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Choice of appropriate beam model and gantry rotational angle for low-dose gradient-based craniospinal irradiation using volumetric-modulated arc therapy

Published online by Cambridge University Press:  04 November 2016

Biplab Sarkar  and
Anirudh Pradhan
Biplab Sarkar*
Affiliation:
Department of Physics, GLA University, Mathura, Uttar Pradesh, India Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Anirudh Pradhan
Affiliation:
Department of Mathematics, GLA University, Mathura, Uttar Pradesh, India
*
Correspondence to: Biplab Sarkar, Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana 122002, India. Tel: +91 956 012 8094. E-mail: [email protected]
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Abstract

Objectives

We aimed to assess the impact of advanced multileaf collimator (MLC) models and flattening filter-free (3F) beam in volumetric-modulated arc therapy (VMAT)-based craniospinal irradiation (CSI).

Methods

CT scans of five medulloblastoma patients who previously received CSI at our hospital were used for the present study. Patients were planned for a prescription dose of 35 Gy to craniospinal axis. A three-dimensional conformal radiotherapy (3DCRT) plan and a VMAT plan using 1 cm MLC leaf width were generated as the gold standard (reference arm). Test VMAT plans were generated using Agility MLC model (MLC leaf width 5 mm) for various combinations of flattened beam (F) and 3F beam for treating the brain and spine planning target volume (PTV). Organs at risks (OARs) were analysed for dose 5, 50, 75 and 90% volumes, mean dose and maximum dose.

Results

All 3DCRT plans and VMAT plans were aimed to cover 95% of PTV by at least 95% prescription dose. VMAT demonstrated lesser dose spillage than 3DCRT to body volume minus PTV (NTID: non tumor integral dose) for a dose threshold above 7·5 Gy. For the low-dose range (1–7 Gy), variation between the dose coverage between all VMAT plans (for either spine or brain PTV) was <1%. Intra-VMAT plan dose variation for all OAR’s for all tested parameters was <1 Gy. Average monitor unit (MU) difference among different VMAT plans ranged between 1·52 and 2·13 when normalised to 3DCRT MU. For VMAT plans, flat beam with 1 cm MLC showed the highest MU, whereas Agility MLC with 3F beam had the least MU values for intra-VMAT plans. No statistical significance variation (p) was observed in between reference arm and test arm plans except for mean dose and V107% for PTV spine. When compared between reference arm 3DCRT and test arm VMAT plans. For OAR’s, no statistical difference was observed between reference and test arm VMAT plans.

Conclusions

Reference arm plans and test arm plans exhibit no statistically significant difference. However, as compared with 3DCRT, VMAT plans are more conformal and produce lesser dose to OAR at the cost of higher delivered MU. 3F beams or finer width MLC’s (width <5 mm) have no advantage over the conventional 1 cm MLC and flat beam except that 3F beams have a shorter beam delivery time. This study demonstrate a significantly lesser spillage dose to NTID/body that of the reported literature, which is attributed to limited rotational arc length used for VMAT plans.

Keywords

craniospinal irradiation (CSI)FFFjunction-free techniquePNETVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 1 , March 2017 , pp. 53 - 64
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Copyright
© Cambridge University Press 2016 

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References

1. Gottardo, N G, Gajjar, A. Current therapy for medulloblastoma. Curr Treat Options Neurol 2006; 8: 319–334.CrossRefGoogle ScholarPubMed
2. Packer, R J, Vezina, G. Management of and prognosis with medulloblastoma: therapy at a crossroads. Arch Neurol 2008; 65: 1419–1424.CrossRefGoogle Scholar
3. 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: 4202–4208.CrossRefGoogle ScholarPubMed
4. Freeman, C R, Taylor, R E, Kortmann, R D, Carrie, C. Radiotherapy for medulloblastoma in children: a perspective on current international clinical research efforts. Med Pediatr Oncol 2002; 39: 99–108.CrossRefGoogle ScholarPubMed
5. del Charco, J O, Bolek, T W, McCollough, W M et al. Medulloblastoma: time-dose relationship based on a 30-year review. Int J Radiat Oncol Biol Phys 1998; 42: 147–154.CrossRefGoogle ScholarPubMed
6. Packer, R J, Sutton, L N, Goldwein, J W et al. Improved survival with the use of adjuvant chemotherapy in the treatment of medulloblastoma. J Neurosurg 1991; 74: 433–440.CrossRefGoogle ScholarPubMed
7. Packer, R J, Sutton, L N, Elterman, R et al. Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. Neurosurgery 1994; 81: 690–698.CrossRefGoogle ScholarPubMed
8. Munshi, A, Jalali, R. A simple technique of supine craniospinal irradiation. Med Dosim 2008; 33 (1): 1–5.CrossRefGoogle ScholarPubMed
9. Liu, A K, Thornton, D, Backus, J, Dzingle, W, Stoehr, S, Newman, F. Supine craniospinal irradiation setup with two spine fields. Med Dosim 2009; 34: 214–216.CrossRefGoogle ScholarPubMed
10. Christ, G, Denninger, D, Dohm, O S, Weigel, B, Hönes, A, Paulsen, F. Craniospinal radiotherapy in an advanced technique. Strahlenther Onkol 2008; 184: 530–535.CrossRefGoogle Scholar
11. Dewit, L, Van Dam, J, Rijnders, A, van de Velde, G, Ang, K K, van der Schueren, E. A modified radiotherapy technique in the treatment of medulloblastoma. Int J Radiat Oncol Biol Phys 1984; 10: 231–241.CrossRefGoogle ScholarPubMed
12. Fogliata, A, Bergström, S, Cafaro, I et al. Cranio-spinal irradiation with volumetric modulated arc therapy: a multi-institutional treatment experience. Radiother Oncol 2011; 99: 79–85.CrossRefGoogle ScholarPubMed
13. Lee, Y K, Brooks, C J, Bedford, J L, Warrington, A P, Saran, F H. Development and evaluation of multiple isocentric volumetric modulated arc therapy technique for craniospinal axis radiotherapy planning. Int J Radiat Oncol Biol Phys 2012; 82: 1006–1012.CrossRefGoogle ScholarPubMed
14. 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: 1000–1009.CrossRefGoogle ScholarPubMed
15. Bloom, H J G. Medulloblastoma in children: increasing survival rates and further prospects. Int J Radiat Oncol Biol Phys 1982; 8: 2023–2027.CrossRefGoogle ScholarPubMed
16. Bloom, H J G, Glees, J, Bell, J. The treatment and long-term prognosis of children with intracranial tumors: a study of 610 cases, 1950–1981. Int J Radiat Oncol Biol Phys 1990; 18: 723–745.CrossRefGoogle ScholarPubMed
17. Deutsch, M, Thomas, P R, Krischer, J et al. Results of a prospective randomized trial comparing standard dose neuraxis irradiation (3600cGy/20) with reduced neuraxis irradiation (2340/13) in patients with low-stage medulloblastoma. Pediatr Neurosurg 1996; 24: 167–177.CrossRefGoogle Scholar
18. Ganesh, T, Sarkar, B, Munshi, A, Mohanti, B. SU-FT-429: Craniospinal Irradiation by VMAT Technique: Impact of FFF Beam and High Resolution MLC On Plan Quality. Med Phys 2016; 43: 3561--3561.CrossRefGoogle Scholar
19. Jan, S, Jarmo, K, Paula, L, Heikki, M. A method to improve target dose homogeneity of craniospinal irradiation using dynamic split field IMRT. Radiother Oncol 2010; 96: 209–215.Google Scholar
20. Hadley, A, Ding, GX. A single-gradient junction technique to replace multiple-junction shifts for craniospinal irradiation treatment. Med Dosim 2014; 39: 314–319.CrossRefGoogle ScholarPubMed
21. Shaffer, R, Vollans, E, Vellani, R, Welsh, M, Moiseenko, V, Goddard, K. A radiotherapy planning study of RapidArc, intensity modulated radiotherapy, three-dimensional conformal radiotherapy, and parallel opposed beams in the treatment of pediatric retroperitoneal tumors. Pediatr Blood Cancer 2011; 56: 16–23.CrossRefGoogle ScholarPubMed
22. Teoh, M, Clark, C H, Wood, K, Whitaker, S, Nisbet, A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84: 967–996.CrossRefGoogle ScholarPubMed
23. Pai Panandiker, A, Ning, H, Likhacheva, A et al. Craniospinal irradiation with spinal IMRT to improve target homogeneity. Int J Radiat Oncol Biol Phys 2007; 68: 1402–1409.CrossRefGoogle ScholarPubMed
24. Wilkinson, J M, Lewis, J, Lawrence, G P, Lucraft, H H, Murphy, E. Craniospinal irradiation using a forward planned segmented field technique. Br J Radiol 2007; 80: 209–215.CrossRefGoogle ScholarPubMed
25. South, M, Chiu, J K, Teh, B S, Bloch, C, Schroeder, T M, Paulino, A C. Supine craniospinal irradiation using intrafractional junction shifts and field-in-field dose shaping: early experience at Methodist Hospital. Int J Radiat Oncol Biol Phys 2008; 71: 477–483.CrossRefGoogle ScholarPubMed
26. Reggiori, G, Mancosu, P, Castiglioni, S et al. Can volumetric modulated arc therapy with flattening filter free beams play a role in stereotactic body radiotherapy for liver lesions? A volume-based analysis. Med Phys 2012; 39: 1112–1118.CrossRefGoogle ScholarPubMed
27. Dzierma, Y, Bell, K, Palm, J, Nuesken, F, Licht, N, Rübe, C. mARC vs. IMRT radiotherapy of the prostate with flat and flattening-filter-free beam energies. Radiat Oncol 2014; 9: 250.CrossRefGoogle ScholarPubMed
28. Nicolini, G, Ghosh-Laskar, S, Shrivastava, S K et al. Volumetric modulation arc radiotherapy with flattening filter-free beams compared with static gantry IMRT and 3D conformal radiotherapy for advanced esophageal cancer: a feasibility study. Int J Radiat Oncol Biol Phys 2012; 84: 553–560.CrossRefGoogle ScholarPubMed
29. Navarria, P, Ascolese, A M, Mancosu, P et al. Volumetric modulated arc therapy with flattening filter free (3F) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non-small cell lung cancer (NSCLC). Radiother Oncol 2013; 107: 414–418.CrossRefGoogle Scholar
30. Thomas, E M, Popple, R A, Prendergast, B M, Clark, G M, Dobelbower, M C, Fiveash, J B. Effects of flattening filter-free and volumetric-modulated arc therapy delivery on treatment efficiency. J Appl Clin Med Phys 2013; 14: 4328.CrossRefGoogle ScholarPubMed
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