Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis

This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ...

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Published in:	Radiation oncology (London, England) Vol. 19; no. 1; p. 49
Main Authors:	Şenkesen, Öznur, Tezcanlı, Evrim, Alkaya, Fadime, İspir, Burçin, Çatlı, Serap, Yeşil, Abdullah, Bezirganoglu, Ebrar, Turan, Sezgi, Köksal, Canan, Güray, Gülay, Hacıislamoğlu, Emel, Durmuş, İsmail Faruk, Çavdar, Şeyma, Aksu, Telat, Çolak, Nurten, Küçükmorkoç, Esra, Doğan, Mustafa, Ercan, Tülay, Karaköse, Fatih, Alpan, Vildan, Ceylan, Cemile, Poyraz, Gökhan, Nalbant, Nilgül, Kınay, Şeyda, İpek, Servet, Kayalılar, Namık, Tatlı, Hamza, Zhu, Mingyao
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 16-04-2024 BioMed Central BMC
Subjects:	Adult Care and treatment Child Children Craniospinal irradiation Craniospinal Irradiation - methods Diagnosis Health aspects Humans Intensity-modulated radiation therapy Medulloblastoma Patient outcomes Proton beam radiotherapy Proton therapy Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted - methods Radiotherapy, Conformal - methods Radiotherapy, Intensity-Modulated - methods Secondary cancer risk Tomotherapy Turkey Volumetric modulated arc therapy Turkey United States Intensity-modulated radiation therapy Craniospinal irradiation Proton therapy Tomotherapy Secondary cancer risk Volumetric modulated arc therapy
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Summary:	This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy. All techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes. Modern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1748-717X 1748-717X
DOI:	10.1186/s13014-024-02435-4