Daniëlle B P Eekers1,2, Erik Roelofs1,3, Macarena Cubillos-Mesías4, Charles Niël5, Robert Jan Smeenk6, Ann Hoeben7, Andre W H Minken5, Marlies Granzier1, Geert O Janssens6,8,9, Johannes H A M Kaanders6, Philippe Lambin3, Esther G C Troost4,10,11,12,13. 1. a Department of Radiation Oncology (MAASTRO) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands. 2. b Proton Therapy Centre South-East Netherlands (ZON-PTC) , Maastricht , The Netherlands. 3. c Department of Radiation Oncology (The D-Lab) , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands. 4. d OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Cal Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden, Rossendorf , Dresden , Germany. 5. e Department of Radiation Oncology , Radiotherapiegroep , Deventer , The Netherlands. 6. f Department of Radiation Oncology , RadboudUMC , Nijmegen , The Netherlands. 7. g Department of Medical Oncology , GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre , Maastricht , The Netherlands. 8. h Princess Maxima Center for Pediatric Oncology , Utrecht , The Netherlands. 9. i Department of Radiation Oncology , University Medical Center Utrecht , Utrecht , The Netherlands. 10. j Department of Radiotherapy and Radiation Oncology , Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany. 11. k Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay , Dresden , Germany. 12. l German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany. 13. m m National Center for Tumor Diseases (NCT) Partner Site Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz Association/Helmholtz-Zentrum Dresden, Rossendorf (HZDR), Dresden, Germany.
Abstract
BACKGROUND AND PURPOSE: Patients with low-grade glioma (LGG) have a prolonged survival expectancy due to better discriminative tumor classification and multimodal treatment. Consequently, long-term treatment toxicity gains importance. Contemporary radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), tomotherapy (TOMO) and intensity-modulated proton therapy (IMPT) enable high-dose irradiation of the target but they differ regarding delivered dose to organs at risk (OARs). The aim of this comparative in silico study was to determine these dosimetric differences in delivered doses. MATERIAL AND METHODS: Imaging datasets of 25 LGG patients having undergone postoperative radiotherapy were included. For each of these patients, in silico treatment plans to a total dose of 50.4 Gy to the target volume were generated for the four treatment modalities investigated (i.e., IMRT, VMAT, TOMO, IMPT). Resulting treatment plans were analyzed regarding dose to target and surrounding OARs comparing IMRT, TOMO and IMPT to VMAT. RESULTS: In total, 100 treatment plans (four per patient) were analyzed. Compared to VMAT, the IMPT mean dose (Dmean) for nine out of 10 (90%) OARs was statistically significantly (p < .02) reduced, for TOMO this was true in 3/10 (30%) patients and for 1/10 (10%) patients for IMRT. IMPT was the prime modality reducing dose to the OARs followed by TOMO. DISCUSSION: The low dose volume to the majority of OARs was significantly reduced when using IMPT compared to VMAT. Whether this will lead to a significant reduction in neurocognitive decline and improved quality of life is to be determined in carefully designed future clinical trials.
BACKGROUND AND PURPOSE:Patients with low-grade glioma (LGG) have a prolonged survival expectancy due to better discriminative tumor classification and multimodal treatment. Consequently, long-term treatment toxicity gains importance. Contemporary radiotherapy techniques such as intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), tomotherapy (TOMO) and intensity-modulated proton therapy (IMPT) enable high-dose irradiation of the target but they differ regarding delivered dose to organs at risk (OARs). The aim of this comparative in silico study was to determine these dosimetric differences in delivered doses. MATERIAL AND METHODS: Imaging datasets of 25 LGG patients having undergone postoperative radiotherapy were included. For each of these patients, in silico treatment plans to a total dose of 50.4 Gy to the target volume were generated for the four treatment modalities investigated (i.e., IMRT, VMAT, TOMO, IMPT). Resulting treatment plans were analyzed regarding dose to target and surrounding OARs comparing IMRT, TOMO and IMPT to VMAT. RESULTS: In total, 100 treatment plans (four per patient) were analyzed. Compared to VMAT, the IMPT mean dose (Dmean) for nine out of 10 (90%) OARs was statistically significantly (p < .02) reduced, for TOMO this was true in 3/10 (30%) patients and for 1/10 (10%) patients for IMRT. IMPT was the prime modality reducing dose to the OARs followed by TOMO. DISCUSSION: The low dose volume to the majority of OARs was significantly reduced when using IMPT compared to VMAT. Whether this will lead to a significant reduction in neurocognitive decline and improved quality of life is to be determined in carefully designed future clinical trials.
Authors: Steven H J Nagtegaal; Szabolcs David; Marielle E P Philippens; Tom J Snijders; Alexander Leemans; Joost J C Verhoeff Journal: Clin Transl Radiat Oncol Date: 2020-11-15
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Authors: Camilla S Byskov; Christian R Hansen; Rikke H Dahlrot; Lene Haldbo-Classen; Charlotte A Haslund; Flemming Kjær-Kristoffersen; Thomas O Kristensen; Yasmin Lassen-Ramshad; Slávka Lukacova; Aida Muhic; Petra W Nyström; Britta Weber; Jesper F Kallehauge Journal: Phys Imaging Radiat Oncol Date: 2021-11-28
Authors: Matthew K Forsthoefel; Elizabeth Ballew; Keith R Unger; Peter H Ahn; Sonali Rudra; Dalong Pang; Sean P Collins; Anatoly Dritschilo; William Harter; Nitika Paudel; Brian T Collins; Jonathan W Lischalk Journal: Front Oncol Date: 2020-05-29 Impact factor: 6.244