High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy.
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TLDR
IMRT_Tomo for CSI is technically easier and potentially dosimetrically favourable compared with IMRT_LA and 3DCRT and can also be realised on a conventional linear accelerator even for spinal lengths exceeding maximum allowable field sizes.Abstract:
This study aimed to establish the feasibility of intensity-modulated radiation therapy (IMRT) in craniospinal irradiation (CSI) using conventional linear accelerator (IMRT_LA) and compare it dosimetrically with helical TomoTherapy (IMRT_Tomo) and three-dimensional conformal radiotherapy (3DCRT). CT datasets of four previously treated patients with medulloblastoma were used to generate 3DCRT, IMRT_LA and IMRT_Tomo plans. A CSI dose of 35 Gy was prescribed to the planning target volume (PTV). IMRT_LA plans for tall patients were generated using an intensity feathering technique. All plans were compared dosimetrically using standardised parameters. The mean volume of each PTV receiving at least 95% of the prescribed dose (V(95%)) was >98% for all plans. All plans resulted in a comparable dose homogeneity index (DHI) for PTV_brain. For PTV_spine, IMRT_Tomo achieved the highest mean DHI of 0.96, compared with 0.91 for IMRT_LA and 0.84 for 3DCRT. The best dose conformity index was achieved by IMRT_Tomo for PTV_brain (0.96) and IMRT_LA for PTV_spine (0.83). The IMRT_Tomo plan was superior in terms of reduction of the maximum, mean and integral doses to almost all organs at risk (OARs). It also reduced the volume of each OAR irradiated to various dose levels, except for the lowest dose volume. The beam-on time was significantly longer in IMRT_Tomo. In conclusion, IMRT_Tomo for CSI is technically easier and potentially dosimetrically favourable compared with IMRT_LA and 3DCRT. IMRT for CSI can also be realised on a conventional linear accelerator even for spinal lengths exceeding maximum allowable field sizes. The longer beam-on time in IMRT_Tomo raises concerns about intrafraction motion and whole-body integral doses.read more
Citations
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Journal ArticleDOI
A comparative study on the risks of radiogenic second cancers and cardiac mortality in a set of pediatric medulloblastoma patients treated with photon or proton craniospinal irradiation.
Rui Zhang,Rui Zhang,Rebecca M. Howell,Rebecca M. Howell,Phillip J. Taddei,Phillip J. Taddei,Phillip J. Taddei,A Giebeler,A Giebeler,A Giebeler,Anita Mahajan,Wayne D. Newhauser,Wayne D. Newhauser,Wayne D. Newhauser +13 more
TL;DR: Passively scattered proton CSI provides superior predicted outcomes by conferring lower predicted risks of second cancer and cardiac mortality than field-in-field photon CSI for all medulloblastoma patients in a large clinically representative sample in the United States, but the magnitude of superiority depends strongly on the patients' anatomical development status.
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Cranio-spinal irradiation with volumetric modulated arc therapy: A multi-institutional treatment experience
Antonella Fogliata,Stefan Bergström,Ines Cafaro,Alessandro Clivio,Luca Cozzi,Giovanna Dipasquale,Per Hållström,Pietro Mancosu,Piera Navarria,Giorgia Nicolini,Emanuela Parietti,G. Pesce,Antonella Richetti,Marta Scorsetti,Eugenio Vanetti,Damien C. Weber +15 more
TL;DR: RapidArc techniques achieved highly conformal treatment plans for 5 adults or paediatric patients with cranio-spinal irradiation with volumetric modulated arc therapy using RapidArc technology.
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Development and Evaluation of Multiple Isocentric Volumetric Modulated Arc Therapy Technique for Craniospinal Axis Radiotherapy Planning
TL;DR: A VMAT technique to treat the craniospinal axis significantly reduces OAR dose, potentially leading to lower late organ toxicity, however, this is achieved at the expense of increased low-dose volumes, which is inherent to the technique, carrying a potentially increased risk of secondary malignancies.
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Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas.
TL;DR: The role of radiotherapy (RT) in the management of primary and recurrent myxopapillary ependymoma (MPE) is assessed.
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Feasibility of real-time motion management with helical tomotherapy
Eric Schnarr,Matt Beneke,Dylan Casey,E Chao,Jonathan Chappelow,Andrea Cox,Doug Henderson,Petr Jordan,Etienne Lessard,Daniel Lucas,Andriy Myronenko,Calvin R. Maurer +11 more
TL;DR: Real-time motion tracking and correction is technically feasible on a helical tomotherapy system and dose differences due to respiratory motion were greatly reduced, in one experiment.
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Radiation-induced second cancers: the impact of 3D-CRT and IMRT
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A simple scoring ratio to index the conformity of radiosurgical treatment plans
TL;DR: A new conformity index is derived that gives an objective score of conformity for a treatment plan and gives no false scores.