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Hippocampus avoidance with fan beam and volumetric arc radiotherapy for base of skull tumours

Published online by Cambridge University Press:  07 July 2010

Ericka Wiebe ,
Luca Cozzi ,
Slav Yartsev ,
Antonella Fogliata ,
Alessandro Clivio ,
Eugenio Vanetti ,
Giorgia Nicolini ,
Jeff Chen ,
Andrew Leung  and
Glenn Bauman
Ericka Wiebe
Affiliation:
Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
Luca Cozzi
Affiliation:
Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Slav Yartsev
Affiliation:
Department of Physics and Engineering, London Regional Cancer Program, London, Ontario, Canada Department of Medical Biophysics, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada Department of Oncology, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
Antonella Fogliata
Affiliation:
Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Alessandro Clivio
Affiliation:
Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Eugenio Vanetti
Affiliation:
Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Giorgia Nicolini
Affiliation:
Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Jeff Chen
Affiliation:
Department of Physics and Engineering, London Regional Cancer Program, London, Ontario, Canada Department of Medical Biophysics, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada Department of Oncology, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
Andrew Leung
Affiliation:
Department of Medical Imaging, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
Glenn Bauman*
Affiliation:
Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada Department of Medical Biophysics, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada Department of Oncology, London Health Sciences Centre and Schulich School of Medicine & Dentistry, University of Western Ontario, Canada
*
Correspondence to: Glenn Bauman, Department of Radiation Oncology, London Regional Cancer Program, Department of Medical Imaging, London Health Sciences Centre, 790 Commissioners Rd E, London, Ontario, N6A 4L6, Canada. Email: glenn.bauman@lhsc.on.ca
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Abstract

Radiosensitive neurogenic stem cells reside in the hippocampi, suggesting that avoidance of the hippocampi may be an important strategy to reduce potential radiation-related cognitive effects. Six patients treated for base of skull tumours were re-planned using co-planar helical fan beam arc therapy (tomotherapy) and co-planar and non-coplanar volumetric arc techniques (RapidArc). The hippocampi were contoured as avoidance structures with the specific goal of minimising the dose. Two gross target volume (GTV) to planning target volume (PTV) expansions (10 and 2 mm) were considered to evaluate the impact of margin selection on organ at risk (OAR) sparing. The dose prescription was 50 Gy to >95% of the PTV. Comparison of the hippocampus avoidance plans demonstrated the importance of non-coplanar delivery when the 10 mm margin was used. With the 2 mm margin, both co-planar and non-coplanar delivery provided similar degrees of sparing. A mean dose of 3–4 Gy and a V6Gy <5% to the hippocampi was realised with the hippocampus sparing techniques. Our comparisons suggest interventions to minimise GTV to PTV margins will have a more profound influence on multiple OAR sparing than the choice of intensity modulated arc delivery technique.

Keywords

Hippocampusintensity modulated radiotherapybrain tumour
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 9 , Issue 2 , June 2010 , pp. 87 - 98
Copyright
Copyright © Cambridge University Press 2010

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