Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

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Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy. / De Saint-Hubert, Marijke; Verellen, Dirk; Poels, Kenneth; Crijns, Wouter; Magliona, Federica; Depuydt, Tom; Vanhavere, Filip; Struelens, Lara.

In: Physics in Medicine and Biology, Vol. 62, No. 13, 5293 , 06.06.2017.

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@article{1ea53c48ad5b4b53975f9975aa7367c9,
title = "Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy",
abstract = "Medulloblastoma treatment involves irradiation of the entire central nervous system, i.e craniospinal irradiation (CSI). This is associated with significant exposure of large volumes of healthy tissuewith a growing concern regarding treatment associated side effects. The current study compares out-of-field organ doses in children receiving CSI with three-dimensional conformalradiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), helical tomotherapy (HT) and an electron-based technique, including as well radiation doses resulting from imaging performed duringtreatment. An extensive phantom study is performed, using an anthropomorphic phantom corresponding to a 5-year old child, in which organ absorbed doses are measured using thermoluminescent detectors (TLDs).Additionally the study evaluates and explores tools for calculating out-of-field patient doses using the treatment planning system (TPS) and analytical models.In our study, 3D-CRT resulted in very high doses to a limited number of organs while it was able to spare organs such as the lungs and breast when compared to IMRT and HT. Both IMRT and HT spread the doseover more organs and were able to spare heart, thyroid, bladder, uterus and testes when compared to 3D-CRT. The electron-based technique considerably decreased the out-of-field doses in deep seated organs but cannotavoid nearby out-of-field organs such as lungs, ribs, adrenals, kidneys and uterus. Daily imaging dose is small compared to the treatment dose burden. TPS error for out-of-field doses was most pronounced for organsfurther away from the target nevertheless no systematic underestimation was observed for any of the studied TPS systems. Finally analytical modeling was most optimal for 3D-CRT although the number of organs thatcan be modeled was limited.To conclude none of the techniques studied was able to spare doses in all organs. Nevertheless the electron based technique showed most promising for out-of-field organ dose reduction during CSI when compared tophoton techniques.",
keywords = "Dose, pediatrics, Craniospinal, irradiations, Medulloblastoma treatment , central nervous system",
author = "{De Saint-Hubert}, Marijke and Dirk Verellen and Kenneth Poels and Wouter Crijns and Federica Magliona and Tom Depuydt and Filip Vanhavere and Lara Struelens",
note = "Score=10",
year = "2017",
month = "6",
day = "6",
doi = "10.1088/1361-6560/aa6c9e",
language = "English",
volume = "62",
journal = "Physics in Medicine and Biology",
issn = "0031-9155",
publisher = "IOP - IOP Publishing",
number = "13",

}

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TY - JOUR

T1 - Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

AU - De Saint-Hubert, Marijke

AU - Verellen, Dirk

AU - Poels, Kenneth

AU - Crijns, Wouter

AU - Magliona, Federica

AU - Depuydt, Tom

AU - Vanhavere, Filip

AU - Struelens, Lara

N1 - Score=10

PY - 2017/6/6

Y1 - 2017/6/6

N2 - Medulloblastoma treatment involves irradiation of the entire central nervous system, i.e craniospinal irradiation (CSI). This is associated with significant exposure of large volumes of healthy tissuewith a growing concern regarding treatment associated side effects. The current study compares out-of-field organ doses in children receiving CSI with three-dimensional conformalradiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), helical tomotherapy (HT) and an electron-based technique, including as well radiation doses resulting from imaging performed duringtreatment. An extensive phantom study is performed, using an anthropomorphic phantom corresponding to a 5-year old child, in which organ absorbed doses are measured using thermoluminescent detectors (TLDs).Additionally the study evaluates and explores tools for calculating out-of-field patient doses using the treatment planning system (TPS) and analytical models.In our study, 3D-CRT resulted in very high doses to a limited number of organs while it was able to spare organs such as the lungs and breast when compared to IMRT and HT. Both IMRT and HT spread the doseover more organs and were able to spare heart, thyroid, bladder, uterus and testes when compared to 3D-CRT. The electron-based technique considerably decreased the out-of-field doses in deep seated organs but cannotavoid nearby out-of-field organs such as lungs, ribs, adrenals, kidneys and uterus. Daily imaging dose is small compared to the treatment dose burden. TPS error for out-of-field doses was most pronounced for organsfurther away from the target nevertheless no systematic underestimation was observed for any of the studied TPS systems. Finally analytical modeling was most optimal for 3D-CRT although the number of organs thatcan be modeled was limited.To conclude none of the techniques studied was able to spare doses in all organs. Nevertheless the electron based technique showed most promising for out-of-field organ dose reduction during CSI when compared tophoton techniques.

AB - Medulloblastoma treatment involves irradiation of the entire central nervous system, i.e craniospinal irradiation (CSI). This is associated with significant exposure of large volumes of healthy tissuewith a growing concern regarding treatment associated side effects. The current study compares out-of-field organ doses in children receiving CSI with three-dimensional conformalradiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), helical tomotherapy (HT) and an electron-based technique, including as well radiation doses resulting from imaging performed duringtreatment. An extensive phantom study is performed, using an anthropomorphic phantom corresponding to a 5-year old child, in which organ absorbed doses are measured using thermoluminescent detectors (TLDs).Additionally the study evaluates and explores tools for calculating out-of-field patient doses using the treatment planning system (TPS) and analytical models.In our study, 3D-CRT resulted in very high doses to a limited number of organs while it was able to spare organs such as the lungs and breast when compared to IMRT and HT. Both IMRT and HT spread the doseover more organs and were able to spare heart, thyroid, bladder, uterus and testes when compared to 3D-CRT. The electron-based technique considerably decreased the out-of-field doses in deep seated organs but cannotavoid nearby out-of-field organs such as lungs, ribs, adrenals, kidneys and uterus. Daily imaging dose is small compared to the treatment dose burden. TPS error for out-of-field doses was most pronounced for organsfurther away from the target nevertheless no systematic underestimation was observed for any of the studied TPS systems. Finally analytical modeling was most optimal for 3D-CRT although the number of organs thatcan be modeled was limited.To conclude none of the techniques studied was able to spare doses in all organs. Nevertheless the electron based technique showed most promising for out-of-field organ dose reduction during CSI when compared tophoton techniques.

KW - Dose

KW - pediatrics

KW - Craniospinal

KW - irradiations

KW - Medulloblastoma treatment

KW - central nervous system

UR - http://ecm.sckcen.be/OTCS/llisapi.dll/open/25543141

U2 - 10.1088/1361-6560/aa6c9e

DO - 10.1088/1361-6560/aa6c9e

M3 - Article

VL - 62

JO - Physics in Medicine and Biology

JF - Physics in Medicine and Biology

SN - 0031-9155

IS - 13

M1 - 5293

ER -

ID: 2835415