Improvement of therapeutic index for brain tumors with daily image guidance
Image-guidance maximizes the therapeutic index of brain irradiation by decreasing setup uncertainty. As dose-volume data emerge defining the tolerance of critical normal structures responsible for neuroendocrine function and neurocognition, minimizing clinical target volume (CTV) to planning target...
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| Veröffentlicht in: | Radiation oncology (London, England) England), 2013-12, Vol.8 (1), p.283-283, Article 283 |
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| creator | Shields, Lisa Be Coons, James M Dedich, Catherine Ragains, Maria Scalf, Kristi Vitaz, Todd W Spalding, Aaron C |
| description | Image-guidance maximizes the therapeutic index of brain irradiation by decreasing setup uncertainty. As dose-volume data emerge defining the tolerance of critical normal structures responsible for neuroendocrine function and neurocognition, minimizing clinical target volume (CTV) to planning target volume (PTV) expansion of targets near these structures potentially lessens long-term toxicity.
We reviewed the treatment records of 29 patients with brain tumors, with a total of 517 fractions analyzed. The CTV was uniformly expanded by 3 mm to create the PTV for all cases. We determined the effect of patient specific factors (prescribed medications, weight gain, tumor location) and image-guidance technique on setup uncertainty and plotted the mean +/- standard deviation for each factor. ANOVA was used to determine significance between these factors on setup uncertainty. We determined the impact of applying the initial three fraction variation as custom PTV-expansion on dose to normal structures.
The initial 3 mm margin encompassed 88% of all measured shifts from daily imaging for all fractions. There was no difference (p = n.s.) in average setup uncertainty between CBCT or kV imaging for all patients. Vertical, lateral, longitudinal, and 3D shifts were similar (p = n.s.) between days 1, 2, and 3 imaging and later fractions. Patients prescribed sedatives experienced increased setup uncertainty (p |
| doi_str_mv | 10.1186/1748-717X-8-283 |
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We reviewed the treatment records of 29 patients with brain tumors, with a total of 517 fractions analyzed. The CTV was uniformly expanded by 3 mm to create the PTV for all cases. We determined the effect of patient specific factors (prescribed medications, weight gain, tumor location) and image-guidance technique on setup uncertainty and plotted the mean +/- standard deviation for each factor. ANOVA was used to determine significance between these factors on setup uncertainty. We determined the impact of applying the initial three fraction variation as custom PTV-expansion on dose to normal structures.
The initial 3 mm margin encompassed 88% of all measured shifts from daily imaging for all fractions. There was no difference (p = n.s.) in average setup uncertainty between CBCT or kV imaging for all patients. Vertical, lateral, longitudinal, and 3D shifts were similar (p = n.s.) between days 1, 2, and 3 imaging and later fractions. Patients prescribed sedatives experienced increased setup uncertainty (p < 0.05), while weight gain, corticosteroid administration, and anti-seizure medication did not associate with increased setup uncertainty. Patients with targets near OAR with individualized margins led to decreased OAR dose. No reductions to targets occurred with individualized PTVs.
Daily imaging allows application of individualized CTV expansion to reduce dose to OAR responsible for neurocognition, learning, and neuroendocrine function below doses shown to correlate with long-term morbidity. The demonstrated reduction in dose to OAR in this study has implications for quality of life and provides the motivation to pursue custom PTV expansion.</description><identifier>ISSN: 1748-717X</identifier><identifier>EISSN: 1748-717X</identifier><identifier>DOI: 10.1186/1748-717X-8-283</identifier><identifier>PMID: 24295338</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Brain Neoplasms - diagnostic imaging ; Brain Neoplasms - radiotherapy ; Brain tumors ; Care and treatment ; Cognition disorders ; Cone-Beam Computed Tomography ; Glioma - diagnostic imaging ; Glioma - radiotherapy ; Health aspects ; Humans ; Magnetic Resonance Imaging ; Meningioma - diagnostic imaging ; Meningioma - radiotherapy ; Organs at Risk ; Phantoms, Imaging ; Pituitary Neoplasms - diagnostic imaging ; Pituitary Neoplasms - radiotherapy ; Quality of Life ; Radiation ; Radiotherapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Risk factors</subject><ispartof>Radiation oncology (London, England), 2013-12, Vol.8 (1), p.283-283, Article 283</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Shields et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Shields et al.; licensee BioMed Central Ltd. 2013 Shields et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b547t-2f6c98e21e902a037970d8a30a8b812b69c8dd81c5bfad5f23aa8a5b6f1d56a83</citedby><cites>FETCH-LOGICAL-b547t-2f6c98e21e902a037970d8a30a8b812b69c8dd81c5bfad5f23aa8a5b6f1d56a83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222040/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222040/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,27911,27912,53778,53780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24295338$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shields, Lisa Be</creatorcontrib><creatorcontrib>Coons, James M</creatorcontrib><creatorcontrib>Dedich, Catherine</creatorcontrib><creatorcontrib>Ragains, Maria</creatorcontrib><creatorcontrib>Scalf, Kristi</creatorcontrib><creatorcontrib>Vitaz, Todd W</creatorcontrib><creatorcontrib>Spalding, Aaron C</creatorcontrib><title>Improvement of therapeutic index for brain tumors with daily image guidance</title><title>Radiation oncology (London, England)</title><addtitle>Radiat Oncol</addtitle><description>Image-guidance maximizes the therapeutic index of brain irradiation by decreasing setup uncertainty. As dose-volume data emerge defining the tolerance of critical normal structures responsible for neuroendocrine function and neurocognition, minimizing clinical target volume (CTV) to planning target volume (PTV) expansion of targets near these structures potentially lessens long-term toxicity.
We reviewed the treatment records of 29 patients with brain tumors, with a total of 517 fractions analyzed. The CTV was uniformly expanded by 3 mm to create the PTV for all cases. We determined the effect of patient specific factors (prescribed medications, weight gain, tumor location) and image-guidance technique on setup uncertainty and plotted the mean +/- standard deviation for each factor. ANOVA was used to determine significance between these factors on setup uncertainty. We determined the impact of applying the initial three fraction variation as custom PTV-expansion on dose to normal structures.
The initial 3 mm margin encompassed 88% of all measured shifts from daily imaging for all fractions. There was no difference (p = n.s.) in average setup uncertainty between CBCT or kV imaging for all patients. Vertical, lateral, longitudinal, and 3D shifts were similar (p = n.s.) between days 1, 2, and 3 imaging and later fractions. Patients prescribed sedatives experienced increased setup uncertainty (p < 0.05), while weight gain, corticosteroid administration, and anti-seizure medication did not associate with increased setup uncertainty. Patients with targets near OAR with individualized margins led to decreased OAR dose. No reductions to targets occurred with individualized PTVs.
Daily imaging allows application of individualized CTV expansion to reduce dose to OAR responsible for neurocognition, learning, and neuroendocrine function below doses shown to correlate with long-term morbidity. The demonstrated reduction in dose to OAR in this study has implications for quality of life and provides the motivation to pursue custom PTV expansion.</description><subject>Brain Neoplasms - diagnostic imaging</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain tumors</subject><subject>Care and treatment</subject><subject>Cognition disorders</subject><subject>Cone-Beam Computed Tomography</subject><subject>Glioma - diagnostic imaging</subject><subject>Glioma - radiotherapy</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Meningioma - diagnostic imaging</subject><subject>Meningioma - radiotherapy</subject><subject>Organs at Risk</subject><subject>Phantoms, Imaging</subject><subject>Pituitary Neoplasms - diagnostic imaging</subject><subject>Pituitary Neoplasms - radiotherapy</subject><subject>Quality of Life</subject><subject>Radiation</subject><subject>Radiotherapy</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy Planning, Computer-Assisted</subject><subject>Risk factors</subject><issn>1748-717X</issn><issn>1748-717X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kk1r3DAQhkVpadKk596KoJdcnOjTli-FNPQjNNBLA70JWRrtKtjSVrbT5N9XZtNttqQIJDHzzKvRyyD0hpJTSlV9RhuhqoY2PypVMcWfocNd5Pmj-wF6NY43hAjJSfsSHTDBWsm5OkRfL4dNTrcwQJxw8nhaQzYbmKdgcYgO7rBPGXfZhIineUh5xL_CtMbOhP4eh8GsAK_m4Ey0cIxeeNOP8PrhPELXnz5-v_hSXX37fHlxflV1UjRTxXxtWwWMQkuYIbxpG-KU4cSoTlHW1a1VzilqZeeNk55xY5SRXe2pk7VR_Ai93-pu5m4AZ0vr2fR6k0s7-V4nE_R-Joa1XqVbLRhjRJAi8GEr0IX0H4H9jE2DXszUi5la6WJ1ETl56CKnnzOMkx7CaKHvTYQ0j5qKumWUMCkK-u4f9CbNORaPFqqRLSnbX2pletAh-lTetouoPpdcNFRytlCnT1BlORiCTRF8KPG9grNtgc1pHDP43T8p0csQPfGzt4_93fF_pob_Bsmdwo8</recordid><startdate>20131202</startdate><enddate>20131202</enddate><creator>Shields, Lisa Be</creator><creator>Coons, James M</creator><creator>Dedich, Catherine</creator><creator>Ragains, Maria</creator><creator>Scalf, Kristi</creator><creator>Vitaz, Todd W</creator><creator>Spalding, Aaron C</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20131202</creationdate><title>Improvement of therapeutic index for brain tumors with daily image guidance</title><author>Shields, Lisa Be ; 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As dose-volume data emerge defining the tolerance of critical normal structures responsible for neuroendocrine function and neurocognition, minimizing clinical target volume (CTV) to planning target volume (PTV) expansion of targets near these structures potentially lessens long-term toxicity.
We reviewed the treatment records of 29 patients with brain tumors, with a total of 517 fractions analyzed. The CTV was uniformly expanded by 3 mm to create the PTV for all cases. We determined the effect of patient specific factors (prescribed medications, weight gain, tumor location) and image-guidance technique on setup uncertainty and plotted the mean +/- standard deviation for each factor. ANOVA was used to determine significance between these factors on setup uncertainty. We determined the impact of applying the initial three fraction variation as custom PTV-expansion on dose to normal structures.
The initial 3 mm margin encompassed 88% of all measured shifts from daily imaging for all fractions. There was no difference (p = n.s.) in average setup uncertainty between CBCT or kV imaging for all patients. Vertical, lateral, longitudinal, and 3D shifts were similar (p = n.s.) between days 1, 2, and 3 imaging and later fractions. Patients prescribed sedatives experienced increased setup uncertainty (p < 0.05), while weight gain, corticosteroid administration, and anti-seizure medication did not associate with increased setup uncertainty. Patients with targets near OAR with individualized margins led to decreased OAR dose. No reductions to targets occurred with individualized PTVs.
Daily imaging allows application of individualized CTV expansion to reduce dose to OAR responsible for neurocognition, learning, and neuroendocrine function below doses shown to correlate with long-term morbidity. The demonstrated reduction in dose to OAR in this study has implications for quality of life and provides the motivation to pursue custom PTV expansion.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24295338</pmid><doi>10.1186/1748-717X-8-283</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Brain Neoplasms - diagnostic imaging Brain Neoplasms - radiotherapy Brain tumors Care and treatment Cognition disorders Cone-Beam Computed Tomography Glioma - diagnostic imaging Glioma - radiotherapy Health aspects Humans Magnetic Resonance Imaging Meningioma - diagnostic imaging Meningioma - radiotherapy Organs at Risk Phantoms, Imaging Pituitary Neoplasms - diagnostic imaging Pituitary Neoplasms - radiotherapy Quality of Life Radiation Radiotherapy Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted Risk factors |
| title | Improvement of therapeutic index for brain tumors with daily image guidance |
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