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A dosimetric comparison of craniospinal irradiation using TomoDirect radiotherapy, TomoHelical radiotherapy and 3D conventional radiotherapy

Published online by Cambridge University Press:  22 June 2017

Shirley W. S. Tsang ,
Mark Collins ,
Jacky T. L. Wong  and
George Chiu
Shirley W. S. Tsang
Affiliation:
Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
Mark Collins*
Affiliation:
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
Jacky T. L. Wong
Affiliation:
Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
George Chiu
Affiliation:
Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
*
Correspondence to: Mark Collins, Faculty of Health and Wellbeing, Sheffield Hallam University, F423 Robert Winston Building, Collegiate Crescent Campus, Sheffield, S10 2BP, UK. Tel: +44 114 225 5555. E-mail: m.l.collins@shu.ac.uk
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Abstract

Aim

The purpose of this study was to dosimetrically compare TomoDirect, TomoHelical and linear accelerator-based 3D-conformal radiotherapy (Linac-3DCRT) for craniospinal irradiation (CSI) in the treatment of medulloblastoma.

Methods

Five CSI patients were replanned with Linac-3DCRT, TomoHelical, TomoDirect-3DCRT and TomoDirect-intensity-modulated radiotherapy (IMRT). Dose of 36 Gy in 20 fractions was prescribed to the planning target volume (PTV). Homogeneity index (HI), non-target integral dose (NTID), dose–volume histograms, organs-at-risk (OARs) Dmax, Dmean and treatment times were compared.

Results

TomoHelical achieved the best PTV homogeneity compared with Linac-3DCRT, TomoDirect-3DCRT and TomoDirect-IMRT (HI of 3·6 versus 20·9, 8·7 and 9·4%, respectively). TomoDirect-IMRT achieved the lowest NTID compared with TomoDirect-3DCRT, TomoHelical and Linac-3DCRT (141 J versus 151 J, 181 J and 250 J), indicating least biological damage to normal tissues. TomoHelical plans achieved the lowest Dmax in all organs except the breasts, and lowest Dmean for most OARs, except in laterally situated OARs, where TomoDirect triumphed. Beam-on time was longest for TomoHelical, followed by TomoDirect and Linac-3DCRT.

Findings

TomoDirect has the potential to lower NTID and shorten treatment times compared with TomoHelical. It reduces PTV inhomogeneity and better spares OARs compared with Linac-3DCRT. Therefore, TomoDirect may be a CSI treatment alternative to TomoHelical and in place of Linac-3DCRT.

Keywords

3DCRTcraniospinal irradiationTomoDirecttomotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 391 - 402
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Copyright
© Cambridge University Press 2017 

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