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Title: Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

Abstract

The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared in terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose.more » HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.« less

Authors:
 [1];  [2]
  1. Regional Medical Physics Department, Freeman Hospital, Freeman Road, Newcastle upon Tyne (United Kingdom)
  2. Northern Centre for Cancer Care, Freeman Hospital, Freeman Road, Newcastle upon Tyne (United Kingdom)
Publication Date:
OSTI Identifier:
22130394
Resource Type:
Journal Article
Journal Name:
Medical Dosimetry
Additional Journal Information:
Journal Volume: 37; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0958-3947
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; BRAIN; COMPUTERIZED TOMOGRAPHY; CT-GUIDED RADIOTHERAPY; DIAPHRAGM; DOSIMETRY; ELECTRONS; EYES; HEALTH HAZARDS; HEART; INFLAMMATION; INTEGRAL DOSES; IRRADIATION; LINEAR ACCELERATORS; NEOPLASMS; PATIENTS; PEDIATRICS; PHOTONS; THYROID; VERTEBRAE

Citation Formats

Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk, and Lewis, Joanne. Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method. United States: N. p., 2012. Web. doi:10.1016/J.MEDDOS.2011.06.002.
Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk, & Lewis, Joanne. Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method. United States. doi:10.1016/J.MEDDOS.2011.06.002.
Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk, and Lewis, Joanne. Sun . "Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method". United States. doi:10.1016/J.MEDDOS.2011.06.002.
@article{osti_22130394,
title = {Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method},
author = {Harron, Elizabeth, E-mail: elizabeth.harron@nuh.nhs.uk and Lewis, Joanne},
abstractNote = {The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared in terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.},
doi = {10.1016/J.MEDDOS.2011.06.002},
journal = {Medical Dosimetry},
issn = {0958-3947},
number = 2,
volume = 37,
place = {United States},
year = {2012},
month = {7}
}