Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2016

Open Access 01-12-2016 | Research

Fractionated stereotactic radiotherapy of benign skull-base tumors: a dosimetric comparison of volumetric modulated arc therapy with Rapidarc® versus non-coplanar dynamic arcs

Authors: Fanny Martin, Florian Magnier, Lucie Berger, Jessica Miroir, Emmanuel Chautard, Pierre Verrelle, Michel Lapeyre, Julian Biau

Published in: Radiation Oncology | Issue 1/2016

Login to get access

Abstract

Background

Benign tumors of the skull base are a challenge when delivering radiotherapy. An appropriate choice of radiation technique may significantly improve the patient’s outcomes. Our study aimed to compare the dosimetric results of fractionated stereotactic radiotherapy between non-coplanar dynamic arcs and coplanar volumetric modulated arctherapy (Rapidarc®).

Methods

Thirteen patients treated with Novalis TX® were analysed: six vestibular schwannomas, four pituitary adenomas and three meningioma. Two treatment plans were created for each case: dynamic arcs (4–5 non coplanar arcs) and Rapidarc® (2 coplanar arcs). All tumors were >3 cm and accessible to both techniques. Patients had a stereotactic facemask (Brainlab) and were daily repositioned by Exactrac®. GTV and CTV were contoured according to tumor type. A 1-mm margin was added to the CTV to obtain PTV. Radiation doses were 52.2–54 Gy, using 1.8 Gy per fraction. Treatment time was faster with Rapidarc®.

Results

The mean PTV V95 % was 98.8 for Rapidarc® and 95.9 % for DA (p = 0.09). Homogeneity index was better with Rapidarc®: 0.06 vs. 0.09 (p = 0.01). Higher conformity index values were obtained with Rapidarc®: 75.2 vs. 67.9 % (p = 0.04). The volume of healthy brain that received a high dose (V90 %) was 0.7 % using Rapidarc® vs. 1.4 % with dynamic arcs (p = 0.05). Rapidarc® and dynamic arcs gave, respectively, a mean D40 % of 10.5 vs. 18.1 Gy (p = 0.005) for the hippocampus and a Dmean of 25.4 vs. 35.3 Gy (p = 0.008) for the ipsilateral cochlea. Low-dose delivery with Rapidarc® and dynamic arcs were, respectively, 184 vs. 166 cm3 for V20 Gy (p = 0.14) and 1265 vs. 1056 cm3 for V5 Gy (p = 0.67).

Conclusions

Fractionated stereotactic radiotherapy using Rapidarc® for large benign tumors of the skull base provided target volume coverage that was at least equal to that of dynamics arcs, with better conformity and homogeneity and faster treatment time. Rapidarc® also offered better sparing of the ipsilateral cochlea and hippocampus. Low-dose delivery were similar between both techniques.
Literature
1.
Soldà F, Wharram B, De Ieso PB, Bonner J, Ashley S, Brada M. Long-term efficacy of fractionated radiotherapy for benign meningiomas. Radiother Oncol. 2013;109:330–4.CrossRefPubMed
2.
Jian BJ, Kaur G, Sayegh ET, Bloch O, Parsa AT, Barani IJ. Fractionated radiation therapy for vestibular schwannoma. J Clin Neurosci. 2014;21:1083–8.CrossRefPubMed
3.
Colin P, Jovenin N, Delemer B, Caron J, Grulet H, Hecart A-C, Lukas C, Bazin A, Bernard M-H, Scherpereel B, Peruzzi P, Nakib I, Redon C, Rousseaux P: Treatment of pituitary adenomas by fractionated stereotactic radiotherapy: a prospective study of 110 patients. Int J Radiat Oncol Biol Phys. 2005;62:333–41.CrossRefPubMed
4.
Berens ME, Rutka JT, Rosenblum ML. Brain tumor epidemiology, growth, and invasion. Neurosurg Clin N Am. 1990;1:1–18.PubMed
5.
6.
7.
8.
Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC. Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med. 1998;339:1426–33.CrossRefPubMed
9.
Gevaert T, Verellen D, Engels B, Depuydt T, Heuninckx K, Tournel K, Duchateau M, Reynders T, De Ridder M: Clinical evaluation of a robotic 6° of freedom treatment couch for frameless radiosurgery. Int J Radiat Oncol Biol Phys. 2012;83:467–74.CrossRefPubMed
10.
Gevaert T, Verellen D, Tournel K, Linthout N, Bral S, Engels B, Collen C, Depuydt T, Duchateau M, Reynders T, Storme G, De Ridder M: Setup accuracy of the Novalis ExacTrac 6DOF system for frameless radiosurgery. Int J Radiat Oncol Biol Phys. 2012;82:1627–35.CrossRefPubMed
11.
Jin J-Y, Yin F-F, Tenn SE, Medin PM, Solberg TD. Use of the BrainLAB ExacTrac X-Ray 6D system in image-guided radiotherapy. Med Dosim. 2008;33:124–34.CrossRefPubMed
12.
Wurm RE, Erbel S, Schwenkert I, Gum F, Agaoglu D, Schild R, Schlenger L, Scheffler D, Brock M, Budach V: Novalis frameless image-guided noninvasive radiosurgery: initial experience. Neurosurgery. 2008;62(5 Suppl):A11–17. discussion A17–18.CrossRefPubMed
13.
Podgorsak EB, Souhami L, Caron JL, Pla M, Clark B, Pla C, Cadman P: A technique for fractionated stereotactic radiotherapy in the treatment of intracranial tumors. Int J Radiat Oncol Biol Phys. 1993;27:1225–30.CrossRefPubMed
14.
Podgorsak EB, Olivier A, Pla M, Lefebvre PY, Hazel J. Dynamic stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 1988;14:115–26.CrossRefPubMed
15.
Szumacher E, Schwartz ML, Tsao M, Jaywant S, Franssen E, Wong CS, Ramaseshan R, Lightstone AW, Michaels H, Hayter C, Laperriere NJ: Fractionated stereotactic radiotherapy for the treatment of vestibular schwannomas: combined experience of the Toronto-Sunnybrook regional cancer centre and the princess margaret hospital. Int J Radiat Oncol Biol Phys. 2002;53:987–91.CrossRefPubMed
16.
Solberg TD, Boedeker KL, Fogg R, Selch MT, DeSalles AA. Dynamic arc radiosurgery field shaping: a comparison with static field conformal and noncoplanar circular arcs. Int J Radiat Oncol Biol Phys. 2001;49:1481–91.CrossRefPubMed
17.
Cardinale RM, Benedict SH, Wu Q, Zwicker RD, Gaballa HE, Mohan R. A comparison of three stereotactic radiotherapy techniques; ARCS vs. noncoplanar fixed fields vs. intensity modulation. Int J Radiat Oncol Biol Phys. 1998;42:431–6.CrossRefPubMed
18.
Gevaert T, Verellin D, Tournel K, Linthout N, Bral S, Engels B et al. Setup accuracy of the novalis exactrac 6DOF system for frameless radiosurgery. Int J Radiat Oncol Biol Phys. 2011; 27: 1627-1635.
19.
Gondi V, Tolakanahalli R, Mehta MP, Tewatia D, Rowley H, Kuo JS, Khuntia D, Tomé WA: Hippocampal-sparing whole-brain radiotherapy: a “How-to” technique using helical tomotherapy and linear accelerator–based intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78:1244–52.CrossRefPubMedPubMedCentral
20.
Gondi V, Hermann BP, Mehta MP, Tomé WA. Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or Low-grade adult brain tumors. Int J Radiat Oncol Biol Phys. 2013;85:348–54.CrossRefPubMed
21.
McKenzie A, van Herk M, Mijnheer B. Margins for geometric uncertainty around organs at risk in radiotherapy. Radiother Oncol. 2002;62:299–307.CrossRefPubMed
22.
Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.CrossRefPubMed
23.
Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Shah S, Shi W, Wendland M, Kachnic L, Mehta MP: Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol. 2014;32:3810–6.CrossRefPubMedPubMedCentral
24.
Bragg CM, Wingate K, Conway J. Clinical implications of the anisotropic analytical algorithm for IMRT treatment planning and verification. Radiother Oncol. 2008;86:276–84.CrossRefPubMed
25.
Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT): Contents. J ICRU 2010, 10:NP.
26.
Ling CC, Zhang P, Archambault Y, Bocanek J, Tang G, LoSasso T. Commissioning and quality assurance of RapidArc radiotherapy delivery system. Int J Radiat Oncol Biol Phys. 2008;72:575–81.CrossRefPubMed
27.
28.
Feuvret L, Noël G, Mazeron J-J, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006;64:333–42.CrossRefPubMed
29.
Ding M, Newman F, Kavanagh BD, Stuhr K, Johnson TK, Gaspar LE. Comparative dosimetric study of three-dimensional conformal, dynamic conformal arc, and intensity-modulated radiotherapy for brain tumor treatment using Novalis system. Int J Radiat Oncol. 2006;66(4, Supplement):S82–6.CrossRef
30.
Anand AK, Kumar P, Patir R, Vaishya S, Bansal AK, Chaudhoory AR, Punnakal AU, Malhotra H, Munjal RK: Fractionated stereotactic radiosurgery with volumetric modulated arc therapy (Rapid Arc) for reradiation in recurrent high grade gliomas. J Cancer Res Ther. 2014;10:97–102.CrossRefPubMed
31.
Wiggenraad RGJ, Petoukhova AL, Versluis L, van Santvoort JPC. Stereotactic radiotherapy of intracranial tumors: a comparison of intensity-modulated radiotherapy and dynamic conformal Arc. Int J Radiat Oncol Biol Phys. 2009;74:1018–26.CrossRefPubMed
32.
Rauschenbach BM, Mackowiak L, Malhotra HK. A dosimetric comparison of three-dimensional conformal radiotherapy, volumetric-modulated arc therapy, and dynamic conformal arc therapy in the treatment of non-small cell lung cancer using stereotactic body radiotherapy. J Appl Clin Med Phys. 2014;15:4898.PubMed
33.
Dickey M, Roa W, Drodge S, Ghosh S, Murray B, Scrimger R, Gabos Z: A planning comparison of 3-dimensional conformal multiple static field, conformal arc, and volumetric modulated arc therapy for the delivery of stereotactic body radiotherapy for early stage lung cancer. Med Dosim. 2015;40:347–51.CrossRefPubMed
34.
Ong CL, Verbakel WFAR, Cuijpers JP, Slotman BJ, Lagerwaard FJ, Senan S. Stereotactic radiotherapy for peripheral lung tumors: a comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol. 2010;97:437–42.CrossRefPubMed
35.
Cambria R, Cattani F, Jereczek-Fossa BA, Pansini F, Ciardo D, Vigorito S, Russo S, Zerini D, Cozzi L, Orecchia R: Planning study to compare dynamic and rapid arc techniques for postprostatectomy radiotherapy of prostate cancer. Strahlenther Onkol. 2014;190:569–74.CrossRefPubMed
36.
Scoccianti S, Detti B, Gadda D, Greto D, Furfaro I, Meacci F, et al. Organs at risk in the brain and their dose-constraints in adults and in children: a radiation oncologist’s guide for delineation in everyday practice. Radiother Oncol. 2015;114:230–8.
37.
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
38.
Bhandare N, Jackson A, Eisbruch A, Pan CC, Flickinger JC, Antonelli P, Mendenhall WM: Radiation therapy and hearing loss. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S50–57.CrossRefPubMedPubMedCentral
39.
Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006;65:1–7.CrossRefPubMed
Metadata
Title
Fractionated stereotactic radiotherapy of benign skull-base tumors: a dosimetric comparison of volumetric modulated arc therapy with Rapidarc® versus non-coplanar dynamic arcs
Authors
Fanny Martin
Florian Magnier
Lucie Berger
Jessica Miroir
Emmanuel Chautard
Pierre Verrelle
Michel Lapeyre
Julian Biau
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2016
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-016-0632-8

Other articles of this Issue 1/2016

Radiation Oncology 1/2016 Go to the issue

Research

Challenges in radiobiological modeling: can we decide between LQ and LQ-L models based on reviewed clinical NSCLC treatment outcome data?

Research

Three-dimensional surface and ultrasound imaging for daily IGRT of prostate cancer

Research

Overall survival after reirradiation of spinal metastases – independent validation of predictive models

Research

Precise film dosimetry for stereotactic radiosurgery and stereotactic body radiotherapy quality assurance using Gafchromic™ EBT3 films

Research

Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer

Review

Soft tissue sarcoma of the extremities: pending questions on surgery and radiotherapy