Intensity Modulated or Volumetric Modulated Radiation Therapy (IMRT or VMAT) to Reduce Alopecia, Xerostomia, and Otitis after Whole Brain Radiation Therapy for Brain Metastases: A Planning Analysis

Mancini, B.R.; Kim, L.H.; Shaitelman, S.F.; Yan, Di; Kestin, L.L.; Grills, I.S.

doi:10.1016/j.ijrobp.2010.07.1944

Cited by 4 publications

(5 citation statements)

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“…In literature, the interpretation of data on intensity modulated techniques in hair-sparing WBRT [10,11] has been impeded by the lack of knowledge on the dose-effect relation of temporary alopecia. Additionally, plan optimization and evaluation in the hair follicle region is limited by known inaccuracies of the TPS in calculating build-up doses [14].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, plan optimization and evaluation in the hair follicle region is limited by known inaccuracies of the TPS in calculating build-up doses [14]. As a consequence, the available dosimetric studies by Roberge et al [11] and Mancini et al [10] do not allow to predict these techniques’ impact on temporary alopecia. This investigation is, to our knowledge, the first study to overcome these issues by quantitatively relating dose measurements and planning data to clinical results on temporary alopecia in WBRT.…”

Section: Discussionmentioning

confidence: 99%

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Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial

et al. 2014

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PurposeTo report the dosimetric results and impact of volumetric arc therapy (VMAT) on temporary alopecia and hair-loss related quality of life (QOL) in whole brain radiotherapy (WBRT).MethodsThe potential of VMAT-WBRT to reduce the dose to the hair follicles was assessed. A human cadaver was treated with both VMAT-WBRT and conventional opposed field (OF) WBRT, while the subcutaneously absorbed dose was measured by radiochromic films and calculated by the planning system. The impact of these dose reductions on temporary alopecia was examined in a prospective phase II trial, with the mean score of hair loss at 1 month after VMAT-WBRT (EORTC-QOL BN20) as a primary endpoint and delivering a dose of 20 Gy in 5 fractions. An interim analysis was planned after including 10 patients to rule out futility, defined as a mean score of hair loss exceeding 56.7. A secondary endpoint was the global alopecia areata severity score measured with the “Severity of Alopecia Tool” (SALT) with a scale of 0 (no hair loss) to 100 (complete alopecia).ResultsFor VMAT-WBRT, the cadaver measurements demonstrated a dose reduction to the hair follicle volume of 20.5% on average and of 41.8% on the frontal-vertex-occipital medial axis as compared to OF-WBRT. In the phase II trial, a total of 10 patients were included before the trial was halted due to futility. The EORTC BN20 hair loss score following WBRT was 95 (SD 12.6). The average median dose to the hair follicle volume was 12.6 Gy (SD 0.9), corresponding to a 37% dose reduction compared to the prescribed dose. This resulted in a mean SALT-score of 75.ConclusionsCompared to OF-WBRT, VMAT-WBRT substantially reduces hair follicle dose. These dose reductions could not be related to an improved QOL or SALT score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial

et al. 2014

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“…Saçlı deri D mean ve D maks dozları IMAT planları ile konv-WBRT'ye göre sırasıyla %32 ve %6 daha az bulunmuştur. Mancini ve ark.nın bildiri olarak sundukları çalışmalarında beyin metastazlı ve 37.5 Gy/15 fx alan 9 olguda konv-WBRT, 4, 7 veya 13 alan YART ve VMAT teknikleri karşılaştırılmıştır 8 . Bu çalışmada saçlı deri V5-10-20-30 Gy dozlarında %10-70 azalma ile en iyi korumanın 13 alan YART planı ile olduğu gösterilmiştir.…”

Section: Kaynaklarunclassified

“…Folikül dozu 25 Gy ile ≥ G3-4 saç kaybı < %20 olup olguların %50'sinde kalıcı saç kaybı için eşik doz 43 Gy ve ortalama eşik doz [16][17][18] Gy olarak bildirilmiştir 5,6 . Saçlı derinin korunması amacıyla 3B-KRT'e kıyasla, YART, helikal tomoterapi (HT) ve VMAT gibi RT yöntemlerinin kullanılması ile bu sorunun üstesinden gelinebileceği bildirilmektedir [7][8][9][10][11][12] . Bu çalışma ile, VMAT tekniği ile tedavi edilen malign glial tümörlü olgularımızın mevcut tedavi planının sanal olarak oluşturulmuş iki farklı RT tekniği ile dozimetrik olarak karşılaştırılması ve saçlı derinin planlamaya dahil edilmesi durumunda kalıcı saç kaybı yan etkisinin değerlendirilmesi amaçlanmıştır.…”

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Dosimetric Comparison of Scalp and Organs at Risk With Different Radiotherapy Techniques in Malign Glial Tumors

Aydın

Sarıhan

Bolat

et al. 2018

Uludağ Üniversitesi Tıp Fakültesi Dergisi

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ÖZET Volumetrik ark (t-VMAT) tekniği ile radyoterapi (RT) uygulanan malign glial tümörlü hastalarda mevcut tedavi planına karşın 1 ark VMAT ve statik 5 alan yoğunluk ayarlı RT tekniği dozimetrik olarak karşılaştırıldı. Çalışmaya en az 50 Gy RT alan 18 malign glial tümörlü olgu dahil edildi. Saçlı deri ortalama, 1 ve 9 cc dozları için 16, 30 ve 24 Gray eşik değerleri kullanıldı. Yöntemler arasında planlama tedavi volümü ve riskli organ dozları açısından anlamlı fark bulunamadı. Planlamanın hangi yöntem ile yapıldığı önemli olmaksızın saçlı derinin planlamaya dahil edilmesiyle birlikte saçlı deri dozlarının anlamlı azaldığı görüldü (p < 0.05). Oniki aylık izlem süresi içinde akut dönemde saç kaybı yaşamalarına rağmen hiçbir olguda kalıcı saç kaybı görülmedi. Bu çalışma ile saçlı derinin tedavi planına dahil edilmesinin hedef volüm dozları açısından olumsuz etkisi olmadığı gibi hastalarımızın kalıcı saç dökülmesinin yaratacağı kozmetik ve psikososyal yan etkilerden korunabileceği ortaya konulmuştur. Anahtar Kelimeler: Malign glial tümör. Radyoterapi tekniği. Saçlı deri. Saç koruyucu tedavi. Dozimetri.

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“…Roberge et al measured surface scalp doses with TLD and calculated doses at 5 mm thickness and reported decrease in mean doses of 53 % and 38 % respectively [ 37 ]. Mancini et al similarly demonstrated decrease scalp dose after VMAT- IMRT [ 38 ]. In a more detailed analysis De Puysseleyr et al, using preliminary cadaveric data and in a prospective study using VMAT IMRT for scalp sparing, showed 37 % reduction to the median dose to the hair follicle volume [ 39 ].…”

Section: Discusssionmentioning

confidence: 99%

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

et al. 2015

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BackgroundWhole brain radiation therapy (WBRT) is widely used for the treatment of brain metastases. Cognitive decline and alopecia are recognized adverse effects of WBRT. Recently hippocampus sparing whole brain radiation therapy (HS-WBRT) has been shown to reduce the incidence of memory loss. In this study, we found that multi-field intensity modulated radiation therapy (IMRT), with strict constraints to the brain parenchyma and to the hippocampus, reduces follicular scalp dose and prevents alopecia.MethodsSuitable patients befitting the inclusion criteria of the RTOG 0933 trial received Hippocampus sparing whole brain radiation. On follow up, they were noticed to have full scalp hair preservation. 5 mm thickness of follicle bearing scalp in the radiation field was outlined in the planning CT scans. Conventional opposed lateral WBRT radiation fields were applied to these patient-specific image sets and planned with the same nominal dose of 30 Gy in 10 fractions. The mean and maximum dose to follicle bearing skin and Dose Volume Histogram (DVH) data were analyzed for conventional and HS-WBRT. Paired t-test was used to compare the means.ResultsAll six patients had fully preserved scalp hair and remained clinically cognitively intact 1–3 months after HS-WBRT. Compared to conventional WBRT, in addition to the intended sparing of the Hippocampus, HS-WBRT delivered significantly lower mean dose (22.42 cGy vs. 16.33 cGy, p < 0.0001), V24 (9 cc vs. 44 cc, p < 0.0000) and V30 (9 cc vs. 0.096 cc, p = 0.0106) to follicle hair bearing scalp and prevented alopecia. There were no recurrences in the Hippocampus area.ConclusionsHS-WBRT, with an 11-field set up as described, while attempting to conserve hippocampus radiation and maintain radiation dose to brain inadvertently spares follicle-bearing scalp and prevents alopecia.

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Intensity Modulated or Volumetric Modulated Radiation Therapy (IMRT or VMAT) to Reduce Alopecia, Xerostomia, and Otitis after Whole Brain Radiation Therapy for Brain Metastases: A Planning Analysis

Cited by 4 publications

References 0 publications

Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial

Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial

Dosimetric Comparison of Scalp and Organs at Risk With Different Radiotherapy Techniques in Malign Glial Tumors

Dosimetric analysis of the alopecia preventing effect of hippocampus sparing whole brain radiation therapy

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