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Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning
BACKGROUND: To date, patients with glioblastoma still have a bad median overall survival rate despite radiation dose-escalation and combined modality treatment. Neurocognitive decline is a crucial adverse event which may be linked to high doses to the cortex. In a planning study, we investigated the...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801703/ https://www.ncbi.nlm.nih.gov/pubmed/29409516 http://dx.doi.org/10.1186/s13014-018-0953-x |
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author | Exeli, Ann-Katrin Kellner, Daniel Exeli, Lukas Steininger, Phil Wolf, Frank Sedlmayer, Felix Deutschmann, Heinz |
author_facet | Exeli, Ann-Katrin Kellner, Daniel Exeli, Lukas Steininger, Phil Wolf, Frank Sedlmayer, Felix Deutschmann, Heinz |
author_sort | Exeli, Ann-Katrin |
collection | PubMed |
description | BACKGROUND: To date, patients with glioblastoma still have a bad median overall survival rate despite radiation dose-escalation and combined modality treatment. Neurocognitive decline is a crucial adverse event which may be linked to high doses to the cortex. In a planning study, we investigated the impact of dose constraints to the cerebral cortex and its relation to the organs at risk for glioblastoma patients. METHODS: Cortical sparing was implemented into the optimization process for two planning approaches: classical intensity-modulated radiotherapy (IMRT) and robust treatment planning. The plans with and without objectives for cortex sparing where compared based on dose-volume histograms (DVH) data of the main organs at risk. Additionally the cortex volume above a critical threshold of 28.6 Gy was elaborated. Furthermore, IMRT plans were compared with robust treatment plans regarding potential cortex sparing. RESULTS: Cortical dose constraints result in a statistically significant reduced cerebral cortex volume above 28.6 Gy without negative effects to the surrounding organs at risk independently of the optimization technique. For IMRT we found a mean volume reduction of doses beyond the threshold of 19%, and 16% for robust treatment planning, respectively. Robust plans delivered sharper dose gradients around the target volume in an order of 3 – 6%. Aside from that the integration of cortical sparing into the optimization process has the potential to reduce the dose around the target volume (4 – 8%). CONCLUSIONS: We were able to show that dose to the cerebral cortex can be significantly reduced both with robust treatment planning and IMRT while maintaining clinically adequate target coverage and without corrupting any organ at risk. Robust treatment plans delivered more conformal plans compared to IMRT and were superior in regards to cortical sparing. |
format | Online Article Text |
id | pubmed-5801703 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58017032018-02-14 Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning Exeli, Ann-Katrin Kellner, Daniel Exeli, Lukas Steininger, Phil Wolf, Frank Sedlmayer, Felix Deutschmann, Heinz Radiat Oncol Research BACKGROUND: To date, patients with glioblastoma still have a bad median overall survival rate despite radiation dose-escalation and combined modality treatment. Neurocognitive decline is a crucial adverse event which may be linked to high doses to the cortex. In a planning study, we investigated the impact of dose constraints to the cerebral cortex and its relation to the organs at risk for glioblastoma patients. METHODS: Cortical sparing was implemented into the optimization process for two planning approaches: classical intensity-modulated radiotherapy (IMRT) and robust treatment planning. The plans with and without objectives for cortex sparing where compared based on dose-volume histograms (DVH) data of the main organs at risk. Additionally the cortex volume above a critical threshold of 28.6 Gy was elaborated. Furthermore, IMRT plans were compared with robust treatment plans regarding potential cortex sparing. RESULTS: Cortical dose constraints result in a statistically significant reduced cerebral cortex volume above 28.6 Gy without negative effects to the surrounding organs at risk independently of the optimization technique. For IMRT we found a mean volume reduction of doses beyond the threshold of 19%, and 16% for robust treatment planning, respectively. Robust plans delivered sharper dose gradients around the target volume in an order of 3 – 6%. Aside from that the integration of cortical sparing into the optimization process has the potential to reduce the dose around the target volume (4 – 8%). CONCLUSIONS: We were able to show that dose to the cerebral cortex can be significantly reduced both with robust treatment planning and IMRT while maintaining clinically adequate target coverage and without corrupting any organ at risk. Robust treatment plans delivered more conformal plans compared to IMRT and were superior in regards to cortical sparing. BioMed Central 2018-02-06 /pmc/articles/PMC5801703/ /pubmed/29409516 http://dx.doi.org/10.1186/s13014-018-0953-x Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Exeli, Ann-Katrin Kellner, Daniel Exeli, Lukas Steininger, Phil Wolf, Frank Sedlmayer, Felix Deutschmann, Heinz Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title | Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title_full | Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title_fullStr | Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title_full_unstemmed | Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title_short | Cerebral cortex dose sparing for glioblastoma patients: IMRT versus robust treatment planning |
title_sort | cerebral cortex dose sparing for glioblastoma patients: imrt versus robust treatment planning |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801703/ https://www.ncbi.nlm.nih.gov/pubmed/29409516 http://dx.doi.org/10.1186/s13014-018-0953-x |
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