Martin T King1, Laszlo Voros2, Gil'ad N Cohen2, Ryan M Lanning1, Ian Ganly3, Chibuzo C O'Suoji4, Suzanne L Wolden5. 1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. 2. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY. 3. Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. 4. Department of Pediatrics, West Virginia University School of Medicine, Charleston, WV. 5. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: woldens@mskcc.org.
Abstract
PURPOSE: To report on the single-catheter high-dose-rate brachytherapy treatment of a 21-month-old girl child with an embryonal, botryoid-type, rhabdomyosarcoma limited to the external auditory canal (EAC). METHODS AND MATERIALS: A 2.4-mm diameter catheter was inserted into the right EAC and placed against the tympanic membrane. A computed tomography simulation scan was acquired. A brachytherapy treatment plan, in which 21 Gy in seven fractions was prescribed to a 1-mm depth along the distal 2 cm of the catheter, was generated. Treatments were delivered under anesthesia without complication. A dosimetric comparison between this plan and an intensity-modulated radiation therapy (IMRT) plan was then conducted. A clinical target volume (CTV), which encompassed a 1-mm margin along the distal 2 cm of the catheter, was delineated for both plans. Given positioning uncertainty under image guidance, a planning target volume (PTV = CTV + 3-mm margin) was defined for the IMRT plan. The IMRT plan was optimized for maximal CTV coverage but subsequently normalized to the same CTV volume receiving 100% of the prescription dose (V100) of the brachytherapy plan. RESULTS: The IMRT plan was normalized to the brachytherapy CTV V100 of 82.0%. The PTV V100 of this plan was 34.1%. The PTV exhibited dosimetric undercoverage within the middle ear and toward the external ear. Mean cochlea doses for the IMRT and brachytherapy plans were 26.7% and 10.5% of prescription, respectively. CONCLUSIONS: For rhabdomyosarcomas limited to the EAC, a standard brachytherapy catheter can deliver a highly conformal radiation plan that can spare the nearby cochlea from excess radiation.
PURPOSE: To report on the single-catheter high-dose-rate brachytherapy treatment of a 21-month-old girlchild with an embryonal, botryoid-type, rhabdomyosarcoma limited to the external auditory canal (EAC). METHODS AND MATERIALS: A 2.4-mm diameter catheter was inserted into the right EAC and placed against the tympanic membrane. A computed tomography simulation scan was acquired. A brachytherapy treatment plan, in which 21 Gy in seven fractions was prescribed to a 1-mm depth along the distal 2 cm of the catheter, was generated. Treatments were delivered under anesthesia without complication. A dosimetric comparison between this plan and an intensity-modulated radiation therapy (IMRT) plan was then conducted. A clinical target volume (CTV), which encompassed a 1-mm margin along the distal 2 cm of the catheter, was delineated for both plans. Given positioning uncertainty under image guidance, a planning target volume (PTV = CTV + 3-mm margin) was defined for the IMRT plan. The IMRT plan was optimized for maximal CTV coverage but subsequently normalized to the same CTV volume receiving 100% of the prescription dose (V100) of the brachytherapy plan. RESULTS: The IMRT plan was normalized to the brachytherapy CTV V100 of 82.0%. The PTV V100 of this plan was 34.1%. The PTV exhibited dosimetric undercoverage within the middle ear and toward the external ear. Mean cochlea doses for the IMRT and brachytherapy plans were 26.7% and 10.5% of prescription, respectively. CONCLUSIONS: For rhabdomyosarcomas limited to the EAC, a standard brachytherapy catheter can deliver a highly conformal radiation plan that can spare the nearby cochlea from excess radiation.
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