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Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma
Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of us...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598548/ https://www.ncbi.nlm.nih.gov/pubmed/31293971 http://dx.doi.org/10.3389/fonc.2019.00531 |
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author | Tensaouti, Fatima Ducassou, Anne Chaltiel, Léonor Bolle, Stéphanie Habrand, Jean Louis Alapetite, Claire Coche-Dequeant, Bernard Bernier, Valérie Claude, Line Carrie, Christian Padovani, Laetitia Muracciole, Xavier Supiot, Stéphane Huchet, Aymeri Leseur, Julie Kerr, Christine Hangard, Grégorie Lisbona, Albert Goudjil, Farid Ferrand, Régis Laprie, Anne |
author_facet | Tensaouti, Fatima Ducassou, Anne Chaltiel, Léonor Bolle, Stéphanie Habrand, Jean Louis Alapetite, Claire Coche-Dequeant, Bernard Bernier, Valérie Claude, Line Carrie, Christian Padovani, Laetitia Muracciole, Xavier Supiot, Stéphane Huchet, Aymeri Leseur, Julie Kerr, Christine Hangard, Grégorie Lisbona, Albert Goudjil, Farid Ferrand, Régis Laprie, Anne |
author_sort | Tensaouti, Fatima |
collection | PubMed |
description | Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of using a simultaneous integrated boost (SIB), comparing VMAT vs. IMPT dose delivery. Material and methods: The cohort included 101 patients. The dose to planning target volume (PTV59.4) was 59.4/1.8 Gy, and the dose to SIB volume (PTV67.6) was 67.6/2.05 Gy. Gross tumor volume (GTV) was defined as the tumor bed plus residual tumor, clinical target volume (CTV59.4) was GTV + 5 mm, and PTV59.4 was CTV59.4 + 3 mm. PTV67.6 was GTV+ 3 mm. After treatment plan optimization, quality indices and doses to target volume and organs at risk (OARs) were extracted and compared with the standard radiation doses that were actually delivered (median = 59.4 Gy [50.4 59.4]). Results: In most cases, the proton treatment resulted in higher quality indices (p < 0.001). Compared with the doses that were initially delivered, mean, and maximum doses to some OARs were no higher with SIB VMAT, and significantly lower with protons (p < 0.001). In the case of posterior fossa tumor, there was a lower dose to the brainstem with protons, in terms of V59 Gy, mean, and near-maximum (D2%) doses. Conclusion: Dose escalation with intensity-modulated proton or photon SIB is feasible in some patients. This approach could be considered for children with unresectable residue or post-operative FLAIR abnormalities, particularly if they have supratentorial tumors. It should not be considered for infratentorial tumors encasing the brainstem or extending to the medulla. |
format | Online Article Text |
id | pubmed-6598548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-65985482019-07-10 Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma Tensaouti, Fatima Ducassou, Anne Chaltiel, Léonor Bolle, Stéphanie Habrand, Jean Louis Alapetite, Claire Coche-Dequeant, Bernard Bernier, Valérie Claude, Line Carrie, Christian Padovani, Laetitia Muracciole, Xavier Supiot, Stéphane Huchet, Aymeri Leseur, Julie Kerr, Christine Hangard, Grégorie Lisbona, Albert Goudjil, Farid Ferrand, Régis Laprie, Anne Front Oncol Oncology Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of using a simultaneous integrated boost (SIB), comparing VMAT vs. IMPT dose delivery. Material and methods: The cohort included 101 patients. The dose to planning target volume (PTV59.4) was 59.4/1.8 Gy, and the dose to SIB volume (PTV67.6) was 67.6/2.05 Gy. Gross tumor volume (GTV) was defined as the tumor bed plus residual tumor, clinical target volume (CTV59.4) was GTV + 5 mm, and PTV59.4 was CTV59.4 + 3 mm. PTV67.6 was GTV+ 3 mm. After treatment plan optimization, quality indices and doses to target volume and organs at risk (OARs) were extracted and compared with the standard radiation doses that were actually delivered (median = 59.4 Gy [50.4 59.4]). Results: In most cases, the proton treatment resulted in higher quality indices (p < 0.001). Compared with the doses that were initially delivered, mean, and maximum doses to some OARs were no higher with SIB VMAT, and significantly lower with protons (p < 0.001). In the case of posterior fossa tumor, there was a lower dose to the brainstem with protons, in terms of V59 Gy, mean, and near-maximum (D2%) doses. Conclusion: Dose escalation with intensity-modulated proton or photon SIB is feasible in some patients. This approach could be considered for children with unresectable residue or post-operative FLAIR abnormalities, particularly if they have supratentorial tumors. It should not be considered for infratentorial tumors encasing the brainstem or extending to the medulla. Frontiers Media S.A. 2019-06-21 /pmc/articles/PMC6598548/ /pubmed/31293971 http://dx.doi.org/10.3389/fonc.2019.00531 Text en Copyright © 2019 Tensaouti, Ducassou, Chaltiel, Bolle, Habrand, Alapetite, Coche-Dequeant, Bernier, Claude, Carrie, Padovani, Muracciole, Supiot, Huchet, Leseur, Kerr, Hangard, Lisbona, Goudjil, Ferrand and Laprie. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Tensaouti, Fatima Ducassou, Anne Chaltiel, Léonor Bolle, Stéphanie Habrand, Jean Louis Alapetite, Claire Coche-Dequeant, Bernard Bernier, Valérie Claude, Line Carrie, Christian Padovani, Laetitia Muracciole, Xavier Supiot, Stéphane Huchet, Aymeri Leseur, Julie Kerr, Christine Hangard, Grégorie Lisbona, Albert Goudjil, Farid Ferrand, Régis Laprie, Anne Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title | Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title_full | Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title_fullStr | Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title_full_unstemmed | Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title_short | Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma |
title_sort | feasibility of dose escalation in patients with intracranial pediatric ependymoma |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598548/ https://www.ncbi.nlm.nih.gov/pubmed/31293971 http://dx.doi.org/10.3389/fonc.2019.00531 |
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