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Title: Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy

Abstract

Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm{sup 3}, occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy{sub 2} using helical tomotherapy and by 81% to 0.73 Gy{sub 2} using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-offmore » with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.« less

Authors:
 [1];  [2];  [1];  [1];  [3];  [1];  [1]
  1. Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, WI (United States)
  2. Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI (United States)
  3. Department of Neuroradiology, University of Wisconsin Comprehensive Cancer Center, Madison, WI (United States)
Publication Date:
OSTI Identifier:
21438062
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 78; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2010.01.039; PII: S0360-3016(10)00139-2; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; AVOIDANCE; COMPUTERIZED TOMOGRAPHY; CT-GUIDED RADIOTHERAPY; HIPPOCAMPUS; LINEAR ACCELERATORS; RADIATION DOSES; ACCELERATORS; BEHAVIOR; BODY; BRAIN; CENTRAL NERVOUS SYSTEM; DIAGNOSTIC TECHNIQUES; DOSES; MEDICINE; NERVOUS SYSTEM; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; RADIOTHERAPY; THERAPY; TOMOGRAPHY

Citation Formats

Gondi, Vinai, Tolakanahalli, Ranjini, Mehta, Minesh P, Tewatia, Dinesh, Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Rowley, Howard, Kuo, John S, Department of Neurological Surgery, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Khuntia, Deepak, Tome, Wolfgang A., E-mail: tome@humonc.wisc.ed, and Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI. Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2010.01.039.
Gondi, Vinai, Tolakanahalli, Ranjini, Mehta, Minesh P, Tewatia, Dinesh, Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Rowley, Howard, Kuo, John S, Department of Neurological Surgery, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Khuntia, Deepak, Tome, Wolfgang A., E-mail: tome@humonc.wisc.ed, & Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI. Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy. United States. https://doi.org/10.1016/j.ijrobp.2010.01.039
Gondi, Vinai, Tolakanahalli, Ranjini, Mehta, Minesh P, Tewatia, Dinesh, Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Rowley, Howard, Kuo, John S, Department of Neurological Surgery, University of Wisconsin Comprehensive Cancer Center, Madison, WI, Khuntia, Deepak, Tome, Wolfgang A., E-mail: tome@humonc.wisc.ed, and Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI. 2010. "Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy". United States. https://doi.org/10.1016/j.ijrobp.2010.01.039.
@article{osti_21438062,
title = {Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy},
author = {Gondi, Vinai and Tolakanahalli, Ranjini and Mehta, Minesh P and Tewatia, Dinesh and Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI and Rowley, Howard and Kuo, John S and Department of Neurological Surgery, University of Wisconsin Comprehensive Cancer Center, Madison, WI and Khuntia, Deepak and Tome, Wolfgang A., E-mail: tome@humonc.wisc.ed and Department of Medical Physics, University of Wisconsin Comprehensive Cancer Center, Madison, WI},
abstractNote = {Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm{sup 3}, occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy{sub 2} using helical tomotherapy and by 81% to 0.73 Gy{sub 2} using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.},
doi = {10.1016/j.ijrobp.2010.01.039},
url = {https://www.osti.gov/biblio/21438062}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 78,
place = {United States},
year = {Mon Nov 15 00:00:00 EST 2010},
month = {Mon Nov 15 00:00:00 EST 2010}
}