Skip to main content Accessibility help
×
Home

A dosimetric comparison of craniospinal irradiation using TomoDirect radiotherapy, TomoHelical radiotherapy and 3D conventional radiotherapy

  • Shirley W. S. Tsang (a1), Mark Collins (a2), Jacky T. L. Wong (a1) and George Chiu (a1)

Abstract

Aim

The purpose of this study was to dosimetrically compare TomoDirect, TomoHelical and linear accelerator-based 3D-conformal radiotherapy (Linac-3DCRT) for craniospinal irradiation (CSI) in the treatment of medulloblastoma.

Methods

Five CSI patients were replanned with Linac-3DCRT, TomoHelical, TomoDirect-3DCRT and TomoDirect-intensity-modulated radiotherapy (IMRT). Dose of 36 Gy in 20 fractions was prescribed to the planning target volume (PTV). Homogeneity index (HI), non-target integral dose (NTID), dose–volume histograms, organs-at-risk (OARs) D max, D mean and treatment times were compared.

Results

TomoHelical achieved the best PTV homogeneity compared with Linac-3DCRT, TomoDirect-3DCRT and TomoDirect-IMRT (HI of 3·6 versus 20·9, 8·7 and 9·4%, respectively). TomoDirect-IMRT achieved the lowest NTID compared with TomoDirect-3DCRT, TomoHelical and Linac-3DCRT (141 J versus 151 J, 181 J and 250 J), indicating least biological damage to normal tissues. TomoHelical plans achieved the lowest D max in all organs except the breasts, and lowest D mean for most OARs, except in laterally situated OARs, where TomoDirect triumphed. Beam-on time was longest for TomoHelical, followed by TomoDirect and Linac-3DCRT.

Findings

TomoDirect has the potential to lower NTID and shorten treatment times compared with TomoHelical. It reduces PTV inhomogeneity and better spares OARs compared with Linac-3DCRT. Therefore, TomoDirect may be a CSI treatment alternative to TomoHelical and in place of Linac-3DCRT.

Copyright

Corresponding author

Correspondence to: Mark Collins, Faculty of Health and Wellbeing, Sheffield Hallam University, F423 Robert Winston Building, Collegiate Crescent Campus, Sheffield, S10 2BP, UK. Tel: +44 114 225 5555. E-mail: m.l.collins@shu.ac.uk

References

Hide All
1. Brodin, N P, Munck Af Rosenschold, P, Aznar, M C et al. Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma. Acta Oncol 2011; 50 (6): 806816.
2. GLOBOCAN. GLOBOCAN 1: cancer incidence and mortality worldwide. J Clin Pathol 2000; 53 (2): 164.
3. Lopez Guerra, J L, Marrone, I, Jaen, J et al. Outcome and toxicity using helical tomotherapy for craniospinal irradiation in pediatric medulloblastoma. Clin Transl Oncol 2014; 16 (1): 96101.
4. Packer, R J, Gajjar, A, Vezina, G et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 2006; 24 (25): 42024208.
5. Ostrom, Q T, Gittleman, H, Liao, P et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007–2011. Neuro Oncol 2014; 16 (suppl 4): iv1iv63.
6. Fossati, P, Ricardi, U, Orecchia, R. Pediatric medulloblastoma: toxicity of current treatment and potential role of protontherapy. Cancer Treat Rev 2009; 35 (1): 7996.
7. Myers, P A, Mavroidis, P, Papanikolaou, N, Stathakis, S. Comparing conformal, arc radiotherapy and helical tomotherapy in craniospinal irradiation planning. J Appl Clin Med Phys 2014; 15 (5): 4724.
8. Barrett, A. Practical Radiotherapy Planning, 4th edition. London: Hodder Arnold, 2009; viii, 468 pp., 20–21, 214–215.
9. Penagaricano, J, Moros, E, Corry, P, Saylors, R, Ratanatharathorn, V. Pediatric craniospinal axis irradiation with helical tomotherapy: patient outcome and lack of acute pulmonary toxicity. Int J Radiat Oncol Biol Phys 2009; 75 (4): 11551161.
10. Huang, F, Parker, W, Freeman, C R. Feasibility and early outcomes of supine-position craniospinal irradiation. Pediatr Blood Cancer 2010; 54 (2): 322325.
11. Parker, W, Brodeur, M, Roberge, D, Freeman, C. Standard and nonstandard craniospinal radiotherapy using helical TomoTherapy. Int J Radiat Oncol Biol Phys 2010; 77 (3): 926931.
12. Sugie, C, Shibamoto, Y, Ayakawa, S et al. Craniospinal irradiation using helical tomotherapy: evaluation of acute toxicity and dose distribution. Technol Cancer Res Treat 2011; 10 (2): 187195.
13. TomoTherapy Treatment System. Tomo Planning Guide 105191A TomoHD Version 1.0.x. Madison, WI: TomoTherapy Incorporated, 2010.
14. Kim, J, Jeong, K, Chung, Y et al. Feasibility of TomoDirect 3D-conformal radiotherapy for craniospinal irradiation. Int J Radiat Oncol 2010; 78 (3): S828.
15. Langner, U W, Molloy, J A, Gleason, J F Jr, Feddock, J M. A feasibility study using TomoDirect for craniospinal irradiation. J Appl Clin Med Phys 2013; 14 (5): 104114.
16. Patil, V M, Oinam, A S, Chakraborty, S, Ghoshal, S, Sharma, S C. Shielding in whole brain irradiation in the multileaf collimator era: dosimetric evaluation of coverage using SFOP guidelines against in-house guidelines. J Cancer Res Ther 2010; 6 (2): 152158.
17. Patel, S, Drodge, S, Jacques, A, Warkentin, H, Powell, K, Chafe, S. A comparative planning analysis and integral dose of volumetric modulated arc therapy, helical tomotherapy, and three-dimensional conformal craniospinal irradiation for pediatric medulloblastoma. J Med Imaging Radiat Sci 2015; 46: 134140.
18. Nakamura, N, Shikama, N, Wada, H et al. Variability in the point to which single direct field irradiation is prescribed for spinal bone metastases: a survey of practice patterns in Japan. J Radiat Res 2013; 54 (6): 10651068.
19. Gupta, T, Sarin, R. Palliative radiation therapy for painful vertebral metastases: a practice survey. Cancer 2004; 101 (12): 28922896.
20. Marks, L B, Yorke, E D, Jackson, A et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76 (3 suppl): S10S19.
21. Roesink, J M, Moerland, M A, Battermann, J J, Hordijk, G J, Terhaard, C H. Quantitative dose-volume response analysis of changes in parotid gland function after radiotherapy in the head-and-neck region. Int J Radiat Oncol Biol Phys 2001; 51 (4): 938946.
22. Société Française de Radiothérapie Oncologique (SFRO). Guide des procédures de radiothérapie externe 2007, 2007. http://www.has-sante.fr/portail/upload/docs/application/pdf/2008-08/guide_de_rth_des_tumeurs_v7_complet.pdf. Accessed on 20th April 2015.
23. Verellen, D, Vanhavere, F. Risk assessment of radiation-induced malignancies based on whole-body equivalent dose estimates for IMRT treatment in the head and neck region. Radiother Oncol 1999; 53 (3): 199203.
24. Yoon, M, Shin, D H, Kim, J et al. Craniospinal irradiation techniques: a dosimetric comparison of proton beams with standard and advanced photon radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81 (3): 637646.
25. Mayneord, W V. The measurement of radiation for medical purposes. Proceedings of the Physical Society, 1942; 54: 405–421.
26. Nguyen, F, Rubino, C, Guerin, S et al. Risk of a second malignant neoplasm after cancer in childhood treated with radiotherapy: correlation with the integral dose restricted to the irradiated fields. Int J Radiat Oncol Biol Phys 2008; 70 (3): 908915.
27. Hall, E J, Wuu, C S. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003; 56 (1): 8388.
28. Barra, S, Gusinu, M, Cavagnetto, F et al. Comparison of treatment plans between 3D-CRT and helical tomotherapy based on integral dose delivered to pediatric patients receiving craniospinal irradiation. Int J Radiat Oncol Biol Phys 2010; 78 (3): S594.
29. Sharma, D S, Gupta, T, Jalali, R, Master, Z, Phurailatpam, R D, Sarin, R. High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy. Br J Radiol 2009; 82 (984): 10001009.
30. Stovall, M, Smith, S A, Langholz, B M et al. Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. Int J Radiat Oncol Biol Phys 2008; 72 (4): 10211030.
31. Srivastava, R, Saini, G, Sharma, P K et al. A technique to reduce low dose region for craniospinal irradiation (CSI) with RapidArc and its dosimetric comparison with 3D conformal technique (3DCRT). J Cancer Res Ther 2015; 11 (2): 488491.

Keywords

A dosimetric comparison of craniospinal irradiation using TomoDirect radiotherapy, TomoHelical radiotherapy and 3D conventional radiotherapy

  • Shirley W. S. Tsang (a1), Mark Collins (a2), Jacky T. L. Wong (a1) and George Chiu (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed