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• W2080755502 abstract "Purpose/Objective(s)To evaluate the feasibility of using tomotherapy to deliver whole brain radiotherapy (WBRT) with hippocampal avoidance, hypothesized to reduce the risk of memory function decline, and simultaneously integrated boost to brain metastases to improve intra-cranial tumor control.Materials/MethodsTen patients treated with radiosurgery and WBRT were replanned on tomotherapy using original CT scans and MR-CT fusion defined target and normal structure contours. Individually contoured hippocampus and amygdale were used as dose-limiting structures (<6 Gy); the whole brain dose was prescribed at 32.25 Gy to 95% in 15 fractions and simultaneous boost doses to individual brain metastases were 63 Gy to lesions ≥2.0 cm in maximum diameter, and 70.8 Gy to lesions <2.0 cm. Plans were generated with a field width (FW) of 2.5 cm, and in five patients with FW of 1.0 cm. Plans were compared regarding prescription isodose to target volume (PITV) ratio, target coverage (TC), conformation number (CN), homogeneity index (HI), and mean normalized total dose (NTDmean).ResultsA 1.0 cm compared with 2.5 cm FW significantly improved the dose distribution. Mean PITV ratio improved from 1.75 ± 0.61 to 1.48 ± 0.37. Whole brain homogeneity (HI) improved by 32% (p < 0.0004) due to the sharper dose gradients afforded by a smaller FW. NTDmean to the hippocampus was 5.9 ± 1.3 and 5.8 ± 1.9 Gy2, for 2.5 and 1.0 cm FW, respectively. Mean treatment delivery time for 2.5 and 1.0 cm FW plans was 10.2 ± 1.0 and 21.8 ± 1.8 minutes (see Fig. and Table).ConclusionsTable 1Statistical analysis of indices for metastases and whole brain in tomotherapy plansMean and standard deviation2.5 cm1.0 cmp valueIndex0.2150.2890.4330.2890.215 vs. 0.4330.2892.5 vs. 0.2891.0Metastases PITV1.76 ± 0.611.75 ± 0.611.76 ± 0.601.48 ± 0.37NS0.038 TC0.932 ± 0.0380.936 ± 0.0370.938 ± 0.0330.925 ± 0.053NSNS CN0.55 ± 0.160.55 ± 0.160.55 ± 0.160.60 ± 0.13NS0.011 HI0.116 ± 0.0440.119 ± 0.0450.120 ± 0.0400.104 ± 0.041NS0.016Whole Brain HI0.485 ± 0.1520.472 ± 0.1450.480 ± 0.1450.322 ± 0.120NS0.0004 TC0.957 ± 0.0070.957 ± 0.0080.956 ± 0.0080.959 ± 0.017NSNSAbbreviations: 0.2892.5 = 0.289 pitch with 2.5 cm FW; 0.2891.0 = 0.289 pitch with 1.0 cm FW; NS = not significant.The two-tailed p values were results from paired t-tests. Open table in a new tab Purpose/Objective(s)To evaluate the feasibility of using tomotherapy to deliver whole brain radiotherapy (WBRT) with hippocampal avoidance, hypothesized to reduce the risk of memory function decline, and simultaneously integrated boost to brain metastases to improve intra-cranial tumor control. To evaluate the feasibility of using tomotherapy to deliver whole brain radiotherapy (WBRT) with hippocampal avoidance, hypothesized to reduce the risk of memory function decline, and simultaneously integrated boost to brain metastases to improve intra-cranial tumor control. Materials/MethodsTen patients treated with radiosurgery and WBRT were replanned on tomotherapy using original CT scans and MR-CT fusion defined target and normal structure contours. Individually contoured hippocampus and amygdale were used as dose-limiting structures (<6 Gy); the whole brain dose was prescribed at 32.25 Gy to 95% in 15 fractions and simultaneous boost doses to individual brain metastases were 63 Gy to lesions ≥2.0 cm in maximum diameter, and 70.8 Gy to lesions <2.0 cm. Plans were generated with a field width (FW) of 2.5 cm, and in five patients with FW of 1.0 cm. Plans were compared regarding prescription isodose to target volume (PITV) ratio, target coverage (TC), conformation number (CN), homogeneity index (HI), and mean normalized total dose (NTDmean). Ten patients treated with radiosurgery and WBRT were replanned on tomotherapy using original CT scans and MR-CT fusion defined target and normal structure contours. Individually contoured hippocampus and amygdale were used as dose-limiting structures (<6 Gy); the whole brain dose was prescribed at 32.25 Gy to 95% in 15 fractions and simultaneous boost doses to individual brain metastases were 63 Gy to lesions ≥2.0 cm in maximum diameter, and 70.8 Gy to lesions <2.0 cm. Plans were generated with a field width (FW) of 2.5 cm, and in five patients with FW of 1.0 cm. Plans were compared regarding prescription isodose to target volume (PITV) ratio, target coverage (TC), conformation number (CN), homogeneity index (HI), and mean normalized total dose (NTDmean). ResultsA 1.0 cm compared with 2.5 cm FW significantly improved the dose distribution. Mean PITV ratio improved from 1.75 ± 0.61 to 1.48 ± 0.37. Whole brain homogeneity (HI) improved by 32% (p < 0.0004) due to the sharper dose gradients afforded by a smaller FW. NTDmean to the hippocampus was 5.9 ± 1.3 and 5.8 ± 1.9 Gy2, for 2.5 and 1.0 cm FW, respectively. Mean treatment delivery time for 2.5 and 1.0 cm FW plans was 10.2 ± 1.0 and 21.8 ± 1.8 minutes (see Fig. and Table). A 1.0 cm compared with 2.5 cm FW significantly improved the dose distribution. Mean PITV ratio improved from 1.75 ± 0.61 to 1.48 ± 0.37. Whole brain homogeneity (HI) improved by 32% (p < 0.0004) due to the sharper dose gradients afforded by a smaller FW. NTDmean to the hippocampus was 5.9 ± 1.3 and 5.8 ± 1.9 Gy2, for 2.5 and 1.0 cm FW, respectively. Mean treatment delivery time for 2.5 and 1.0 cm FW plans was 10.2 ± 1.0 and 21.8 ± 1.8 minutes (see Fig. and Table). ConclusionsTable 1Statistical analysis of indices for metastases and whole brain in tomotherapy plansMean and standard deviation2.5 cm1.0 cmp valueIndex0.2150.2890.4330.2890.215 vs. 0.4330.2892.5 vs. 0.2891.0Metastases PITV1.76 ± 0.611.75 ± 0.611.76 ± 0.601.48 ± 0.37NS0.038 TC0.932 ± 0.0380.936 ± 0.0370.938 ± 0.0330.925 ± 0.053NSNS CN0.55 ± 0.160.55 ± 0.160.55 ± 0.160.60 ± 0.13NS0.011 HI0.116 ± 0.0440.119 ± 0.0450.120 ± 0.0400.104 ± 0.041NS0.016Whole Brain HI0.485 ± 0.1520.472 ± 0.1450.480 ± 0.1450.322 ± 0.120NS0.0004 TC0.957 ± 0.0070.957 ± 0.0080.956 ± 0.0080.959 ± 0.017NSNSAbbreviations: 0.2892.5 = 0.289 pitch with 2.5 cm FW; 0.2891.0 = 0.289 pitch with 1.0 cm FW; NS = not significant.The two-tailed p values were results from paired t-tests. Open table in a new tab Abbreviations: 0.2892.5 = 0.289 pitch with 2.5 cm FW; 0.2891.0 = 0.289 pitch with 1.0 cm FW; NS = not significant. The two-tailed p values were results from paired t-tests." @default.
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• W2080755502 title "Whole Brain Radiation Therapy With Hippocampal Avoidance and Simultaneously Integrated Brain Metastases Boost With Helical Tomotherapy: A Planning Study" @default.
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