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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] [What about the content of this article? (0)] [Affiliation(s)] [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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