Enrica Seravalli1, Mirjam Bosman1, Yasmin Lassen-Ramshad2, Anne Vestergaard2, Foppe Oldenburger3, Jorrit Visser3, Efi Koutsouveli4, Chryssa Paraskevopoulou4, Gail Horan5, Thankamma Ajithkumar5, Beate Timmermann6, Carolina-Sofia Fuentes6, Gillian Whitfield7, Thomas Marchant8, Laetitia Padovani9, Eloise Garnier9, Lorenza Gandola10, Silvia Meroni10, Bianca A W Hoeben11, Martijn Kusters11, Claire Alapetite12, Sandra Losa12, Farid Goudjil12, Henriette Magelssen13, Morten Egeberg Evensen13, Frank Saran14, Gregory Smyth15, Barbara Rombi16, Roberto Righetto16, Rolf-Dieter Kortmann17, Geert O Janssens1. 1. a Department of Radiation Oncology , University Medical Center Utrecht and Princess Maxima Centre for Pediatric Oncology , Utrecht , The Netherlands. 2. b Department of Oncology and Danish Center for Particle Therapy , Aarhus University Hospital , Aarhus , Denmark. 3. c Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands. 4. d Department of Radiation Oncology , Hygeia Hospital , Athens , Greece. 5. e Department of Oncology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK. 6. f Clinic for Particle Therapy , West German Protontherapy Center Essen, University Hospital Essen , Essen , Germany. 7. g The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK and The Children's Brain Tumour Research Network, University of Manchester, Royal Mancheste Children's Hospital , Manchester , UK. 8. h The Christie NHS Foundation Trust , Manchester , UK. 9. i Department of Radiotherapy , Centre Hospitalier Universitaire de La Timone , Marseille , France. 10. j Pediatric Radiotherapy Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy. 11. k Department of Radiation Oncology , Radboud University Medical Center , Nijmegen , The Netherlands. 12. l Department of Radiation Oncology , Institut Curie and Centre de protontherapie , Paris and Orsay , France. 13. m Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital , Oslo , Norway. 14. n The Royal Marsden NHS Foundation Trust , Sutton , UK. 15. o Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust , London , UK. 16. p Protontherapy Center, Azienda Provinciale per i Servizi Sanitari APSS , Trento , Italy. 17. q Department of Radiation Therapy, University Hospital Leipzig , Leipzig , Germany.
Abstract
PURPOSE: Conventional techniques (3D-CRT) for craniospinal irradiation (CSI) are still widely used. Modern techniques (IMRT, VMAT, TomoTherapy®, proton pencil beam scanning [PBS]) are applied in a limited number of centers. For a 14-year-old patient, we aimed to compare dose distributions of five CSI techniques applied across Europe and generated according to the participating institute protocols, therefore representing daily practice. MATERIAL AND METHODS: A multicenter (n = 15) dosimetric analysis of five different techniques for CSI (3D-CRT, IMRT, VMAT, TomoTherapy®, PBS; 3 centers per technique) was performed using the same patient data, set of delineations and dose prescription (36.0/1.8 Gy). Different treatment plans were optimized based on the same planning target volume margin. All participating institutes returned their best treatment plan applicable in clinic. RESULTS: The modern radiotherapy techniques investigated resulted in superior conformity/homogeneity-indices (CI/HI), particularly in the spinal part of the target (CI: 3D-CRT:0.3 vs. modern:0.6; HI: 3D-CRT:0.2 vs. modern:0.1), and demonstrated a decreased dose to the thyroid, heart, esophagus and pancreas. Dose reductions of >10.0 Gy were observed with PBS compared to modern photon techniques for parotid glands, thyroid and pancreas. Following this technique, a wide range in dosimetry among centers using the same technique was observed (e.g., thyroid mean dose: VMAT: 5.6-24.6 Gy; PBS: 0.3-10.1 Gy). CONCLUSIONS: The investigated modern radiotherapy techniques demonstrate superior dosimetric results compared to 3D-CRT. The lowest mean dose for organs at risk is obtained with proton therapy. However, for a large number of organs ranges in mean doses were wide and overlapping between techniques making it difficult to recommend one radiotherapy technique over another.
PURPOSE: Conventional techniques (3D-CRT) for craniospinal irradiation (CSI) are still widely used. Modern techniques (IMRT, VMAT, TomoTherapy®, proton pencil beam scanning [PBS]) are applied in a limited number of centers. For a 14-year-old patient, we aimed to compare dose distributions of five CSI techniques applied across Europe and generated according to the participating institute protocols, therefore representing daily practice. MATERIAL AND METHODS: A multicenter (n = 15) dosimetric analysis of five different techniques for CSI (3D-CRT, IMRT, VMAT, TomoTherapy®, PBS; 3 centers per technique) was performed using the same patient data, set of delineations and dose prescription (36.0/1.8 Gy). Different treatment plans were optimized based on the same planning target volume margin. All participating institutes returned their best treatment plan applicable in clinic. RESULTS: The modern radiotherapy techniques investigated resulted in superior conformity/homogeneity-indices (CI/HI), particularly in the spinal part of the target (CI: 3D-CRT:0.3 vs. modern:0.6; HI: 3D-CRT:0.2 vs. modern:0.1), and demonstrated a decreased dose to the thyroid, heart, esophagus and pancreas. Dose reductions of >10.0 Gy were observed with PBS compared to modern photon techniques for parotid glands, thyroid and pancreas. Following this technique, a wide range in dosimetry among centers using the same technique was observed (e.g., thyroid mean dose: VMAT: 5.6-24.6 Gy; PBS: 0.3-10.1 Gy). CONCLUSIONS: The investigated modern radiotherapy techniques demonstrate superior dosimetric results compared to 3D-CRT. The lowest mean dose for organs at risk is obtained with proton therapy. However, for a large number of organs ranges in mean doses were wide and overlapping between techniques making it difficult to recommend one radiotherapy technique over another.
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