Whole Brain Radiotherapy with Hippocampal Avoidance and Simultaneously Integrated Brain Metastases Boost: a Planning Study

Overview

Journal Int J Radiat Oncol Biol Phys

Specialties Oncology
Radiology

Date 2007 Sep 18

PMID 17869672

Citations 69

Authors

Alonso N Gutierrez

David C Westerly

Wolfgang A Tome

Hazim A Jaradat

Thomas R Mackie

Soren M Bentzen

Deepak Khuntia

Minesh P Mehta

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the feasibility of using tomotherapy to deliver whole brain radiotherapy with hippocampal avoidance, hypothesized to reduce the risk of memory function decline, and simultaneously integrated boost to brain metastases to improve intracranial tumor control.

Methods And Materials: Ten patients treated with radiosurgery and whole brain radiotherapy underwent repeat planning using tomotherapy with the original computed tomography scans and magnetic resonance imaging-computed tomography fusion-defined target and normal structure contours. The individually contoured hippocampus was used as a dose-limiting structure (<6 Gy); the whole brain dose was prescribed at 32.25 Gy to 95% in 15 fractions, and the simultaneous boost doses to individual brain metastases were 63 Gy to lesions >or=2.0 cm in the maximal diameter and 70.8 Gy to lesions <2.0 cm. The plans were generated with a field width (FW) of 2.5 cm and, in 5 patients, with a FW of 1.0 cm. The plans were compared regarding conformation number, prescription isodose/target volume ratio, target coverage, homogeneity index, and mean normalized total dose.

Results: A 1.0-cm FW compared with a 2.5-cm FW significantly improved the dose distribution. The mean conformation number improved from 0.55 +/- 0.16 to 0.60 +/- 0.13. Whole brain homogeneity improved by 32% (p <0.001). The mean normalized total dose to the hippocampus was 5.9 +/- 1.3 Gy(2) and 5.8 +/- 1.9 Gy(2) for 2.5- and 1.0-cm FW, respectively. The mean treatment delivery time for the 2.5- and 1.0-cm FW plans was 10.2 +/- 1.0 and 21.8 +/- 1.8 min, respectively.

Conclusion: Composite tomotherapy plans achieved three objectives: homogeneous whole brain dose distribution equivalent to conventional whole brain radiotherapy; conformal hippocampal avoidance; and radiosurgically equivalent dose distributions to individual metastases.

Citing Articles

Hippocampal avoidance whole-brain radiotherapy with simultaneous integrated boost in lung cancer brain metastases and utility of the Hopkins verbal learning test for testing cognitive impairment in Chinese patients: a prospective phase II study.

Li Z, Wang J, Deng L, Zhai Y, Zhang T, Bi N BMC Cancer. 2024; 24(1):899.

PMID: 39060968 PMC: 11282618. DOI: 10.1186/s12885-024-12559-1.

Cost of Treatment for Brain Metastases Using Data From a National Health Insurance.

Crooks J, Dominic O, Shepard M, Yu A, Liang Y, Karlovits S Adv Radiat Oncol. 2024; 9(5):101438.

PMID: 38567144 PMC: 10985802. DOI: 10.1016/j.adro.2024.101438.

Dosimetric and radiobiological comparison of IMRT, VMAT, and helical tomotherapy planning techniques in hippocampal sparing whole brain radiotherapy with simultaneous integrated boost for multiple brain metastases.

Balasubramanian S, Shobana M, Anabalagan D, Thanasekar P, Joel S, Chaudhary P Radiat Environ Biophys. 2024; 63(1):47-57.

PMID: 38194100 DOI: 10.1007/s00411-023-01052-1.

Hippocampal avoidance whole brain radiotherapy in brain metastasis using volumetric modulated arc therapy: experience from a Regional Cancer Centre of Eastern India.

Deepsikha G, Maji T, Lahiri D, Roy S, Bhanja S, Rangineni S Rep Pract Oncol Radiother. 2023; 28(4):468-477.

PMID: 37795235 PMC: 10547418. DOI: 10.5603/RPOR.a2023.0048.

Dosimetric investigation of whole-brain radiotherapy with helical intensity modulated radiation therapy and volumetric modulated arc therapy for scalp sparing.

Shirata R, Inoue T, Sugimoto S, Saito A, Omura M, Minagawa Y BJR Open. 2023; 5(1):20220037.

PMID: 37035770 PMC: 10077410. DOI: 10.1259/bjro.20220037.

References

Delattre J, Krol G, Thaler H, Posner J . Distribution of brain metastases. Arch Neurol. 1988; 45(7):741-4. DOI: 10.1001/archneur.1988.00520310047016. View

Boswell S, Tome W, Jeraj R, Jaradat H, Mackie T . Automatic registration of megavoltage to kilovoltage CT images in helical tomotherapy: an evaluation of the setup verification process for the special case of a rigid head phantom. Med Phys. 2006; 33(11):4395-404. DOI: 10.1118/1.2349698. View

Bauman G, Yartsev S, Fisher B, Kron T, Laperriere N, Heydarian M . Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol. 2007; 30(1):38-44. DOI: 10.1097/01.coc.0000245473.41035.c4. View

Shepard D, Olivera G, Reckwerdt P, Mackie T . Iterative approaches to dose optimization in tomotherapy. Phys Med Biol. 2000; 45(1):69-90. DOI: 10.1088/0031-9155/45/1/306. View

Nakamura J, Verhey L, Smith V, Petti P, Lamborn K, Larson D . Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys. 2001; 51(5):1313-9. DOI: 10.1016/s0360-3016(01)01757-6. View

Monje M, Mizumatsu S, Fike J, Palmer T . Irradiation induces neural precursor-cell dysfunction. Nat Med. 2002; 8(9):955-62. DOI: 10.1038/nm749. View

Shaw E, Scott C, Suh J, Kadish S, Stea B, Hackman J . RSR13 plus cranial radiation therapy in patients with brain metastases: comparison with the Radiation Therapy Oncology Group Recursive Partitioning Analysis Brain Metastases Database. J Clin Oncol. 2003; 21(12):2364-71. DOI: 10.1200/JCO.2003.08.116. View

Andrews D, Scott C, Sperduto P, Flanders A, Gaspar L, Schell M . Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004; 363(9422):1665-72. DOI: 10.1016/S0140-6736(04)16250-8. View

Ghia A, Tome W, Thomas S, Cannon G, Khuntia D, Kuo J . Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys. 2007; 68(4):971-7. DOI: 10.1016/j.ijrobp.2007.02.016. View

10.

DeAngelis L, Delattre J, Posner J . Radiation-induced dementia in patients cured of brain metastases. Neurology. 1989; 39(6):789-96. DOI: 10.1212/wnl.39.6.789. View

11.

Lebesque J, Keus R . The simultaneous boost technique: the concept of relative normalized total dose. Radiother Oncol. 1991; 22(1):45-55. DOI: 10.1016/0167-8140(91)90068-r. View

12.

Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R . Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys. 1993; 27(5):1231-9. DOI: 10.1016/0360-3016(93)90548-a. View

13.

Mackie T, Holmes T, Swerdloff S, Reckwerdt P, Deasy J, Yang J . Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy. Med Phys. 1993; 20(6):1709-19. DOI: 10.1118/1.596958. View

14.

Roman D, Sperduto P . Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys. 1995; 31(4):983-98. DOI: 10.1016/0360-3016(94)00550-8. View

15.

Abayomi O . Pathogenesis of irradiation-induced cognitive dysfunction. Acta Oncol. 1996; 35(6):659-63. DOI: 10.3109/02841869609083995. View

16.

Yang J, Mackie T, Reckwerdt P, Deasy J, Thomadsen B . An investigation of tomotherapy beam delivery. Med Phys. 1997; 24(3):425-36. DOI: 10.1118/1.597909. View

17.

vant Riet A, Mak A, Moerland M, Elders L, Van Der Zee W . A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: application to the prostate. Int J Radiat Oncol Biol Phys. 1997; 37(3):731-6. DOI: 10.1016/s0360-3016(96)00601-3. View

18.

Low D, Harms W, Mutic S, Purdy J . A technique for the quantitative evaluation of dose distributions. Med Phys. 1998; 25(5):656-61. DOI: 10.1118/1.598248. View

19.

Dische S, Saunders M . The CHART regimen and morbidity. Acta Oncol. 1999; 38(2):147-52. DOI: 10.1080/028418699431546. View

20.

Fenwick J, Tome W, Kissick M, Mackie T . Modelling simple helically delivered dose distributions. Phys Med Biol. 2005; 50(7):1505-17. DOI: 10.1088/0031-9155/50/7/013. View