Prospective study on dosimetric comparison of helical tomotherapy and 3DCRT for craniospinal irradiation – A single institution experience

Bandurska-Luque, Anna; Piotrowski, Tomasz; Skrobała, A.; Ryczkowski, Adam; Adamska, Krystyna; Kaźmierska, Joanna

doi:10.1016/j.rpor.2014.12.002

Cited by 18 publications

(18 citation statements)

References 29 publications

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“…Although we are aware of the fact that this work is based on the analysis of one patient only, we do not expect that expanding the number of patients will change our findings given the fact that the CSA target volume is quite consistent in between patients, and in relation to the surrounding structures [46]. The widest range of OARs mean doses for five different patients planned by VMAT at our department was 3 Gy.…”

Section: Discussionmentioning

confidence: 87%

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

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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

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Section: Discussionmentioning

confidence: 87%

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

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“…Increased fluorine-18 fludeoxyglucose ( 18 F-FDG) uptake is associated with cellular metabolism, fluorine-18-labelled 3ʹ-deoxy-3ʹ-fluorothymidine uptake with proliferation and 18 F-fluoromisonidazole uptake with hypoxia while carbon-11-labelled choline uptake is associated with lipid metabolism. 9 Thus, by assessing biological information and incorporating this into the treatment planning process, it becomes possible to identify subvolumes (which may be more or less radioresistant than the surrounding areas) and to target these, as appropriate, with a higher or lower radiation dose. Modern technology is now sufficiently advanced to allow for generating very sophisticated dose distribution, 10,11 such as that contoured in DPBN, to fully target and modulate the dose as suitable to each region of the tumour, thereby increasing cell killing and tumour control.…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment planning parameters for dose painting head and neck plans delivered with tomotherapy

Skórska

Piotrowski

Ryczkowski

et al. 2016

BJR

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Objective: The aim of this study was to determine which physical delivery parameter changes are most suitable for multiple-level dose-painting treatment plans with helical tomotherapy (HT). Methods: A total of 96 treatment plans were generated for 12 patients who had undergone fluorine-18 fludeoxyglucose positron emission tomography/CT ( 18 F-FDG-PET/CT) scan to plan head and neck cancer treatment. Based on these PET-CT images, the dose was escalated to 96 Gy in 32 fractions as a function of PET intensity values. The intensity-based prescription was converted into seven discrete dose levels. For the same patient, different HT plans were optimized by varying parameters such as field width (FW), pitch (PF) and modulation factor (MF). Dose conformity was evaluated using quality-volume histograms, quality factors (QFs), weighted index of achievement (IOA w ), coldness (IOC w ) and hotness (IOH w ). Moreover, doses to organs at risk (OARs), target volumes and execution time were analyzed. Results: Median QFs were the best for FW 5 1.05 cm (QF 5 2.10) and the worst for FW 5 2.5 cm (QF 5 3.04). The same trend was observed for IOA w , IOC w and IOH w . Combination of FW 5 1.05 cm and MF 5 5 leads to the longest beam-on time (above 25 min), whereas FW 5 2.5 cm and MF 5 3 lead to the shortest time (below 8 min). Data analyzed based on dose-volume histogram showed that changes in FW had the strongest impact on plan quality, whereas the effect of MF and PF changes was moderate. Conclusion: HT is suitable for multiple-level dose-painting treatment plans. Advances in knowledge: Changes in FW and MF had the greatest impact on dose distribution quality and beam-on time. Changes in PF only influenced doses to the OARs.

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“…HT is a new revolutionary technology that can complete CSI in one session, and the abutment between irradiation fields is avoided. Compared with 3DCRT and IMRT, HT can provide better dose uniformity and conformity in CSI plan [ 7 , 8 ]. In this study, data in Table 3 showed that V 95% of HT, VMAT, and 3D-CRT was close to 100%, and the lowest value is 97.58% of patient 5 with 3D-CRT.…”

Section: Discussionmentioning

confidence: 99%

“…The OAR volume exposed to high doses decreased in the HT plan, while the OAR volume exposed to low doses increased. It was a major drawback of HT [ 7 , 8 ]. Table 4 showed that V 5% and V 10% of OAR were high, reaching 100% in some cases with HT.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for Adult Medulloblastoma: Evaluation of Helical Tomotherapy, Volumetric Intensity Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy and the Results of Helical Tomotherapy Therapy

Sun¹,

Yang

et al. 2018

BioMed Research International

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Introduction All adult medulloblastoma (AMB) patients should be treated with craniospinal irradiation (CSI) postoperatively. Because of the long irradiation range, multiple radiation fields must be designed for conventional radiotherapy technology. CSI can be completed in only one session with helical tomotherapy (HT). We evaluated the dose of HT, volumetric intensity modulated arc therapy (VMAT), and three-dimensional conformal radiotherapy (3D-CRT) of AMB and the results of 5 cases of AMB treated with HT. Methods Complete craniospinal and posterior cranial fossa irradiation with HT, VMAT, and 3D-CRT and dose evaluation were performed. And results of 5 cases of AMB treated with HT were evaluated. Results A large volume of tissue was exposed to low dose radiation in the organs at risk (OAR), while a small volume was exposed to high dose radiation with HT. The conformity and uniformity of the targets were good with HT and VMAT, and the volume of targets exposed to high dose with VMAT was larger than that of HT. The uniformity of 3D-CRT was also good, but the dose conformity was poor. The main toxicity was hematologic toxicity, without 4th-degree bone marrow suppression. There was 3rd-degree inhibition in the white blood cells, hemoglobin, and platelets. The three female patients suffered menstrual disorders during the course of radiation. Two female patients with heavy menstruation suffered 3rd-degree anemia inhibition, and 2 patients suffered amenorrhea after radiotherapy. Although menstrual cycle was normal, the third patient was not pregnant. Conclusion CSI with HT is convenient for clinical practice, and the side effects are mild. With good conformity and uniformity, VMAT can also be used for selection in CSI. For poor conformity, 3D-CRT should not be the priority selection for CSI. In female patients, the ovaries should be protected.

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Prospective study on dosimetric comparison of helical tomotherapy and 3DCRT for craniospinal irradiation – A single institution experience

Cited by 18 publications

References 29 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)

Comparison of treatment planning parameters for dose painting head and neck plans delivered with tomotherapy

Radiotherapy for Adult Medulloblastoma: Evaluation of Helical Tomotherapy, Volumetric Intensity Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy and the Results of Helical Tomotherapy Therapy

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