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Title: Physiologic and Radiographic Evidence of the Distal Edge of the Proton Beam in Craniospinal Irradiation

Abstract

Purpose: Fatty replacement of bone marrow resulting from radiation therapy can be seen on T1-weighted magnetic resonance (MR) images. We evaluated the radiographic appearance of the vertebral bodies in children treated with proton craniospinal irradiation (CSI) to illustrate the distal edge effect of proton radiotherapy. Methods and Materials: The study cohort consisted of 13 adolescents aged 12-18 years who received CSI with proton radiotherapy at Massachusetts General Hospital. Ten of these patients had reached maximal or near-maximal growth. Proton beam radiation for these 10 patients was delivered to the thecal sac and exiting nerve roots only, whereas the remaining 3 patients had a target volume that included the thecal sac, exiting nerve roots, and entire vertebral bodies. Median CSI dose was 27 [range, 23.4-36] cobalt gray equivalent (CGE) given in 1.8-CGE fractions. Magnetic resonance images of the spine were obtained after completion of radiotherapy. Results: Magnetic resonance images of patients who received proton radiotherapy to the thecal sac only demonstrate a sharp demarcation of hyperintense T1-weighted signal in the posterior aspects of the vertebral bodies, consistent with radiation-associated fatty marrow replacement. Magnetic resonance images of the patients prescribed proton radiotherapy to the entire vertebral column had corresponding hyperintense T1-weighted signalmore » involving the entire vertebral bodies. Conclusion: The sharp delineation of radiation-associated fatty marrow replacement in the vertebral bodies demonstrates the rapid decrease in energy at the edge of the proton beam. This provides evidence for a sharp fall-off in radiation dose and supports the premise that proton radiotherapy spares normal tissues unnecessary irradiation.« less

Authors:
 [1];  [2];  [2];  [1];  [1]
  1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
  2. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States)
Publication Date:
OSTI Identifier:
20951687
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 68; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2007.02.021; PII: S0360-3016(07)00243-X; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BONE MARROW; DOSIMETRY; IMAGES; IRRADIATION; NMR IMAGING; PATIENTS; PROTON BEAMS; RADIATION DOSES; RADIOTHERAPY; VERTEBRAE

Citation Formats

Krejcarek, Stephanie C, Grant, P Ellen, Henson, John W, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, Tarbell, Nancy J, and Yock, Torunn I. Physiologic and Radiographic Evidence of the Distal Edge of the Proton Beam in Craniospinal Irradiation. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2007.02.021.
Krejcarek, Stephanie C, Grant, P Ellen, Henson, John W, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, Tarbell, Nancy J, & Yock, Torunn I. Physiologic and Radiographic Evidence of the Distal Edge of the Proton Beam in Craniospinal Irradiation. United States. https://doi.org/10.1016/j.ijrobp.2007.02.021
Krejcarek, Stephanie C, Grant, P Ellen, Henson, John W, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, Tarbell, Nancy J, and Yock, Torunn I. 2007. "Physiologic and Radiographic Evidence of the Distal Edge of the Proton Beam in Craniospinal Irradiation". United States. https://doi.org/10.1016/j.ijrobp.2007.02.021.
@article{osti_20951687,
title = {Physiologic and Radiographic Evidence of the Distal Edge of the Proton Beam in Craniospinal Irradiation},
author = {Krejcarek, Stephanie C and Grant, P Ellen and Henson, John W and Pappas Center for Neuro-oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA and Tarbell, Nancy J and Yock, Torunn I},
abstractNote = {Purpose: Fatty replacement of bone marrow resulting from radiation therapy can be seen on T1-weighted magnetic resonance (MR) images. We evaluated the radiographic appearance of the vertebral bodies in children treated with proton craniospinal irradiation (CSI) to illustrate the distal edge effect of proton radiotherapy. Methods and Materials: The study cohort consisted of 13 adolescents aged 12-18 years who received CSI with proton radiotherapy at Massachusetts General Hospital. Ten of these patients had reached maximal or near-maximal growth. Proton beam radiation for these 10 patients was delivered to the thecal sac and exiting nerve roots only, whereas the remaining 3 patients had a target volume that included the thecal sac, exiting nerve roots, and entire vertebral bodies. Median CSI dose was 27 [range, 23.4-36] cobalt gray equivalent (CGE) given in 1.8-CGE fractions. Magnetic resonance images of the spine were obtained after completion of radiotherapy. Results: Magnetic resonance images of patients who received proton radiotherapy to the thecal sac only demonstrate a sharp demarcation of hyperintense T1-weighted signal in the posterior aspects of the vertebral bodies, consistent with radiation-associated fatty marrow replacement. Magnetic resonance images of the patients prescribed proton radiotherapy to the entire vertebral column had corresponding hyperintense T1-weighted signal involving the entire vertebral bodies. Conclusion: The sharp delineation of radiation-associated fatty marrow replacement in the vertebral bodies demonstrates the rapid decrease in energy at the edge of the proton beam. This provides evidence for a sharp fall-off in radiation dose and supports the premise that proton radiotherapy spares normal tissues unnecessary irradiation.},
doi = {10.1016/j.ijrobp.2007.02.021},
url = {https://www.osti.gov/biblio/20951687}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 68,
place = {United States},
year = {Sun Jul 01 00:00:00 EDT 2007},
month = {Sun Jul 01 00:00:00 EDT 2007}
}