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

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2024年4月16日

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Öznur Şenkesen,
Evrim Tezcanlı,
Fadime Alkaya,
Burçin İspir,
Serap Çatlı,
Abdullah Yeşil,
Ebrar Bezirganoglu,
Sezgi Turan,
Canan Köksal,
Gülay Güray,
Emel Hacıislamoğlu,
İsmail Faruk Durmuş,
Şeyma Çavdar,
Telat Aksu,
Nurten Çolak,
Esra Küçükmorkoç,
Mustafa Doğan,
Tülay Ercan,
Fatih Karaköse,
Vildan Alpan,
Cemile Ceylan,
Gökhan Poyraz,
Nilgül Nalbant,
Şeyda Kınay,
Servet İpek,
Namık Kayalılar,
Hamza Tatlı,
Mingyao Zhu

摘要

Objective

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.

Methods

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.

Results

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.

Conclusion

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.