Hippocampal-sparing whole-brain radiotherapy: a "how-to" technique using helical tomotherapy and linear accelerator-based intensity-modulated radiotherapy.
Hippocampal-sparing whole-brain radiotherapy: a "how-to" technique using helical tomotherapy and linear accelerator-based intensity-modulated radiotherapy.
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DOI：
10.1016/j.ijrobp.2010.01.039
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发表时间：
2010-11-15
影响因子：
7
通讯作者：
Tome, Wolfgang A.
中科院分区：
文献类型：
--
作者：
Gondi, Vinai;Tolakanahalli, Ranjini;Mehta, Minesh P.;Tewatia, Dinesh;Rowley, Howard;Kuo, John S.;Khuntia, Deepak;Tome, Wolfgang A.
关键词：
在颅脑照射期间保护海马体，在轮廓和治疗计划方面提出了重要的技术挑战。在这里，我们报告了我们的初步经验，全脑放射治疗的患者使用海马区保留。对5例既往接受全脑放疗保留海马区的匿名病例进行回顾分析。海马体被画出轮廓，并使用围绕海马体的5 mm体积扩张来创建海马体回避区域。螺旋断层放射治疗和基于直线加速器的调强放射治疗计划被生成，处方剂量为30Gy10次。平均海马区回避体积为3.3cm3，占全脑计划靶体积的2.1%。螺旋断层放射治疗免除了海马区的照射，平均剂量为5.5GY，最大剂量为12.8GY。基于直线加速器的调强放射治疗免除了海马区的照射，中位剂量为7.8Gy.最大剂量为15.3Gy.在每个部分的基础上，使用螺旋断层放射治疗的海马区的平均剂量(归一化为2-Gy2次)减少了87%至0.49Gy2，使用基于直线加速器的调强放射治疗减少了81%至0.73Gy2。两种调强放射治疗方式的靶区覆盖率和均质性均可接受，差异主要归因于螺旋断层放射治疗的剂量下降更快。现代调强放射治疗技术允许保留海马体，具有可接受的靶区覆盖率和同质性。基于令人信服的临床前证据，第二阶段合作小组试验已经开发出来，以测试假定的神经认知益处。
Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein, we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. 5 anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5mm volumetric expansion around the hippocampus. Helical tomotherapy and LINAC-based IMRT treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. On average, the hippocampal avoidance volume was 3.3 cm3, occupying 2.1% of the whole brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy2 using helical tomotherapy and by 81% to 0.73 Gy2 using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.
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影响因子：
82.9
作者：
Eriksson, PS;Perfilieva, E;Gage, FH
通讯作者：
Gage, FH
影响因子：
--
作者：
Nagai, R;Tsunoda, S;Asada, H
通讯作者：
Asada, H
DOI：
10.1016/j.ijrobp.2005.04.011
发表时间：
2005-08-01
影响因子：
7
作者：
Van Vulpen, M;Field, C;Fallone, BG
通讯作者：
Fallone, BG
影响因子：
2.9
作者：
COLLIER, TJ;QUIRK, GJ;ROUTTENBERG, A
通讯作者：
ROUTTENBERG, A
影响因子：
64.8
作者：
Kempermann, G;Kuhn, HG;Gage, FH
通讯作者：
Gage, FH