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

Sun, Zhenliang; Yang, Shengchun; Du, Fukuan; Cheng, Xiaolong; Li, Qinglin; Ye, Hua; Jin, Tengchuan; Hu, Qingjiang; Chen, Xiaozhong; Chen, Yuanyuan; Chen, Ming

doi:10.1155/2018/9153496

Cited by 20 publications

(10 citation statements)

References 24 publications

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“…Through the megavolt images obtained from each treatment, tumor dose distribution and tumor during treatment can be observed. The treatment plan can be changed, and the target volume can be adjusted in a timely fashion [21]. The ability to treat different target areas, from the stereotactic treatment of small tumors to systemic treatment, is performed by a single spiral beam.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dosimetric Gains Provided by Intensity-Modulated Radiotherapy, Volume-Modulated Arc Therapy, and Helical Tomotherapy for High-Grade Glioma

Liu

Wang

et al. 2020

BioMed Research International

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Purpose. Because of the poor prognosis for high-grade glioma (HGG) patients, it is important to increase the dose of the tumor to improve the efficacy while minimizing the dose of organs at risk (OARs). Thus, we evaluated the potential dosimetric gains of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) or volume-modulated arc therapy (VMAT) for high-grade glioma (HGG). Methods. A total of 42 HGG patients were retrospectively selected who had undergone helical tomotherapy; then, IMRT and VMAT plans were generated and optimized for comparison after contouring crucial neuronal structures for neurogenesis and neurocognitive function. IMRT and VMAT were optimized with the Eclipse treatment planning system (TPS) (Version 11.0.31) and HT using TomoTherapy Hi-Art Software (Version 2.0.7) (Accuray, Madison, WI, USA). All three techniques were optimized for simultaneously delivering 60 Gy to planning target volume (PTV) 1 and 50-54 Gy to PTV2. We also analyzed the homogeneity index (HI) and conformity index (CI) of PTVs and organ at risk (OAR) sparing. Results. There was no significant difference in the PTV coverage among IMRT, VMAT, or HT. As for the HI, HT plans (PTV1 HI: 0.09±0.03, PTV2 HI: 0.17±0.05) had the best homogeneity when compared to IMRT plans (PTV1 HI: 0.10±0.04, PTV2 HI: 0.18±0.04) and VMAT plans (PTV1 HI: 0.11±0.03, PTV2 HI: 0.20±0.03). The CI value of HT (PTV1 CI: 0.98±0.03, PTV2: 0.98±0.05) was closest to the optimal value. Except for the IMRT and VMAT groups, there were statistically significant differences between the other two groups of the CI values in both PTV1 and PTV2. The other comparison values were statistically significant except for the optic nerve, and VMAT had the best sparing of the optic chiasm. The mean and max doses of OARs declined significantly in HT. Conclusions. For high-grade glioma patients, HT had superior outcomes in terms of PTV coverage and OAR sparing as compared with IMRT/VMAT.

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Section: Introductionmentioning

confidence: 99%

Comparison of Dosimetric Gains Provided by Intensity-Modulated Radiotherapy, Volume-Modulated Arc Therapy, and Helical Tomotherapy for High-Grade Glioma

Liu

Wang

et al. 2020

BioMed Research International

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“…On the technical side, field junctions have been necessary to achieve the required vertical radiation field extension, posing dosimetric challenges. However, the use of modern irradiation techniques, such as intensity-modulated radiotherapy (IMRT), helical treatment delivery and proton therapy, has helped overcome some of the obstacles 21,26–29…”

Section: Introductionmentioning

confidence: 99%

<p>Outcome and prognostic factors following palliative craniospinal irradiation for leptomeningeal carcinomatosis</p>

Shafie¹,

Böhm²,

Weber³

et al. 2019

CMAR

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BackgroundLeptomeningeal carcinomatosis (LC) is a severe complication of metastatic tumor spread to the central nervous system. Prognosis is dismal with a median overall survival (OS) of ~10–15 weeks. Treatment options include radiotherapy (RT) to involved sites, systemic chemo- or targeted therapy, intrathecal chemotherapy and best supportive care with dexamethasone. Craniospinal irradiation (CSI) is a more aggressive radiotherapeutic approach, for which very limited data exists. Here, we report on our 10-year experience with palliative CSI of selected patients with LC.Patients and methodsTwenty-five patients received CSI for the treatment of LC at our institution between 2008 and 2018. Patients were selected individually for CSI based on clinical performance, presenting symptoms and estimated benefit. Median patient age was 53 years (IQR: 45–59), and breast cancer was the most common primary. Additional brain metastases were found in 18 patients (72.0%). RT was delivered at a TomoTherapy machine, using helical intensity-modulated radiotherapy (IMRT). The most commonly prescribed dose was 36 Gy in 20 fractions, corresponding to a median biologically equivalent dose of 40.8 Gy (IQR: 39.0–2.5). Clinical performance and neurologic function were assessed before and in response to therapy, and deficits were retrospectively quantified on the 5-point neurologic function scale (NFS). A Cox proportional hazards model with univariate and multivariate analyses was fitted for survival.ResultsTwenty-one patients died and four were alive at the time of analysis. Median OS from LC diagnosis was 19.3 weeks (IQR: 9.3–34.0, 95% CI: 11.0–32.0). In univariate analysis, a Karnofsky performance scale index (KPI) ≥70% (P=0.001), age ≤55 years at LC diagnosis (P=0.022), cerebrospinal fluid (CSF) protein <100 mg/dL (P=0.018) and no more than mild or moderate neurologic deficits (NFS ≤2; P=0.007) were predictive of longer OS. So were the neurologic response to treatment (P=0.018) and the application of systemic therapy after RT completion (P=0.029). The presence of CSF flow obstruction was predictive of shorter OS (P=0.026). In multivariate analysis, age at LC diagnosis (P=0.018), KPI (P<0.001) and neurologic response (P=0.037) remained as independent prognostic factors for longer OS. Treatment-associated toxicity was manageable and mostly grades I and II according to the Common Terminology Criteria for Adverse Events v4.0. Eight patients (32%) developed grade III myelosuppression. Neurologic symptom stabilization could be achieved in 40.0% and a sizeable improvement in 28.0% of all patients.ConclusionCSI for the treatment of LC is feasible and may have therapeutic value in carefully selected patients, alleviating symptoms or delaying neurologic deterioration. OS after CSI was comparable to the rates described in current literature for patients with LC. The use of modern irradiation techniques such as helical IMRT is warranted to limit toxicity. Patient selection should take into account prognostic factors such as age, clinical performanc...

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“…However, our study found that 2 out of 36 patients with medulloblastoma developed frontal lobe metastasis, which was considered as a possible failure of the sieve plate area. With the progress of radiotherapy technology, especially the development of VMAT and TOMO program for the treatment of whole brain and spinal cord technology [11,12], the dose distribution in the target region was more uniform than that of 3DCRT and IMRT.…”

Section: Discussionmentioning

confidence: 99%

Recurrence pattern and Survival analysis in patients undergoing radiotherapy IMRT technique for medulloblastoma

Chang

Wang

et al. 2020

Preprint

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Objective The technique of radiotherapy is associated with the recurrence pattern and prognosis of postoperative treatment for medulloblastoma. Our aim was to assess recurrence patterns and survival in patients with medulloblastoma between three-dimensional conformation (3D-CRT) and intensity modulated radiotherapy (IMRT). To analyze the factors affecting the prognosis, such as the use of 3D-CRT or IMRT, the time interval of surgical and radiotherapy, whether there is chemotherapy and chemotherapy regimen.Methods In this study, 36 patients with medulloblastoma were conducted investigating and data were analyzed from May 2009 to September 2017. The median survival of each group was calculated for different clinical stages,pathological types and treatment methods. The PFS and OS for patients curves were derived by Kaplan-Meier estimation, and which were calculated using the Cox proportional hazards model between the IMRT and 3D-CRT treatment groups.Results Up to the follow-up date, 7 of the 9 patients in the 3D-CRT group had recurrence and 9 of the 27 patients in the IMRT group had recurrence. The 2-year and 5-year PFS of the IMRT group were 74.1% and 65.8%, and which of the 3D-CRT group were 55.6% and 22.2%, respectively. The PFS was significantly higher for patients treated with IMRT compared with 3D-CRT (P<0.05). The 2-year overall survival rates of the IMRT group compared with the 3D-CRT group were the same, the 5-year overall survival rate of the IMRT group was higher than that of the 3D-CRT group, however, there was no statistical difference. The PFS and OS for patients with low-risk groups were better than those of the high-risk group (P<0.05). There was no statistical difference between the M2 group and the M3 group in the 2-year and 5-year OS(P>0.05). There was no statistical difference in the chemotherapy-free group, the EP chemotherapy regimen and the temozolomide (TMZ) chemotherapy group in the 2-year and 5-year PFS and OS(P>0.05). The results of multivariate Cox proportional hazards model analysis showed that the residual, recurrence or metastasis before radiotherapy were independent prognostic factors affecting PFS(P<0.05). Radiotherapy mode was negatively correlated, although there was no statistical significance(P=0.061).Conclusions IMRT can reduce the risk of spinal cord recurrence compared with 3D-CRT, especially the low rate of spinal cord recurrence. The development of the technique of radiotherapy was associated with improvements in medulloblastoma prognosis.

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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

Cited by 20 publications

References 24 publications

Comparison of Dosimetric Gains Provided by Intensity-Modulated Radiotherapy, Volume-Modulated Arc Therapy, and Helical Tomotherapy for High-Grade Glioma

Comparison of Dosimetric Gains Provided by Intensity-Modulated Radiotherapy, Volume-Modulated Arc Therapy, and Helical Tomotherapy for High-Grade Glioma

<p>Outcome and prognostic factors following palliative craniospinal irradiation for leptomeningeal carcinomatosis</p>

Recurrence pattern and Survival analysis in patients undergoing radiotherapy IMRT technique for medulloblastoma

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