Standard and Nonstandard Craniospinal Radiotherapy Using Helical TomoTherapy

Parker, William; Brodeur, M.; Roberge, David; Freeman, Carolyn R.

doi:10.1016/j.ijrobp.2009.09.020

Cited by 64 publications

(48 citation statements)

References 8 publications

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“…The classical approach is to use parallel-opposed lateral cranial fields matched to a direct posterior field. The subsequent development of threedimensional (3D) conformal and intensity-modulated RT has seen these solutions increasingly used to deliver CSI and boost the posterior fossa, [14][15][16][17] and there is increasing interest in proton RT for both conditions, not least as reduced integral doses to normal structures may improve toxicity and second malignancy rates.…”

Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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Objective: There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. Methods: 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42,45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. Results: IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was 20.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Conclusion: Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

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Section: Clinical Settingmentioning

confidence: 99%

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Noble¹,

Scoffings²,

Ajithkumar³

et al. 2016

BJR

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“…Acute pulmonary toxicity is improved [46]. However, the main difficulty encountered with HT is the fact that a substantial volume of healthy tissues receive low doses (Figure 3) [47,48]. After calculation of organ-equivalent doses, risk of secondary cancers in relationship to the irradiation of organs at risk seems to be higher with HT than with proton therapy [49].…”

Section: Discussionmentioning

confidence: 99%

Craniospinal Irradiation (CSI) in Acute Lymphoblastic Leukemia: Comparison between Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and Helical Tomotherapy (HT)

Jacob¹,

JP²,

Chira³

2012

J Nucl Med Radiat Ther

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“…The unique geometry of helical tomotherapy (HT) enables the possibility of treating the entire craniospinal axis without any field junctions or field matching [4]. This feature and other positive characteristics of HT compared to 3DCRT delivery of CSI, such as superior target coverage and a more homogenous target dose, have been reported in the literature [4][5][6], making it an attractive modality for CSI. The disadvantage of CSI with HT is that almost the entire patient is irradiated to some extent, with large volumes of normal tissue exposed to low dose (relative to the target dose).…”

Section: Introductionmentioning

confidence: 99%

“…This so-called dose bath may be associated with acute and late adverse effects, e.g. haematological toxicity and secondary cancers [3,5,[7][8][9][10][11][12]. Thus, even if a HT plan can fulfil typical normal tissue tolerance criteria better than a 3DCRT plan, it does not necessarily mean that the therapeutic result is better as a different spectrum of side-effects might become apparent.…”

Section: Introductionmentioning

confidence: 99%

Haematological toxicity in adult patients receiving craniospinal irradiation – Indication of a dose-bath effect

Petersson

Gebre‐Medhin

Ceberg

et al. 2014

Radiotherapy and Oncology

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Haematological toxicity in adult patients receiving craniospinal irradiation -Indication of a dose-bath effect.Petersson, Kristoffer; Gebre-Medhin, Maria; Ceberg, Crister; Nilsson, Per; Engström, Per; Knoos, Tommy; Kjellén, Elisabeth Link to publication Citation for published version (APA): Petersson, K., Gebre-Medhin, M., Ceberg, C., Nilsson, P., Engström, P., Knöös, T., & Kjellén, E. (2014). Haematological toxicity in adult patients receiving craniospinal irradiation -Indication of a dose-bath effect. Radiotherapy and Oncology, 111(1), 47-51. DOI: 10.101647-51. DOI: 10. /j.radonc.2014 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Haematological toxicity in adult patients receiving craniospinal irradiation -indication of a dose-bath effect Abstract Background and PurposeThe purpose of this study was to investigate the correlation between the haematological toxicity observed in patients treated with craniospinal irradiation, and the dose distribution in normal tissue, specifically the occurrence of large volumes exposed to low dose. Material and MethodsTwenty adult male patients were included in this study; eight treated with helical tomotherapy (HT), and twelve with three-dimensional conformal radiation therapy. The relative volume of red bone marrow and body that was exposed to low dose (i.e. the so-called dose bath) was evaluated and correlated with nadir blood values during treatment, i.e. the severity of anaemia, leukopenia, and thrombocytopenia. The correlation was tested for different dose levels representing the dose bath using the Pearson product-moment correlation method. ResultsWe found a significant correlation between the volume of red bone marrow exposed to low dose and the severity of thrombocytopenia during treatment. Furthermore, for the HT patients, a significant correlation was found between the relative volume of the body exposed to low dose and the severity of anaemia and leukopenia. ConclusionsThe severity of haematological toxicity correlated with the fraction of red bone marrow or body that was exposed to low dose.

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Standard and Nonstandard Craniospinal Radiotherapy Using Helical TomoTherapy

Cited by 64 publications

References 8 publications

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves

Craniospinal Irradiation (CSI) in Acute Lymphoblastic Leukemia: Comparison between Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and Helical Tomotherapy (HT)

Haematological toxicity in adult patients receiving craniospinal irradiation – Indication of a dose-bath effect

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