Sparing of the Neural Stem Cell Compartment During Whole-Brain Radiation Therapy: A Dosimetric Study Using Helical Tomotherapy

Marsh, J. W.; Godbole, Rohit; Herskovic, Arnold; Gielda, Benjamin T.; Turian, J

doi:10.1016/j.ijrobp.2009.12.012

Cited by 47 publications

(37 citation statements)

References 65 publications

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“…Our approach is to reduce the irradiation dose in all regions of active neurogenesis in the brain, including the SVZ. The same concept was proposed by Marsh et al, in which they used an approach similar to ours, reducing the dose to 11 to 12 Gy in the NSC region [17].…”

Section: Discussionmentioning

confidence: 93%

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Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer

Tarnawski

Michalecki²,

Blamek³

et al. 2011

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Prophylactic cranial irradiation (PCI) is performed on patients with limited or extensive small-cell lung cancer to reduce incidence of brain metastases and prolong survival. PCI may induce neurocognitive impairment. Decreasing irradiation of neural stem cells (NSC) might reduce PCI-induced toxicity. We tested the feasibility of reducing irradiation doses to neural stem cell (NSC) regions while maintaining prescribed doses to the planned target volume (PTV).Irradiation plans utilizing intensity-modulated radiotherapy (IMRT), helical TomoTherapy, and RapidArc for 10 consecutive lung cancer patients were evaluated. The dose distribution, dose-volume histograms, and dose homogeneity indexes were analyzed. Planned and actual dose distributions were compared by dosimetric analysis. Both helical tomotherapy and LINAC-based IMRT reduced the radiation dose to the NSC regions by approximately 45% while maintaining the full dose to the rest of brain. Measured dose distributions matched the planned dose distributions.Protecting the regions of active neurogenesis is technically feasible. Whether reducing the dose by 35% to 45% is sufficient to reduce treatment toxicity, however, can only be addressed in a randomized study. Further reducing the dose within the NSC region might also significantly decrease the dosage to the PTV.

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Section: Discussionmentioning

confidence: 93%

“…For these patients, the issue of reducing the long-term treatment toxicity is of particular importance. Marsh et al published a dosimetric study in which helical tomotherapy was used to reduce the dose in regions of active neurogenesis during WBRT [17].…”

mentioning

confidence: 99%

Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer

Tarnawski

Michalecki²,

Blamek³

et al. 2011

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“…Multiple groups, including investigators at our own institution, are evaluating techniques for reducing the late cognitive sequelae of whole brain radiotherapy [53][54][55][56][57][58]. Many of these approaches involve dose reduction to the hippocampus, located in the medial temporal lobe [54,55,57,58].…”

Section: Discussionmentioning

confidence: 99%

“…Many of these approaches involve dose reduction to the hippocampus, located in the medial temporal lobe [54,55,57,58]. Our institution has performed dosimetric studies investigating the feasibility of dose reduction to the neural stem cell compartment (NSC) and limbic circuit (submitted for publication) using helical Tomotherapy (TomoTherapy @ , Madison, WI) [58]. While exclusion of the pituitary and infindibular stalk was not the goal of these studies, the planning at-risk volume in the limbic dosimetry study (submitted for publication) frequently included the pituitary, infundibular stalk, and sellar region.…”

Section: Discussionmentioning

confidence: 99%

Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature

et al. 2010

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We present a case report of a patient recently treated at our institution for an isolated non-small cell lung cancer metastatic lesion to the sella, report the lack of involvement of the pituitary gland in a large single-institution series of treated intracranial parenchymal metastases, and review the pertinent literature. We reviewed cranial imaging studies (CT and MRI) for 935 metastases in 155 patients treated at our institution over the previous 3 years for intracranial metastatic disease. Special attention was paid to the skull base to document the presence of any metastatic disease involving the pituitary gland, infundibular stalk, sella turcica (including anterior and posterior clinoids), or diaphragm sellae. We found no other involvement of the pituitary gland or other sellar structures by metastatic disease in this series. Intracranial metastatic disease rarely involves the pituitary gland and infundibular stalk parenchyma, suggesting that this structure may be safely omitted from the treatment field during WBRT and prophylactic cranial irradiation (PCI). This treatment approach should reduce the late sequelae of treatment to this critical organ.

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“…The Hippocampus is a structure that is crucial to NCF and hippocampal metastases are rare. Sparing of this region with PCI is feasible using advanced RT planning and delivery systems (Marsh et al 2010, Hsu et al 2010). The hope is that these technical advances translate into meaningful benefits for patients.…”

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confidence: 99%

Prophylactic Cranial Irradiation

Lester

2011

Medical Radiology

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Sparing of the Neural Stem Cell Compartment During Whole-Brain Radiation Therapy: A Dosimetric Study Using Helical Tomotherapy

Cited by 47 publications

References 65 publications

Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer

Feasibility of reducing the irradiation dose in regions of active neurogenesis for prophylactic cranial irradiation in patients with small-cell lung cancer

Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature

Prophylactic Cranial Irradiation

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