Proton Radiotherapy for Midline Central Nervous System Lesions: A Class Solution

Neil C. Estabrook, Mark W. McDonald, Ted A. Hoene, Greg K. Bartlett, Peter A S Johnstone, Kevin P. McMullen, Jeffrey C. Buchsbaum

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Midline and central lesions of the brain requiring conventional radiotherapy (RT) present complex difficulties in dose avoidance to organs at risk (OAR). In either definitive or adjuvant settings, proper RT coverage of these lesions involves unnecessary treatment of large volumes of normal brain. We propose a class solution for these lesions using proton radiotherapy (PrT). Materials and Methods: The records of the Indiana University Health Proton Therapy Center were reviewed for patients presenting between January 1, 2005 and October 1, 2013 with midline central nervous system (CNS) lesions. Twenty-four patients were identified. After Institutional Review Board approval was granted, their dosimetry was reviewed for target volume doses and OAR dose avoidance. Results: For these cases, meningiomas were the most common histology (8 cases), and next most prevalent were craniopharyngiomas (6 cases). The others were various different deep midline brain tumors (10 cases). In all cases, fields formed by vertex and/or anterior/posterior superior oblique PrT beams along the midsagittal plane were used to provide coverage with minimal dose to the brain stem or to the cerebral hemispheres. The median prescribed dose to the planning target volume for treating these patients was 54.0 Gy RBE (range 48.6-62.5) with a mean dose of 53.5 Gy RBE. The average of the mean doses to the brain stems using these fields in the 24 plans was 18.4 Gy RBE (range 0.0-44.7). Similarly, the average of the mean doses to the hippocampi was 15.8 Gy RBE (range 0.0-52.6). Conclusions: We consider these patients to be optimally treated with PrT. The use of modified midsagittal PrT schemas allows for the treatment of midline CNS lesions with sparing of most of the uninvolved brain.

Original languageEnglish
Pages (from-to)111-117
Number of pages7
JournalOncology
Volume89
Issue number2
DOIs
StatePublished - Jul 22 2015

Fingerprint

Protons
Radiotherapy
Central Nervous System
Organs at Risk
Brain Stem
Brain
Proton Therapy
Craniopharyngioma
Research Ethics Committees
Cerebrum
Meningioma
Brain Neoplasms
Hippocampus
Histology
Health
Therapeutics

Keywords

  • Craniopharyngioma
  • Meningioma
  • Pediatric tumors
  • Proton radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Estabrook, N. C., McDonald, M. W., Hoene, T. A., Bartlett, G. K., Johnstone, P. A. S., McMullen, K. P., & Buchsbaum, J. C. (2015). Proton Radiotherapy for Midline Central Nervous System Lesions: A Class Solution. Oncology, 89(2), 111-117. https://doi.org/10.1159/000377727

Proton Radiotherapy for Midline Central Nervous System Lesions : A Class Solution. / Estabrook, Neil C.; McDonald, Mark W.; Hoene, Ted A.; Bartlett, Greg K.; Johnstone, Peter A S; McMullen, Kevin P.; Buchsbaum, Jeffrey C.

In: Oncology, Vol. 89, No. 2, 22.07.2015, p. 111-117.

Research output: Contribution to journalArticle

Estabrook, NC, McDonald, MW, Hoene, TA, Bartlett, GK, Johnstone, PAS, McMullen, KP & Buchsbaum, JC 2015, 'Proton Radiotherapy for Midline Central Nervous System Lesions: A Class Solution', Oncology, vol. 89, no. 2, pp. 111-117. https://doi.org/10.1159/000377727
Estabrook NC, McDonald MW, Hoene TA, Bartlett GK, Johnstone PAS, McMullen KP et al. Proton Radiotherapy for Midline Central Nervous System Lesions: A Class Solution. Oncology. 2015 Jul 22;89(2):111-117. https://doi.org/10.1159/000377727
Estabrook, Neil C. ; McDonald, Mark W. ; Hoene, Ted A. ; Bartlett, Greg K. ; Johnstone, Peter A S ; McMullen, Kevin P. ; Buchsbaum, Jeffrey C. / Proton Radiotherapy for Midline Central Nervous System Lesions : A Class Solution. In: Oncology. 2015 ; Vol. 89, No. 2. pp. 111-117.
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abstract = "Objective: Midline and central lesions of the brain requiring conventional radiotherapy (RT) present complex difficulties in dose avoidance to organs at risk (OAR). In either definitive or adjuvant settings, proper RT coverage of these lesions involves unnecessary treatment of large volumes of normal brain. We propose a class solution for these lesions using proton radiotherapy (PrT). Materials and Methods: The records of the Indiana University Health Proton Therapy Center were reviewed for patients presenting between January 1, 2005 and October 1, 2013 with midline central nervous system (CNS) lesions. Twenty-four patients were identified. After Institutional Review Board approval was granted, their dosimetry was reviewed for target volume doses and OAR dose avoidance. Results: For these cases, meningiomas were the most common histology (8 cases), and next most prevalent were craniopharyngiomas (6 cases). The others were various different deep midline brain tumors (10 cases). In all cases, fields formed by vertex and/or anterior/posterior superior oblique PrT beams along the midsagittal plane were used to provide coverage with minimal dose to the brain stem or to the cerebral hemispheres. The median prescribed dose to the planning target volume for treating these patients was 54.0 Gy RBE (range 48.6-62.5) with a mean dose of 53.5 Gy RBE. The average of the mean doses to the brain stems using these fields in the 24 plans was 18.4 Gy RBE (range 0.0-44.7). Similarly, the average of the mean doses to the hippocampi was 15.8 Gy RBE (range 0.0-52.6). Conclusions: We consider these patients to be optimally treated with PrT. The use of modified midsagittal PrT schemas allows for the treatment of midline CNS lesions with sparing of most of the uninvolved brain.",
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