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Thakur N, Bansal N, Sudan M, Sharma A. Optimising craniospinal irradiation for medulloblastoma: a dosimetric comparison of two VMAT planning methods. Ecancermedicalscience 2024; 18:1700. [PMID: 38774570 PMCID: PMC11108045 DOI: 10.3332/ecancer.2024.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Indexed: 05/24/2024] Open
Abstract
Background Craniospinal irradiation (CSI) poses a challenging planning process because of the complex target volume. Traditional 3D conformal CSI does not spare any critical organs, resulting in toxicity in patients. Here the dosimetric advantages of volumetric-modulated arc therapy (VMAT) using partial arc and avoidance sectors are compared with each other in planning in adult patients undergoing CSI to develop a clinically feasible technique that is both effective and efficient. Patient and methods Eight adult patients treated with CSI were retrospectively identified. In total 16 plans were made. We generated two plans for each patient: 1. VMAT plan using partial arc, namely VMAT_pa. 2. VMAT plan using avoidance sectors, namely VMAT_as. The dose prescribed was 36 Gy in 20 fractions. The dose-volume histogram for planning target volume (PTV) and organs at risk (OAR) (lens, eye, heart, thyroid, lungs, liver, gonads and kidneys) were analysed and compared. Dose parameters of mean dose, V95%, and V107% for the PTV were evaluated. Results The median length of PTV is 65.58 cm (45.8-79.5). The volume of PTV receiving 95% of the dose (V95%) in both the plans are 97.51% (VMAT_as) and 97.99% (VMAT_pa) (p = 0.121) while V107% are 0.733 and 0.742 for VMAT_as and VMAT_pa, respectively (p = 0.969). The doses of OARs such as lens, eye, liver and gonads were comparable. The mean heart dose was 10.4 and 9.0 Gy in VMAT_as and VMAT_pa plans, respectively (p = 0.005). Significant lower doses to the thyroid, kidneys and lungs were seen in VMAT plans using avoidance sectors. Conclusion This study provides a practically useful VMAT planning method for the treatment of CSI and illustrates the ability of VMAT using avoidance sectors to generate highly conformal and homogeneous treatment plans for CSI, while limiting the dose to the relevant OARs.
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Affiliation(s)
- Niketa Thakur
- Department of Radiation Oncology, All India Institute of Medical Sciences (AIIMS), Bilaspur 174037, India
| | - Nancy Bansal
- Department of Radiation Oncology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar 143501, India
| | - Meena Sudan
- Department of Radiation Oncology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar 143501, India
| | - Abhishek Sharma
- Department of Anesthesia and Critical Care, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
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Şenkesen Ö, Tezcanlı E, Alkaya F, İspir B, Çatlı S, Yeşil A, Bezirganoglu E, Turan S, Köksal C, Güray G, Hacıislamoğlu E, Durmuş İF, Çavdar Ş, Aksu T, Çolak N, Küçükmorkoç E, Doğan M, Ercan T, Karaköse F, Alpan V, Ceylan C, Poyraz G, Nalbant N, Kınay Ş, İpek S, Kayalılar N, Tatlı H, Zhu M. Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis. Radiat Oncol 2024; 19:49. [PMID: 38627747 PMCID: PMC11022438 DOI: 10.1186/s13014-024-02435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. METHODS Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy. RESULTS All techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes. CONCLUSION Modern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.
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Affiliation(s)
- Öznur Şenkesen
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
- Department of Radiation Oncology, Acıbadem Ataşehir Hospital, Acıbadem Mehmet Ali Aydınlar University, Kayışdağı Cad. No:32, Ataşehir, Istanbul, Turkey.
| | - Evrim Tezcanlı
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
- Department of Radiation Oncology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Fadime Alkaya
- Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey
| | - Burçin İspir
- Department of Radiation Oncology, Acıbadem Adana Hospital, Adana, Turkey
| | - Serap Çatlı
- Radiation Oncology Department, Gazi University, Ankara, Turkey
| | - Abdullah Yeşil
- Department of Radiation Oncology, Medicana Bursa Hospital, Bursa, Turkey
| | | | - Sezgi Turan
- Department of Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Canan Köksal
- Department of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Gülay Güray
- Department of Radiation Oncology, Medikal Park Bahçelievler Hospital, Istanbul, Turkey
| | - Emel Hacıislamoğlu
- Department of Radiation Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
| | - İsmail Faruk Durmuş
- Department of Radiation Oncology, Yeni Yuzyıl University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Şeyma Çavdar
- Department of Radiation Oncology, Medicana Ankara Hospital, Ankara, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Ondokuz Mayıs University, Samsun, Turkey
| | - Nurten Çolak
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Esra Küçükmorkoç
- Department of Radiation Oncology, Anadolu Medical Center, Istanbul, Turkey
| | - Mustafa Doğan
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | - Tülay Ercan
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Fatih Karaköse
- Department of Radiation Oncology, Koc University Hospital, Istanbul, Turkey
| | - Vildan Alpan
- Department of Radiation Oncology, American Hospital, Istanbul, Turkey
| | - Cemile Ceylan
- Department of Radiation Oncology, Istanbul Onkology Hospital, Istanbul, Turkey
| | - Gökhan Poyraz
- Department of Radiation Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Nilgül Nalbant
- Department of Radiation Oncology, Basaksehir Cam Ve Sakura City Hospital, Istanbul, Turkey
| | - Şeyda Kınay
- Department of Radiation Oncology, Dokuz Eylul University, İzmir, Turkey
| | - Servet İpek
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Namık Kayalılar
- Department of Radiation Oncology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Hamza Tatlı
- Elekta Instrument AB, Barbaros Mah. Begonya Sok. Nidakule, Ataşehir, Istanbul, Turkey
| | - Mingyao Zhu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Joseph A, Akinsete A, Adeneye S, Balogun O, Awofeso O, Oladipo A, Ajose A, Elhamamsi I, Merrell K, Ngwa W, Puthoff D, Shour AR, Onitilo A. Feasibility and Safety of Implementing Volumetric Arc Therapy (VMAT) for Pediatric Craniospinal Irradiation in a Low-Middle-Income Region: The Nigerian Experience. Adv Radiat Oncol 2024; 9:101325. [PMID: 38405304 PMCID: PMC10885594 DOI: 10.1016/j.adro.2023.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/19/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Volumetric modulated arc therapy (VMAT) is a relatively new treatment technique in sub-Saharan Africa. Although craniospinal irradiation (CSI) in the pediatric population has been practiced in Nigeria for many years, the use of VMAT to deliver this treatment is previously undocumented. We reviewed the first set of patients to undergo CSI at a cancer center in Nigeria, detailing the treatment technique, the progress experienced, dose statistics achieved, treatment toxicities, and cancer outcomes to date. Methods and Materials This was a prospective case series of 5 children with histologically diagnosed cancers requiring CSI whose parents consented to the study. They were recruited at evaluation and followed through the process of their therapy. Toxicity was monitored at weekly review appointments using the Common Terminology Criteria for Adverse Events version 5.0. Follow-up of the children will continue in the long-term effects clinic. Results Five patients with a median age of 6 were recruited. Diagnoses were intracranial germ cell tumor (n = 2), medulloblastoma (n = 1), pineoblastoma (n = 1), and ependymoma (n = 1). For all patients, a dose of 36.0 Gy in 1.8 Gy daily fractions was prescribed to the entire neuraxis. A subsequent boost of 18 Gy (n = 4) to 19.8 Gy (n = 1) in 10 daily fractions to the primary tumor bed (n = 2) and posterior fossa (n = 2) was delivered. Four patients had chemotherapy before, during, or after radiation therapy. No patient experienced grade 3 or greater toxicity. Conclusions Our results indicate great progress has been made in the delivery of CSI in Nigeria, demonstrating tolerable acute side effects using VMAT. This series suggests the feasibility of implementing VMAT technology in low- or middle-income countries. Additional follow-up will be needed to determine whether survival rates and chronic toxicity rates are similar to those reported in the literature.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye Akinsete
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Samuel Adeneye
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Radiation Biology, Radiotherapy and Radiodiagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Onyinye Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Opeyemi Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Aishat Oladipo
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat Ajose
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ibrahim Elhamamsi
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Wilfred Ngwa
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Puthoff
- Office of Research and Sponsored Programs, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Abdul R. Shour
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Adedayo Onitilo
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
- Department of Oncology, Cancer Care and Research Center, Marshfield Clinic Health System, Marshfield, Wisconsin
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Ziemann C, Cremers F, Motisi L, Albers D, MacPherson M, Rades D. Novel hybrid treatment planning approach for irradiation a pediatric craniospinal axis. Med Dosim 2023; 49:93-101. [PMID: 37798155 DOI: 10.1016/j.meddos.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/19/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
This study presents a new treatment planning approach merging 3D-CRT and VMAT fields into a hybrid treatment plan (HybTP), in order to achieve an optimum dose coverage of the planning target volume (PTV) and protection of OAR. Craniospinal axis irradiation (CSI) treated with 3D conformal radiotherapy (3D-CRT) is associated with high doses to the heart and eye lenses but provides better sparing of lungs and kidneys compared to volumetric modulated arc therapy (VMAT). VMAT treatment spares eye lenses and the heart, but lungs and kidneys are not as effective as 3D-CRT. Thus, a combination of both techniques (HybTP) may be optimal in sparing all these organs at risk (OAR). The results of HybTP are compared with helical tomotherapy (HT), intensity modulated radio therapy (IMRT), VMAT, and 3D-CRT plans. Hybrid, HT, VMAT, IMRT, and 3D-CRT treatment plans for a male child (age 6 years) with medulloblastoma were created and compared. A total dose of 35.2 Gy (PTV) with a dose per fraction of 1.6 Gy was prescribed. The following dose acceptance criteria were defined: The plans were compared regarding dose homogeneity index (HI) and conformity index (CI), PTV coverage, (particularly at cribriform plate) and doses at OARs. Best conformity was achieved with HT (CI = 0.98) followed by VMAT (CI = 0.96), IMRT (CI = 0.91), HybTP (CI = 0.86), and 3D-CRT (CI = 0.83). The homogeneity index varied marginally. For both HT and IMRT the HI was 0.07, and for 3D-CRT, VMAT and HybTP the HI was between 0.13 and 0.15. The cribriform plate was sufficiently covered by HybTP, VMAT, and 3D-CRT. The dose acceptance criteria for OARs were met by HT and HybTP. VMAT did not meet the criteria for lung (Dmean = right 10.4 Gy/left 10.2 Gy), 3D-CRT did not meet the criteria for eye lenses (Dmax = right 32.3 Gy/left 33.1), and heart (V25≈44%) and IMRT did not meet the criteria for lung (Dmean = right 11.1 Gy/left 11.2 Gy) and eye lenses (Dmax = right 12.2 Gy/left 13.1). HybTP meets all defined acceptance criteria and has proved to be a reasonable alternative for CSI. With HybTP that combines VMAT at the brain and heart with 3D-CRT posterior spinal fields (to spare lungs and kidneys), both appropriate coverage of the PTV and sparing of OAR can be achieved.
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Affiliation(s)
- Christian Ziemann
- Department of Radiotherapy, University Medical Center Schleswig Holstein/Campus Luebeck, Luebeck, Germany.
| | - Florian Cremers
- Department of Radiotherapy, University Medical Center Schleswig Holstein/Campus Luebeck, Luebeck, Germany
| | - Laura Motisi
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Suisse
| | - Dirk Albers
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miller MacPherson
- University of Ottawa, The Ottawa Hospital, Department of Radiology, Radiation Oncology, and Medical Physics, Ottawa, Canada
| | - Dirk Rades
- Department of Radiotherapy, University Medical Center Schleswig Holstein/Campus Luebeck, Luebeck, Germany
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Zhang Y, Huang Y, Lin J, Ding S, Gong X, Liu Q, Gong C. Multi-isocenter VMAT craniospinal irradiation using feasibility dose-volume histogram-guided auto-planning technique. JOURNAL OF RADIATION RESEARCH 2023:7150737. [PMID: 37141634 DOI: 10.1093/jrr/rrad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/07/2022] [Indexed: 05/06/2023]
Abstract
This study aims to propose a novel treatment planning methodology for multi-isocenter volumetric modulated arc therapy (VMAT) craniospinal irradiation (CSI) using the special feasibility dose-volume histogram (FDVH)-guided auto-planning (AP) technique. Three different multi-isocenter VMAT -CSI plans were created, including manually based plans (MUPs), conventional AP plans (CAPs) and FDVH-guided AP plans (FAPs). The CAPs and FAPs were specially designed by combining multi-isocenter VMAT and AP techniques in the Pinnacle treatment planning system. Specially, the personalized optimization parameters for FAPs were generated using the FDVH function implemented in PlanIQ software, which provides the ideal organs at risk (OARs) sparing for the specific anatomical geometry based on the valuable assumption of the dose fall-off. Compared to MUPs, CAPs and FAPs significantly reduced the dose for most of the OARs. FAPs achieved the best homogeneity index (0.092 ± 0.013) and conformity index (0.980 ± 0.011), while CAPs were slightly inferior to the FAPs but superior to the MUPs. As opposed to MUPs, FAPs delivered a lower dose to OARs, whereas the difference between FAPs and CAPs was not statistically significant except for the optic chiasm and inner ear_L. The two AP approaches had similar MUs, which were significantly lower than the MUPs. The planning time of FAPs (145.00 ± 10.25 min) was slightly lower than that of CAPs (149.83 ± 14.37 min) and was substantially lower than that of MUPs (157.92 ± 16.11 min) with P < 0.0167. Overall, introducing the multi-isocenter AP technique into VMAT-CSI yielded positive outcomes and may play an important role in clinical CSI planning in the future.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
| | - Jiafan Lin
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
| | - Xiaochang Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
| | - Qiegen Liu
- Department of Electronic Information Engineering, 999 Xuefu Dadao, Honggutan District, Nanchang 330031, China
| | - Changfei Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang 330029, China
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Miyata J, Tominaga Y, Kondo K, Sonoda Y, Hanazawa H, Sakai M, Itasaka S, Oita M, Kuroda M. Dosimetric comparison of pencil beam scanning proton therapy with or without multi-leaf collimator versus volumetric-modulated arc therapy for treatment of malignant glioma. Med Dosim 2023; 48:105-112. [PMID: 36914455 DOI: 10.1016/j.meddos.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 03/14/2023]
Abstract
This study aimed to examine the dosimetric effect of intensity-modulated proton therapy (IMPT) with a multi-leaf collimator (MLC) in treating malignant glioma. We compared the dose distribution of IMPT with or without MLC (IMPTMLC+ or IMPTMLC-, respectively) using pencil beam scanning and volumetric-modulated arc therapy (VMAT) in simultaneous integrated boost (SIB) plans for 16 patients with malignant gliomas. High- and low-risk target volumes were assessed using D2%, V90%, V95%, homogeneity index (HI), and conformity index (CI). Organs at risk (OARs) were evaluated using the average dose (Dmean) and D2%. Furthermore, the dose to the normal brain was evaluated using from V5Gy to V40Gy at 5 Gy intervals. There were no significant differences among all techniques regarding V90%, V95%, and CI for the targets. HI and D2% for IMPTMLC+ and IMPTMLC- were significantly superior to those for VMAT (p < 0.01). The Dmean and D2% of all OARs for IMPTMLC+ were equivalent or superior to those of other techniques. Regarding the normal brain, there was no significant difference in V40Gy among all techniques whereas V5Gy to V35Gy in IMPTMLC+ were significantly smaller than those in IMPTMLC- (with differences ranging from 0.45% to 4.80%, p < 0.05) and VMAT (with differences ranging from 6.85% to 57.94%, p < 0.01). IMPTMLC+ could reduce the dose to OARs, while maintaining target coverage compared to IMPTMLC- and VMAT in treating malignant glioma.
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Affiliation(s)
- Junya Miyata
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan; Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yuki Tominaga
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan; Department of Radiotherapy, Medical Co. Hakuhokai, Osaka Proton Therapy Clinic, Osaka, Osaka, Japan
| | - Kazuto Kondo
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yasuaki Sonoda
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hideki Hanazawa
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Mami Sakai
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoshi Itasaka
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masataka Oita
- Faculty of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Okayama, Japan.
| | - Masahiro Kuroda
- Graduate School of Health Sciences, Okayama University, Okayama, Okayama, Japan
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7
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Wang X, Li C, Li G, Zhao J, Bai S. A Script-Based Automatic Intensity Modulated Radiation Therapy Planning Method With Robust Optimization for Craniospinal Irradiation. Pract Radiat Oncol 2023; 13:e209-e215. [PMID: 36108963 DOI: 10.1016/j.prro.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
This report describes a script-based automatic planning method with robust optimization for craniospinal irradiation (CSI) to reduce sensitivity to field matching errors and increase planning efficiency. The data of 10 CSI patients with planning target volume (PTV) lengths between 49.8 and 85.0 cm were retrospectively studied. Robust intensity modulated radiation therapy plans with ±5-mm longitudinal position uncertainty were generated by the automatic planning script. A simple dose prediction model and a self-adjusting method were implied in the automatic plans. The plans' robustness against setup errors was evaluated by deliberately shifting the middle beamset ±5 mm in the superior-inferior direction. Manual and nonrobust plans were also created to evaluate the automatic robust plans' quality, efficiency, and robustness. There were no significant differences between the manual and automatic plans in terms of homogeneity index; conformity index; D1%, D2%, and D98% of PTV; and average doses of organs at risk. However, the D99% of the PTV in the automatic plans was slightly inferior to that in the manual plans. Compared with the manual plans, the automatic plans greatly increased efficiency, with a reduction in planning time of approximately 48%. When ±5-mm superior-inferior errors were introduced, the average deviations of the maximum dose D1% and minimum dose D99% to the spinal cord were 4.9% (±1.1%) and -3.4% (±1.3%), respectively. However, the corresponding values of the nonrobust plans were 20.0% (±5.4%) and -21.2 (±6.3%), respectively. The script-based automatic CSI planning method, combining robust optimization and a dose prediction model, efficiently created a good-quality plan that was robust to setup errors.
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Affiliation(s)
- Xuetao Wang
- Division of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changhu Li
- Division of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangjun Li
- Division of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianling Zhao
- Division of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sen Bai
- Division of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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8
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Stroubinis T, Psarras M, Zygogianni A, Protopapa M, Kouloulias V, Platoni K. Craniospinal Irradiation: A Dosimetric Comparison Between O-Ring Linac and Conventional C-arm Linac. Adv Radiat Oncol 2022; 8:101139. [PMID: 36636383 PMCID: PMC9830104 DOI: 10.1016/j.adro.2022.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/16/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to perform a dosimetric evaluation between craniospinal irradiation volumetric modulated arc therapy plans designed for an O-Ring and a conventional C-arm Linac. Methods and Materials Two adult patients were selected for this study. Two plans were designed one for a TrueBeam Edge and one for Halcyon O-ring Linac for each patient. The evaluation of the plans was conducted in terms of dose volume histogram analysis of the target volume and organs at risk (OARs) along with total plan monitor units and beam-on time. Paired sample t test was performed to compare Dmax and Dmean of OARs for each plan's comparison. The delivery of volumetric modulated arc therapy plans was evaluated using Octavius 4D phantom. Results All plans demonstrated dose distributions with sufficient planned target volume conformity and homogeneity. The Homogeneity Index and Conformity Index for all plans were found comparable. The paired sample t test did not demonstrate significant difference in terms of Dmax and Dmean of OARs between plans for both patients. All plans met the threshold of 90%, with Halcyon plans having higher gamma passing rates. Conclusions Craniospinal irradiation plans generated for Halcyon and Edge are equivalent in terms of plan quality and dose sparing at OARs. The small variations may have originated from the differences in beam profile or mean energy, the degree of the modulation for each plan and characteristics of multi leaf collimators for each treatment unit. Halcyon is able to deliver a distinctly faster treatment, but Edge provides an automatic rotational correction for patient positioning.
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Affiliation(s)
- Theodoros Stroubinis
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, Athens, Greece,Corresponding author: Theodoros Stroubinis
| | - Michalis Psarras
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Protopapa
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, Athens, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Kalliopi Platoni
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Pediatric radiotherapy for thoracic and abdominal targets: organ motion, reported margin sizes, and delineation variations – a systematic review. Radiother Oncol 2022; 173:134-145. [DOI: 10.1016/j.radonc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
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10
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Nguyen M, Dang T, Deegan L, Henry K, Jones S, Pullar A, Cheuk R, Gibbs A, Sim L, Hargrave C. Modified volumetric modulated arc therapy technique with reduced planning and treatment time for craniospinal irradiation utilising two isocentres. J Med Radiat Sci 2022; 69:357-366. [PMID: 35460199 PMCID: PMC9442318 DOI: 10.1002/jmrs.582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Paediatric patients (individuals below 18 years of age) requiring cranial‐spinal irradiation (CSI) at our institution are commonly planned and treated using a three isocentre (3‐ISO) volumetric modulated arc therapy (VMAT) technique. A modified two isocentre (2‐ISO) VMAT technique was investigated with the aim to improve workflow and reduce planning and treatment time. Methods Five CSI paediatric patients previously treated with a 3‐ISO VMAT technique were retrospectively replanned using a 2‐ISO VMAT technique. The 2‐ISO VMAT plans were reviewed and approved by a radiation oncologist (RO) before undergoing patient‐specific quality assurance (QA) procedures, performed by a radiation oncology medical physicist (ROMP). Planning target volume (PTV) coverage, organ‐at‐risk (OAR) dose as well as planning and treatment durations of the first five patients utilising 2‐ISO technique were compared with 3‐ISO technique. Results The average percentage difference in PTV coverage by 95% reference dose between the 2‐ISO and 3‐ISO is 0.14%, and the average difference in OAR median dose is 0.68 Gy. Conformity and homogeneity indices have the same averages at 1.18 and 0.4 respectively. Patient‐specific physics QA results were all comparable with the 3‐ISO averages at 98.84% and the 2‐ISO at 98.71%. Planning duration for the 2‐ISO was reduced by up to 75%, and daily treatment duration was reduced by up to 50%. Of all the previously treated CSI patients using a 3‐ISO technique, 45% were suitable for the 2‐ISO technique. Conclusion The 2‐ISO VMAT technique provided comparable dose distribution based on PTV coverage, OAR dose and plan metric indices. Reduced planning and treatment duration with the 2‐ISO technique facilitated improved workflow with decreased sedation time for paediatric patients requiring a general anaesthesia.
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Affiliation(s)
- Minh Nguyen
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Thu Dang
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Liz Deegan
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Kelsie Henry
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Andrew Pullar
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Robyn Cheuk
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia.,Radiation Oncology and Radiation Therapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Adrian Gibbs
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Lucy Sim
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia.,Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Majer M, Ambrožová I, Davídková M, De Saint-Hubert M, Kasabašić M, Knežević Ž, Kopeć R, Krzempek D, Krzempek K, Miljanić S, Mojżeszek N, Veršić I, Stolarczyk L, Harrison RM, Olko P. Out-of-field doses in pediatric craniospinal irradiations with 3D-CRT, VMAT and scanning proton radiotherapy - a phantom study. Med Phys 2022; 49:2672-2683. [PMID: 35090187 DOI: 10.1002/mp.15493] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Craniospinal irradiation (CSI) has greatly increased survival rates for patients with a diagnosis of medulloblastoma and other primitive neuroectodermal tumors. However, as it includes exposure of a large volume of healthy tissue to unwanted doses, there is a strong concern about the complications of the treatment, especially for the children. To estimate the risk of second cancers and other unwanted effects, out-of-field dose assessment is necessary. The purpose of this study is to evaluate and compare out-of-field doses in pediatric CSI treatment using conventional and advanced photon radiotherapy (RT) and advanced proton therapy. To our knowledge, it is the first such comparison based on in-phantom measurements. Additionally, for out-of-field doses during photon RT in this and other studies, comparisons were made using analytical modeling. METHODS In order to describe the out-of-field doses absorbed in a pediatric patient during actual clinical treatment, an anthropomorphic phantom which mimics the 10-year-old child was used. Photon 3D-conformal radiotherapy (3D-CRT) and two advanced, highly conformal techniques: photon volumetric modulated arc therapy (VMAT) and active pencil beam scanning (PBS) proton radiotherapy were used for CSI treatment. Radiophotoluminescent (RPL) and poly-allyl-diglycol-carbonate (PADC) nuclear track detectors were used for photon and neutron dosimetry in the phantom, respectively. Out-of-field doses from neutrons were expressed in terms of dose equivalent. A two-Gaussian model was implemented for out-of-field doses during photon RT. RESULTS The mean VMAT photon doses per target dose to all organs in this study were under 50% of the target dose (i.e., <500 mGy/Gy), while the mean 3D-CRT photon dose to oesophagus, gall bladder and thyroid, exceeded that value. However, for 3D-CRT, better sparing was achieved for eyes and lungs. The mean PBS photon doses for all organs were up to 3 orders of magnitude lower compared to VMAT and 3D-CRT and exceeded 10 mGy/Gy only for the oesophagus, intestine and lungs. The mean neutron dose equivalent during PBS for 8 organs of interest (thyroid, breasts, lungs, liver, stomach, gall bladder, bladder, prostate) ranged from 1.2 mSv/Gy for bladder to 23.1 mSv/Gy for breasts. Comparison of out-of-field doses in this and other phantom studies found in the literature showed that a simple and fast two-Gaussian model for out-of-field doses as a function of distance from the field edge can be applied in a CSI using photon RT techniques. CONCLUSIONS PBS is the most promising technique for out-of-field dose reduction in comparison to photon techniques. Among photon techniques, VMAT is a preferred choice for most of out-of-field organs and especially for the thyroid, while doses for eyes, breasts and lungs, are lower for 3D-CRT. For organs outside the field edge, a simple analytical model can be helpful for clinicians involved in treatment planning using photon RT but also for retrospective data analysis for cancer risk estimates and epidemiology in general. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marija Majer
- Ruđer Bošković Institute, Zagreb, 10000, Croatia
| | - Iva Ambrožová
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | - Marie Davídková
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | | | - Mladen Kasabašić
- Osijek University Hospital, Osijek, 31000, Croatia.,Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Osijek, 31000, Croatia
| | | | - Renata Kopeć
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Dawid Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Katarzyna Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | | | - Natalia Mojżeszek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Ivan Veršić
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, 10000, Croatia
| | - Liliana Stolarczyk
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland.,Danish Center for Particle Therapy, Aarhus, Denmark
| | - Roger M Harrison
- University of Newcastle, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
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Rao A. Dosimetric study of Rapid Arc therapy during Craniospinal Irradiation in Adult patients. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Hussain S, Hafeez A, Nazim H, Gohar R, Mallick MJ. Field-in-Field Technique With Intrafractionally Modulated Junction Shifts for Craniospinal Irradiation Planning With Three-Dimensional Conformal Radiation Therapy. Cureus 2021; 13:e14744. [PMID: 34084672 PMCID: PMC8164000 DOI: 10.7759/cureus.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Planning craniospinal irradiation (CSI) with ''field-in-field'' (FIF) homogenization technique in combination with daily, intrafractional modulation of the field junctions is needed to avoid spinal cord overdose. Photon-based techniques for CSI may result in dose inhomogeneity within the treatment volume and usually require a weekly manual shift of the field junctions to minimize the possibility of spinal cord overdose. Nowadays, FIF technique is used to feather out the dose inhomogeneity caused by multiple fields. We have started using this technique after acquiring advanced technology machines in recent years. METHODS AND MATERIALS Sixteen patients treated with three-dimensional conformal radiation therapy (3D-CRT) for CSI were retrospectively chosen for analysis. These patients were treated during 2019-2020. Contouring of planning target volume (PTV) and organs at risk (OAR) was done, and planning was done on Varian EclipseTM Treatment Planning System (TPS) (Varian Medical Systems, Palo Alto, CA). These patients were planned with lateral craniocervical fields and posterior spinal fields using a forward-planned FIF technique. Field junctions were automatically modulated and custom-weighted for maximal homogeneity within each treatment fraction. Dose-volume histogram (DVH) was used for analysis of results. A corresponding plan without FIF technique was planned; then maximum dose at the junction was noted for each patient with both plans, and the readings were evaluated. Paired sample t-test was used to compute the p-values for the inferential statistics. RESULTS Without FIF technique, the volume receiving 110% of the prescribed dose ranged from 39% to 74% (mean: 62.12%) and volume receiving 120% dose ranged from 8% to 28% (mean: 17.68%), whereas with FIF technique, the thecal sac volume receiving 110% of dose ranged from 2% to 18% (mean: 11%) and volume receiving 120% ranged from 0% to 2%. Volume receiving 100% of the dose was also calculated in both techniques; mean values of this dose range was almost similar in both groups. Later p-value was calculated, and in both dose ranges of thecal sac volume receiving 110% and 120%, the difference in values was statistically significant. Therefore, it proved that plan inhomogeneity improved with FIF technique. This technique provided consistent dose delivery during each fraction of treatment across the junctions. The maximum doses calculated at the junction were higher in the CSI plans without FIF compared to those with FIF technique. CONCLUSION This study concludes that better dose homogeneity is achieved with FIF technique as compared to non-FIF technique, and the difference in values was statistically significant.
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Affiliation(s)
| | | | - Hira Nazim
- Oncology, Ziauddin University, Karachi, PAK
| | - Rahim Gohar
- Oncology, Aga Khan University Hospital, Nairobi, KEN
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