita

Takaoka

et al. 2023

Cancers

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“…HT could provide higher dose homogeneity, consistent with other literature reports. [8][9][10] For pediatric patients during cranial irradiation, the hippocampus should be avoided from irradiation as much as possible. The hippocampal injury in cranial irradiation could result in potential cognitive decline, especially in terms of short-term memory formation and recall.…”

Section: Discussionmentioning

confidence: 99%

“…Many different radiation modalities and techniques have been performed for dosimetric discussion for the tumor involving the scalp or calvarium. [5][6][7][8][9][10][11] IMRT could provide the best target-dose homogeneity and coverage among 3DCRT and HDR techniques in extensive scalp lesion irradiation. 5 RapidArc (RA) was selected as the optimal solution, with marginally better conformality, shorter delivery time, and lower monitor units than static IMRT for total dura irradiation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Absolute Dose Achievable Between Helical Tomotherapy and RapidArc in Total Dura Mater Irradiation for Child Cancer

Sun

Zhang

Wang

et al. 2022

Technol Cancer Res Treat

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Background and Purpose: In this study, the absolute dose achievable between helical tomotherapy (HT) plans and RapidArc (RA) plans for total dura mater irradiation (TDMI) was compared. Materials and methods: A planning study was conducted on nine children's case datasets with dura mater metastasis of neuroblastoma. The target included the entire calvarium and skull base and formed a closed volume with a certain thickness around the brain. HT and RA plans with four coplanar full arcs (RA4) with half-field technique were generated for the comparison of absolute dose achievable. In total, 30.6 Gy was prescribed as D95% (ie, dose to 95% of PTV volume). Results: In the dosimetric comparison between the two modalities, HT provided more homogenous dose distribution than RA4 (mean HI5−95%: 1.046 vs 1.088, P < .001). The V107% and D2Gy of PTV in HT versus RA4 were 3.06% versus 30.47% and 32.59 Gy versus 33.45 Gy, respectively. HT reduced the Dmean and V5Gy of the brain, brainstem, and hippocampus by 25%–48% and 27%–56% compared with RA4, respectively. Conclusion: Both techniques could provide sufficient coverage for targets, but HT offered more homogenous dose to PTV and lower dose to the central region of the brain involving the brainstem and hippocampus. RA4 could be completed in a shorter time with lower MUs, but with relatively higher dose to the brain or hippocampus. In terms of dosimetry, HT may improve long-term cognitive decline in these young pediatric patients with TDMI.

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“… 19 The definition of CI was previously described in detail. 16 Differences of dosimetric parameters between the two techniques were analyzed by Student's t-test. Statistical analyses were carried out with EZR, 20 a graphical user interface for R Version 3.4.1 (The R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Methodsmentioning

confidence: 99%

“… 14 , 15 In recent years, proton therapy has gradually spread and intensity-modulated proton therapy (IMPT) enables an excellent dose distribution. 16 Our hypothesis was that IMPT could achieve comparable target coverage and hippocampus- and scalp-avoidance compared with IMRT. To investigate this hypothesis, HA-WBRT plans using HT and IMPT were generated and a planning study comparing dosimetric data of the two techniques was conducted.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Helical Tomotherapy and Intensity-Modulated Proton Therapy in Hippocampus- and Scalp-Sparing Whole Brain Radiotherapy

Takaoka¹,

Tomita

Mizuno

et al. 2021

Technol Cancer Res Treat

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Objective: Cognitive decline and alopecia after radiotherapy are challenging problems. We aimed to compare whole brain radiotherapy (WBRT) plans reducing radiation dose to the hippocampus and scalp between helical tomotherapy (HT) and intensity-modulated proton therapy (IMPT). Methods: We conducted a planning study of WBRT for 10 patients. The clinical target volume was defined as the whole brain excluding the hippocampus avoidance (HA) region. The prescribed dose was 30 Gy in 10 fractions to cover 95% of the target. Constraint goals were defined for the target and organs at risk (OAR). Results: Both techniques met the dose constraints for the target and OAR. However, the coverage of the target (dose covering 95% [D95%] and 98% [D98%] of the volume) were better in IMPT than HT (HT vs IMPT: D95%, 29.9 Gy vs 30.0 Gy, P < .001; D98%, 26.7 Gy vs 28.1 Gy, P = .002). The homogeneity and conformity of the target were also better in IMPT than HT (HT vs IMPT: homogeneity index, 1.50 vs 1.28, P < .001; conformity index, 1.30 vs 1.14, P < .001). IMPT reduced the D100% of the hippocampus by 59% (HT vs IMPT: 9.3 Gy vs 3.8 Gy, P < .001) and reduced the Dmean of the hippocampus by 37% (HT vs IMPT: 11.1 Gy vs 7.0 Gy, P < .001) compared with HT. The scalp IMPT reduced the percentage of the volume receiving at least 20 Gy (V20Gy) and V10Gy compared with HT (HT vs IMPT: V20Gy, 56.7% vs 6.6%, P < .001; V10Gy, 90.5% vs 37.1%, P < .001). Conclusion: Both techniques provided acceptable target dose coverage. Especially, IMPT achieved excellent hippocampus- and scalp-sparing. HA-WBRT using IMPT is a promising treatment to prevent cognitive decline and alopecia.

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Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp

Cited by 9 publications

References 45 publications

Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study

Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study

Comparison of Absolute Dose Achievable Between Helical Tomotherapy and RapidArc in Total Dura Mater Irradiation for Child Cancer

Dosimetric Comparison of Helical Tomotherapy and Intensity-Modulated Proton Therapy in Hippocampus- and Scalp-Sparing Whole Brain Radiotherapy

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