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Title: Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations

Abstract

Purpose: To optimally exploit fractionation effects in the context of radiosurgery treatments of large cerebral arteriovenous malformations (AVMs). In current practice, fractionated treatments divide the dose evenly into several fractions, which generally leads to low obliteration rates. In this work, we investigate the potential benefit of delivering distinct dose distributions in different fractions. Methods and Materials: Five patients with large cerebral AVMs were reviewed and replanned for intensity modulated arc therapy delivered with conventional photon beams. Treatment plans allowing for different dose distributions in all fractions were obtained by performing treatment plan optimization based on the cumulative biologically effective dose delivered at the end of treatment. Results: We show that distinct treatment plans can be designed for different fractions, such that high single-fraction doses are delivered to complementary parts of the AVM. All plans create a similar dose bath in the surrounding normal brain and thereby exploit the fractionation effect. This partial hypofractionation in the AVM along with fractionation in normal brain achieves a net improvement of the therapeutic ratio. We show that a biological dose reduction of approximately 10% in the healthy brain can be achieved compared with reference treatment schedules that deliver the same dose distribution in allmore » fractions. Conclusions: Boosting complementary parts of the target volume in different fractions may provide a therapeutic advantage in fractionated radiosurgery treatments of large cerebral AVMs. The strategy allows for a mean dose reduction in normal brain that may be valuable for a patient population with an otherwise normal life expectancy.« less

Authors:
 [1];  [1];  [2]; ;  [1]
  1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)
  2. Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States)
Publication Date:
OSTI Identifier:
22648721
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 95; Journal Issue: 3; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; FRACTIONATED IRRADIATION; MALFORMATIONS; PHOTON BEAMS; RADIATION DOSE DISTRIBUTIONS

Citation Formats

Unkelbach, Jan, E-mail: junkelbach@mgh.harvard.edu, Bussière, Marc R., Chapman, Paul H., Loeffler, Jay S., and Shih, Helen A. Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2016.02.001.
Unkelbach, Jan, E-mail: junkelbach@mgh.harvard.edu, Bussière, Marc R., Chapman, Paul H., Loeffler, Jay S., & Shih, Helen A. Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations. United States. doi:10.1016/J.IJROBP.2016.02.001.
Unkelbach, Jan, E-mail: junkelbach@mgh.harvard.edu, Bussière, Marc R., Chapman, Paul H., Loeffler, Jay S., and Shih, Helen A. Fri . "Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations". United States. doi:10.1016/J.IJROBP.2016.02.001.
@article{osti_22648721,
title = {Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations},
author = {Unkelbach, Jan, E-mail: junkelbach@mgh.harvard.edu and Bussière, Marc R. and Chapman, Paul H. and Loeffler, Jay S. and Shih, Helen A.},
abstractNote = {Purpose: To optimally exploit fractionation effects in the context of radiosurgery treatments of large cerebral arteriovenous malformations (AVMs). In current practice, fractionated treatments divide the dose evenly into several fractions, which generally leads to low obliteration rates. In this work, we investigate the potential benefit of delivering distinct dose distributions in different fractions. Methods and Materials: Five patients with large cerebral AVMs were reviewed and replanned for intensity modulated arc therapy delivered with conventional photon beams. Treatment plans allowing for different dose distributions in all fractions were obtained by performing treatment plan optimization based on the cumulative biologically effective dose delivered at the end of treatment. Results: We show that distinct treatment plans can be designed for different fractions, such that high single-fraction doses are delivered to complementary parts of the AVM. All plans create a similar dose bath in the surrounding normal brain and thereby exploit the fractionation effect. This partial hypofractionation in the AVM along with fractionation in normal brain achieves a net improvement of the therapeutic ratio. We show that a biological dose reduction of approximately 10% in the healthy brain can be achieved compared with reference treatment schedules that deliver the same dose distribution in all fractions. Conclusions: Boosting complementary parts of the target volume in different fractions may provide a therapeutic advantage in fractionated radiosurgery treatments of large cerebral AVMs. The strategy allows for a mean dose reduction in normal brain that may be valuable for a patient population with an otherwise normal life expectancy.},
doi = {10.1016/J.IJROBP.2016.02.001},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 95,
place = {United States},
year = {Fri Jul 01 00:00:00 EDT 2016},
month = {Fri Jul 01 00:00:00 EDT 2016}
}