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Integral dose delivered to normal brain with conventional intensity‐modulated radiotherapy ( IMRT ) and helical tomotherapy IMRT during partial brain radiotherapy for high‐grade gliomas with and without selective sparing of the hippocampus, limbic circuit and neural stem cell compartment
Author(s) -
Marsh James C,
Ziel G Ellis,
Diaz Aidnag Z,
Wendt Julie A,
Gobole Rohit,
Turian Julius V
Publication year - 2013
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12048
Subject(s) - tomotherapy , medicine , nuclear medicine , radiation therapy , glioma , hippocampus , radiology , cancer research
We compared integral dose with uninvolved brain ( ID brain ) during partial brain radiotherapy ( PBRT ) for high‐grade glioma patients using helical tomotherapy ( HT ) and seven field traditional inverse‐planned intensity‐modulated radiotherapy ( IMRT ) with and without selective sparing ( SPA ) of contralateral hippocampus, neural stem cell compartment ( NSC ) and limbic circuit. Methods We prepared four PBRT treatment plans for four patients with high‐grade gliomas (60 Gy in 30 fractions delivered to planning treatment volume (PTV 60 Gy )). For all plans, a structure denoted ‘uninvolved brain’ was created, which included all brain tissue not part of PTV or standard ( STD ) organs at risk ( OAR ). No dosimetric constraints were included for uninvolved brain. Selective SPA plans were prepared with IMRT and HT ; contralateral hippocampus, NSC and limbic circuit were contoured; and dosimetric constraints were entered for these structures without compromising dose to PTV or STD OAR . We compared V 100 and D 95 for PTV 46 Gy and PTV 60 Gy , and ID brain for all plans. Results There were no significant differences in V 100 and D 95 for PTV 46 Gy and PTV 60 Gy . ID brain was lower in traditional IMRT versus HT plans for STD and SPA plans (mean ID brain 23.64 Gy vs. 28 Gy and 18.7 Gy vs. 24.5 Gy , respectively) and in SPA versus STD plans both with IMRT and HT (18.7 Gy vs. 23.64 Gy and 24.5 Gy vs. 28 Gy , respectively). Conclusions In the setting of PBRT for high‐grade gliomas, IMRT reduces ID brain compared with HT with or without selective SPA of contralateral hippocampus, limbic circuit and NSC , and the use of selective SPA reduces ID brain compared with STD PBRT delivered with either traditional IMRT or HT .