Analysis of dosimetric parameter on craniospinal irradiation with Helical Tomotherapy (HT), 3D Conformal Radiotherapy (3DCRT), and Intensity Modulated Radiotherapy (IMRT)

Abstract

Author(s): Fauzan Herdian, Anak Agung Sagung Ari Lestari, Vito Filbert Jayalie, Handoko, Wahyu Edi Wibowo, Muhammad Djakaria, Soehartati Gondhowiardjo

Traditional craniospinal irradiation consists of a large treatment area divided into several fields that can create dose overlaps in the inter-field junction. This analysis compares the dosimetric parameter of craniospinal irradiation with HT, 3DCRT, and LINAC-based IMRT and find the optimal technique in terms of dose distribution, organ-sparing, and body radiation exposure. In our hospital, 3DCRT, IMRT, and HT plan were made from CT data of 10 patients indicated for craniospinal irradiation, with a total dose of 36 Gy in 20 fractions. Cranial and spinal PTV coverage was evaluated using the Conformity Index (CI) and Homogeneity Index (HI). Dose received by critical organs, body-wide radiation exposure, number of Monitor Units (MU), and beam on duration were recorded and compared. In cranial PTV, HT and IMRT had better HI and CI compared to 3DCRT with no significant difference between IMRT and HT. In spinal PTV, HT had better HI and CI compared to IMRT and 3DCRT. 3DCRT has the highest mean dose in most of the critical organs, while HT has the highest whole-body radiation exposure, highest number of MU, and the longest beam on duration. For doses in inter-field junction, there is no statistically significant difference between 3DCRT and IMRT techniques. HT technique achieved the highest HI and CI but also had the highest body-wide radiation exposure, highest MU number, and longest beam on duration, in contrast to 3DCRT Proper consideration of the technique used in craniospinal irradiation is important to prevent late side effects, such as secondary malignancy.

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Editors List

  • Osamu Tanaka

    Osamu Tanaka
    Assistant Professor,
    Department of Radiation Oncology
    Asahi University Hospital
    Gifu city, Gifu, Japan

  • Maher Abdel Fattah Al-Shayeb

    Department of Surgical Sciences, Ajman University, UAE

  • Andrzej Zdziennicki

    Institute of Gynecology and Obstetrics, Medical University of Lodz, I Clinic of Gynecology and Gynecological Oncology (Lodz, Poland)

  • Krzysztof Urbanski

    Head of the Oncology Gynecology Clinic, Oncology Center - Instytut im. Maria Sklodowska Curie, Department in Krakow (Krakow, Poland)

  • Andrzej Szawlowski

    Klinika Nowotworow Gornego Odcinka Uklad Digestii, Oncology Center - Institute (Warsaw, Poland)