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Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning

Authors: Ann-Katrin Exeli, Daniel Kellner, Lukas Exeli, Phil Steininger, Frank Wolf, Felix Sedlmayer, Heinz Deutschmann

Published in: Radiation Oncology | Issue 1/2018

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Abstract

Background

To date, patients with glioblastoma still have a bad median overall survival rate despite radiation dose-escalation and combined modality treatment. Neurocognitive decline is a crucial adverse event which may be linked to high doses to the cortex. In a planning study, we investigated the impact of dose constraints to the cerebral cortex and its relation to the organs at risk for glioblastoma patients.

Methods

Cortical sparing was implemented into the optimization process for two planning approaches: classical intensity-modulated radiotherapy (IMRT) and robust treatment planning. The plans with and without objectives for cortex sparing where compared based on dose-volume histograms (DVH) data of the main organs at risk. Additionally the cortex volume above a critical threshold of 28.6 Gy was elaborated. Furthermore, IMRT plans were compared with robust treatment plans regarding potential cortex sparing.

Results

Cortical dose constraints result in a statistically significant reduced cerebral cortex volume above 28.6 Gy without negative effects to the surrounding organs at risk independently of the optimization technique. For IMRT we found a mean volume reduction of doses beyond the threshold of 19%, and 16% for robust treatment planning, respectively. Robust plans delivered sharper dose gradients around the target volume in an order of 3 – 6%. Aside from that the integration of cortical sparing into the optimization process has the potential to reduce the dose around the target volume (4 – 8%).

Conclusions

We were able to show that dose to the cerebral cortex can be significantly reduced both with robust treatment planning and IMRT while maintaining clinically adequate target coverage and without corrupting any organ at risk. Robust treatment plans delivered more conformal plans compared to IMRT and were superior in regards to cortical sparing.
Literature
1.
Barani I, Larson D. Current understanding and treatment of glioblastoma. Cancer Treat Res. 2015;163:49–73.CrossRefPubMed
2.
Nachbichler SB, Schupp G, Ballhausen H, et al. Temozolomide during radiotherapy of glioblastoma multiforme. Strahlenther Onkol. 2017;193:1–7.CrossRef
3.
Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–66.CrossRefPubMed
4.
Meyers C, Brown PD. Role and relevance of Neurocognitive assessment in clinical trials of patients with CNS tumors. J Clin Oncol. 2006;24:1305–9.CrossRefPubMed
5.
Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S. Mechanisms of radiotherapy associated cognitive disability in patients with brain tumours. Neurol. 2016;185:52–64.
6.
Karunamuni R, Moore K, Seibert T, Li N, White NS, Bartsch H, et al. Radiation sparing of cerebral cortex in brain tumor patients using quantitative neuroimaging. Radiother Oncol. 2016;118:29–34.CrossRefPubMedPubMedCentral
7.
Karunamuni R, Bartsch H, White N, Moiseenko V, Carmona R, Marshall D, Seibert T, et al. Dose-dependent cortical thinning after partial brain irradiation in high-grade Glioma. Int J Radiat Oncol Biol Phys. 2016;94:297–304.CrossRefPubMed
8.
Chu M, Zinchenko Y, Henderson SG, Sharpe MB. Robust optimization for intensity modulated radiation therapy treatment planning under uncertainty. Phys Med Biol. 2005;50:54–63.CrossRef
9.
Fredriksson A, Forsgren A, Hardemark B. Minimax optimization for handling range and setup uncertainties in proton therapy. Med Phys. 2011;38:1672–84.CrossRefPubMed
10.
Goitein M. Calculation of the uncertainty in the dose delivered during radiation therapy. Med Phys. 1985;12:608–12.CrossRefPubMed
11.
Lens E, Kotte AN, Patel A, Heerkens HD, Bal M, van Tienhoven G, et al. Probabilistic treatment planning for pancreatic cancer treatment: prospective incorporation of respiratory motion shows only limited dosimetric benefit. Acta Oncol. 2016;25:1–7.
12.
Fontanarosa D, van der Laan HP, Witte M, Shakirin G, Roelofs E, Langendijk JA, et al. An in silico comparison between margin-based and probabilistic target-planning approaches in head and neck cancer patients. Radiother Oncol. 2013;109:430–6.CrossRefPubMed
13.
Baum C, Alber M, Birkner M, Nüsslin F. Robust treatment planning for intensity modulated radiotherapy of prostate cancer based on coverage probabilities. Radiother Oncol. 2006;78:27–35.CrossRefPubMed
14.
van der Voort S, van de Water S, Perkó Z, Heijmen B. Lathouwers D3, Hoogeman M. Robustness recipes for Minimax robust optimization in intensity modulated proton therapy for Oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 2016;95:163–70.CrossRefPubMed
15.
Farzin M, Molls M, Astner S, Rondak I-C, Oechsner M. Simultaneous integrated vs. sequential boost in VMAT radiotherapy of high-grade gliomas. Strahlenther Onkol. 2015;191:945–52.CrossRefPubMed
16.
Adeberg S, Harrabi SB, Bougatf N, Bernhardt D, Rieber J, Koerber SA, et al. Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma. Strahlenther Onkol. 2016;192:770–9.CrossRefPubMed
17.
Briere TM, McAleer MF, Levy LB, Yang JN. Sparing of normal tissues with volumetric arc radiation therapy for glioblastoma: single institution clinical experience. Radiat Oncol. 2017;12:79.CrossRefPubMedPubMedCentral
18.
Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, et al. ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol. 2016;118:35–42.CrossRefPubMed
19.
Seidel C, Kortmann R-D. Radiotherapie des Glioblastoms. ASCO bestätigt ASTRO-Leitlinie. Strahlenther Onkol. 2017;193:513–4.CrossRefPubMed
20.
Landberg T, Chavaudra J, Dobbs J, Gerard JP, Hanks G, Horiot JC, et al. Report 62, journal of the international commission on radiation units and measurements 1999.
21.
22.
23.
Gol A, Kellaway P, Shapiro M, Hurst CM. Studies of hippocampectomy in the monkey, baboon, and cat. Behavioral changes and a preliminary evaluation of cognitive function. Neurology. 1963;13:1031–41.CrossRefPubMed
24.
Eichenbaum H. Hippocampus: cognitive processes and neural representations that underlie declarative memory. Neuron. 2004;44:109–20.CrossRefPubMed
25.
Kazda T, Jancalek R, Pospisil P, Sevela O, Prochazka, Miroslav Vrzal M, et al. Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy. Radiat Oncol. 2014;9:139.CrossRefPubMedPubMedCentral
26.
27.
Khalifa J, Tensaouti F, Lusque A, Plas B, Lotterie JA, Benouaich-Amiel A, et al. Subventricular zones: new key targets for glioblastoma treatment. Radiat Oncol. 2017;12:67.CrossRefPubMedPubMedCentral
28.
Hofmaier J, Kantz S, Söhn M, Dohm OS, Bächle S, Alber M, et al. Hippocampal sparing radiotherapy for glioblastoma patients: a planning study using volumetric modulated arc therapy. Radiat Oncol. 2016;11:118.CrossRefPubMedPubMedCentral
29.
Boehling NS, Grosshans DR, Bluett JB, Palmer MT, Song X, Amos RA, et al. Dosimetric comparison of three-dimensional conformal proton radiotherapy, intensity-modulated proton therapy, and intensity-modulated radiotherapy for treatment of pediatric craniopharyngiomas. Int J Radiat Oncol Biol Phys. 2012;82:643–52.CrossRefPubMed
30.
Harrabi SB, Bougatf N, Mohr A, Haberer T, Herfarth K, Combs SE, et al. Dosimetric advantages of proton therapy over conventional radiotherapy with photons in young patients and adults with low-grade glioma. Strahlenther Onkol. 2016;192:759–69.CrossRefPubMedPubMedCentral
31.
Avishek Chatterjee A, Serban M, Abdulkarim B, Panet-Raymond V, Souhami L, Shenouda G, Sabri S, et al. Performance of knowledge-based radiation therapy planning for the Glioblastoma disease site. Int J Radiation Oncol Biol Phys. 2017;99:1–8.CrossRef
32.
Lee TF, Fang FM, Chao PJ, Wang LK, Leung SW. Dosimetric comparison of helical tomotherapy and step-and-shoot intensity-modulated radiotherapy in nasopharyngeal carcinoma. Radiother Oncol. 2008;89:89–96.CrossRefPubMed
33.
Mayo C, Yorke E, Merchant TE. Radiation associated brainstem injury. Int J Radiat Oncol Biol Phys. 2010;76:36–41.CrossRef
34.
Kojima S, Suzuki K, Hirata M, Shinohara H, Ueno E. Depicting the semicircular canals with inner-ear MRI: a comparison of the SPACE and TrueFISP sequences. J Magn Reson Imaging. 2013;37:652–9.CrossRefPubMed
35.
Pan CC, Eisbruch A, Lee JS, Snorrason RM, Ten Haken RK, Kileny PR. Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients. Int J Radiat Oncol Biol Phys. 2005;61:1393–402.CrossRefPubMed
36.
Parsons JT, Bova FJ, Fitzgerald CR, Mendenhall WM, Million RR. Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys. 1994;30:755–63.CrossRefPubMed
37.
Yamazaki H, Shiomi H, Tsubokura T, Kodani T, Nishimura T, Aibe N, et al. Quantitative assessment of interobserver variability in target volume delineation on stereotacticradiotherapy treatment for pituitary adenoma and meningioma near optic tract. Radiat Oncol. 2011;6:10.CrossRefPubMedPubMedCentral
Metadata
Title
Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning
Authors
Ann-Katrin Exeli
Daniel Kellner
Lukas Exeli
Phil Steininger
Frank Wolf
Felix Sedlmayer
Heinz Deutschmann
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-0953-x

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