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 language | English |
|---|---|
| Pages (from-to) | 111-117 |
| Number of pages | 7 |
| Journal | Oncology |
| Volume | 89 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jul 22 2015 |
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Keywords
- Craniopharyngioma
- Meningioma
- Pediatric tumors
- Proton radiotherapy
ASJC Scopus subject areas
- Cancer Research
- Oncology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Proton Radiotherapy for Midline Central Nervous System Lesions
T2 - A Class Solution
AU - Estabrook, Neil C.
AU - McDonald, Mark W.
AU - Hoene, Ted A.
AU - Bartlett, Greg K.
AU - Johnstone, Peter A S
AU - McMullen, Kevin P.
AU - Buchsbaum, Jeffrey C.
PY - 2015/7/22
Y1 - 2015/7/22
N2 - 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.
AB - 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.
KW - Craniopharyngioma
KW - Meningioma
KW - Pediatric tumors
KW - Proton radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=84937514655&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937514655&partnerID=8YFLogxK
U2 - 10.1159/000377727
DO - 10.1159/000377727
M3 - Article
C2 - 25895699
AN - SCOPUS:84937514655
VL - 89
SP - 111
EP - 117
JO - Oncology
JF - Oncology
SN - 0890-9091
IS - 2
ER -