Atmaram S Pai Panandiker1, Chris Beltran2, Jonathan Gray2, Chiaho Hua2. 1. Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: Atmaram.Pai-Panandiker@STJUDE.ORG. 2. Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
PURPOSE: Our purpose was to determine methods for image guided intensity modulated radiation therapy (IMRT) in pediatric abdominal high-risk neuroblastoma and to quantify the degree of normal tissue dose reduction by using volumes compliant with International Commission on Radiation Units and Measurements (ICRU) Report 62. METHODS AND MATERIALS: Eight consecutive children with high-risk abdominal neuroblastoma (median age, 2.5 years; range, 20 months-5 years) were treated with IMRT using volumes accounting for physiologic motion (IMRT_phys) and daily pretreatment cone beam computed tomographic localization. Comparative IMRT planning using conventional volumes (IMRT_std) provided quantification for dose reduction to normal tissues. RESULTS: The IMRT_phys plan reduced the mean planning target volume from 668.8 ± 200.6 cc to 393.0 ± 132.5 cc (P < .001) and reduced mean body V50 from 1774.4 ± 383.9 cc to 1385.7 ± 365.7 cc (P < .001). The IMRT_phys plan reduced the percent mean dose to the ipsilateral kidney from 70.1% ± 4.3% to 66.0% ± 5.2% (P =.002); that to the contralateral kidney was reduced from 56.3% ± 7.0% to 40.7% ± 9.5% (P < .001), and that to the liver was reduced from 57.8% ± 16.0% to 22.1% ± 6.8% (P = .001). CONCLUSIONS: For IMRT planning, ICRU 62-compliant volume definition with image guidance in the pediatric abdomen enables volumetric reduction of the planning target volume and reduces normal tissue dose. These methods provide a framework for more conformal treatment planning in the pediatric abdomen.
PURPOSE: Our purpose was to determine methods for image guided intensity modulated radiation therapy (IMRT) in pediatric abdominal high-risk neuroblastoma and to quantify the degree of normal tissue dose reduction by using volumes compliant with International Commission on Radiation Units and Measurements (ICRU) Report 62. METHODS AND MATERIALS: Eight consecutive children with high-risk abdominal neuroblastoma (median age, 2.5 years; range, 20 months-5 years) were treated with IMRT using volumes accounting for physiologic motion (IMRT_phys) and daily pretreatment cone beam computed tomographic localization. Comparative IMRT planning using conventional volumes (IMRT_std) provided quantification for dose reduction to normal tissues. RESULTS: The IMRT_phys plan reduced the mean planning target volume from 668.8 ± 200.6 cc to 393.0 ± 132.5 cc (P < .001) and reduced mean body V50 from 1774.4 ± 383.9 cc to 1385.7 ± 365.7 cc (P < .001). The IMRT_phys plan reduced the percent mean dose to the ipsilateral kidney from 70.1% ± 4.3% to 66.0% ± 5.2% (P =.002); that to the contralateral kidney was reduced from 56.3% ± 7.0% to 40.7% ± 9.5% (P < .001), and that to the liver was reduced from 57.8% ± 16.0% to 22.1% ± 6.8% (P = .001). CONCLUSIONS: For IMRT planning, ICRU 62-compliant volume definition with image guidance in the pediatric abdomen enables volumetric reduction of the planning target volume and reduces normal tissue dose. These methods provide a framework for more conformal treatment planning in the pediatric abdomen.
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Authors: Atmaram S Pai Panandiker; Shelly Sharma; Mihir H Naik; Shengjie Wu; Chiaho Hua; Chris Beltran; Matthew J Krasin; Thomas E Merchant Journal: Int J Radiat Oncol Biol Phys Date: 2011-05-27 Impact factor: 7.038
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