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Tüm Beyin Radyoterapisinde YART Tekniği ile Hipokampus Korumalı Planların Dozimetrik Karşılaştırılması

Yıl 2021, Cilt: 31 Sayı: 1, 76 - 81, 31.01.2021

Öz

Amaç: Bu çalışmada tüm beyin radyoterapi tedavisinde hipokampus korumalı dinamik yoğunluk ayarlı radyoterapi D-YART ve statik yoğunluk ayarlı radyoterapi S-YART tekniklerinin dozimetrik karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Bölümümüzde 2019-2020 yılları arasında tüm beyin kanseri nedeniyle radyoterapi uygulanan 10 hasta çalışmaya dahil edilmişitir. Her hasta için hipokampus korumalı tüm beyine yönelik iki farklı yoğunluk ayarlı radyoterapi YART planları hazırlanmıştır. Planlanan hedef hacim PTV , hipokampus, beyin sapı, optik kiazma, göz, lens gibi risk altındaki organlar RAO , doz homojenite indeksi DHI , conformite indeksi CI , monitör ünitler MU açısından D-YART planları S-YART planları ile karşılaştırılmıştır.Bulgular: Yapılan istatistiksel karşılaştırma sonucunda PTV’ye ait değerlerin analizinde D-YART ve S-YART arasında CI değerinde anlamlı fark görülmüştür p=0.000 . Hipokamus korumalı YART planlarında S-YART tekniğinde beyin sapı, optik kiazma,ve optik sinir gibi kritik organların aldığı ortalama dozlar D-YART tekniğine göre anlamlı derecede azaldığı görülmüştür sırasıyla p=0.000, p=0.003, p=0001 ve p=0.000 . Lens dozları analiz edildiğinde, sağ ve sol lenslerin ortalama doz değerlerinin S-YART tekniğinde daha düşük olduğu gözlenmiştir. p=0.000 .Sonuç: Tüm beyin radyoterapisi nedeniyle hipokampus korumasına yönelik D-YART tekniği ile S-YART teknikleri karşılaştırıldığında, S-YART tekniğinin hipokampus ve diğer kritik organları daha iyi koruduğu görülmüştür

Kaynakça

  • Gondi V, Tolakanahalli R, Mehta M, et al. Hippocam- pal-sparing whole brain radiotherapy: A “how-to” tech- nique, utilizing helical tomotherapy and linacbased inten- sity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2010;78:1244–52.
  • Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain me- tastases. Histology, multiplicity, surgery and survival cancer 1996 ;78:1781-8.
  • Marsh J, Gielda B, Herskovic A, et al. Sparing of the hip- pocampus and limbic circuit during whole brain radiation therapy: a dosimetric study using helical tomotherapy. J Med Imaging Radiat Oncol 2010;54:375-82.
  • Raineki C, Holman PJ, Debiec J, et al. Functional emergen- ce of the hippocampus in context fear learning in infant rats. Hippocampus 2010;20:1037-46.
  • De Angelis LM, Delattre JY, Posner JB. Radiationinduced dementia in patients cured of brain metastases. Neurology 1989;39:789-96.
  • DD, Sperduto PW. Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 1995;31:983- 98.
  • Jeneson A, Mauldin KN, Hopkins RO, et al. The role of the hippocampus in retaining relational information across short delays: the importance of memory load. Learn Mem. 2011;18:301-5.
  • Hamilton GF, Murawski NJ, St. Cyr SA, et al. Neona- tal alcohol exposure disrupts hippocampal neurogenesis and contextual fear conditioning in adult rats. Brain Res. 2011;1412:88-101.
  • Deng W, Saxe MD, Gallina IS, et al. Adult-born hippo- campal dentate granule cells undergoing maturation modulate learning and memory in the brain. J Neurosci 2009;29:13532-42.
  • Grosu AL, Oehlke O, Sturm D. Whole-brain irradiation with hippocampal sparing and dose escalation on metasta- ses: Neurocognitive testing and biological imaging a phase ii prospective randomized multicentre study 2016:1–86.
  • Oehlke O, Wucherpfennig D, Fels F, et al. Whole brain irradiation with hippocampal sparing and dose escala- tion on multiple brain metastases. Strahlenther Onkol 2015;191:461-9.
  • Ghia A, Tomé W, Thomas S, et al. Distribution of brain- metastases in relationtothehippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys. 2007;68:971.
  • ICRU (International Commission on Radiation Unıts and Measurements), Prescribing, Recording and Raporting Ele- ctron Beam Therapy, Report No.71, Bethesda, MD.2009.
  • T. Landberg, J. Chavaudra, J. Dobbs, J. -P. Gerard, G. Hanks, J. -C. Horiot, K. -A. Johansson, T. Möller, J. Purdy, N. Sunt- haralingam, H. Svensson, 1. Introduction, Journal of the International Commission on Radiation Units and Measu- rements, 1–2. 1999;32:1-2.
  • ICRU Report 83: Prescribing, recording, and Reporting Photon Beam İntensity Modulated Radiation Therapy(IM- RT). J ICRU 2010;10:1-106.
  • Monje ML, Mizumatsu S, Fike JR, et al. Irradiation induces- neural precursor-cell dysfunction. Nat Med. 2002;8:955-62.
  • Krayenbuehl J, Martino MD, Guckenberger M, Andrats- chke N. Improved plan quality with automated radiothe- rapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial. Radiation Oncology 2017;12:161.
  • Harth S, Abo-Madyan Y, Zheng L, et al. Estimation of int- racranial failure risk following hippocampal-sparing whole brain radiotherapy. Radiother Oncol. 2013;109:152–8.
  • Gondi V, Tolakanahalli R, Mehta MP, et al. Hippocampals- paring whole brain radiotherapy: a ‘’How-To’’ technique, utilizing helical tomotherapy and LINAC based intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(4):1244-52.
  • Jiang A, Sun W, Zhao F, et al. Dosimetric evaluation of four whole brain radiation therapy approaches with hip- pocampus and inner ear avoidance and simultaneous in- tegrated boost for limited brain metastases. Radiat Oncol 2019;14(1):46.
  • Karunamuni R, Bartsch H, White NS, et al. Dose-dependent cortical thinning after partial brain irradiation in high-gra- de glioma. Int J Radiat Oncol Biol Phys 2016;94:297–304.
  • Corn BW, Yousem DM, Scott CB, et al. White matter chan- ges are correlated significantly with radiation dose. Ob- servations from a randomized doseescalation trial for ma- lignant glioma (radiation therapy oncology group 83-02) Cancer. 1994;74:2828–35.

Dosimetric comparison of imrt plans in whole brain hippocampal sparing radiotherapy

Yıl 2021, Cilt: 31 Sayı: 1, 76 - 81, 31.01.2021

Öz

Objective: The aim of this study was to compare dosimetric advantages of using dynamic intensity-modulated radiation therapy D-IMRT and static intensity-modulated radiation therapy S-IMRT techniques for whole-brain radiation therapy WBRT with hippocampus sparing HS . Material and Methods: 10 patients with whole brain radiorherapy were retrospectively selected between the years of 2019-2020. For wholebrain radiation therapy WBRT with hippocampus sparing HS , two treatment plans were created and compared with respect to the doses received by planning target volume PTV and the organ at risk OARs including hipokampus, brain system, optic chiasma, eyes, lens, the dose homogeneity index DHI , conformity indexes CI and total monitor unit counts MU required for the treatment. Results : As a result of the statistical comparison, a significant difference was observed in the CI value between D-YART and S-YART p = 0.000 . The mean doses of critical organs such as the brainstem, optic chiasma, and optic nerve were significantly reduced in the S-YART plans compared to the D-YART plans p = 0.000, p = 0.003, p = 0001 and p = 0.000, respectively . When the lens doses were analyzed, it was observed that the mean dose values of the right and left lenses were lower in the S-YART technique p = 0.000 . Conclusions: For whole-brain radiation therapy WBRT with hippocampus sparing HS , S-IMRT provided better protection for hippocampus and OARs compared to D-IMRT

Kaynakça

  • Gondi V, Tolakanahalli R, Mehta M, et al. Hippocam- pal-sparing whole brain radiotherapy: A “how-to” tech- nique, utilizing helical tomotherapy and linacbased inten- sity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2010;78:1244–52.
  • Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain me- tastases. Histology, multiplicity, surgery and survival cancer 1996 ;78:1781-8.
  • Marsh J, Gielda B, Herskovic A, et al. Sparing of the hip- pocampus and limbic circuit during whole brain radiation therapy: a dosimetric study using helical tomotherapy. J Med Imaging Radiat Oncol 2010;54:375-82.
  • Raineki C, Holman PJ, Debiec J, et al. Functional emergen- ce of the hippocampus in context fear learning in infant rats. Hippocampus 2010;20:1037-46.
  • De Angelis LM, Delattre JY, Posner JB. Radiationinduced dementia in patients cured of brain metastases. Neurology 1989;39:789-96.
  • DD, Sperduto PW. Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 1995;31:983- 98.
  • Jeneson A, Mauldin KN, Hopkins RO, et al. The role of the hippocampus in retaining relational information across short delays: the importance of memory load. Learn Mem. 2011;18:301-5.
  • Hamilton GF, Murawski NJ, St. Cyr SA, et al. Neona- tal alcohol exposure disrupts hippocampal neurogenesis and contextual fear conditioning in adult rats. Brain Res. 2011;1412:88-101.
  • Deng W, Saxe MD, Gallina IS, et al. Adult-born hippo- campal dentate granule cells undergoing maturation modulate learning and memory in the brain. J Neurosci 2009;29:13532-42.
  • Grosu AL, Oehlke O, Sturm D. Whole-brain irradiation with hippocampal sparing and dose escalation on metasta- ses: Neurocognitive testing and biological imaging a phase ii prospective randomized multicentre study 2016:1–86.
  • Oehlke O, Wucherpfennig D, Fels F, et al. Whole brain irradiation with hippocampal sparing and dose escala- tion on multiple brain metastases. Strahlenther Onkol 2015;191:461-9.
  • Ghia A, Tomé W, Thomas S, et al. Distribution of brain- metastases in relationtothehippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys. 2007;68:971.
  • ICRU (International Commission on Radiation Unıts and Measurements), Prescribing, Recording and Raporting Ele- ctron Beam Therapy, Report No.71, Bethesda, MD.2009.
  • T. Landberg, J. Chavaudra, J. Dobbs, J. -P. Gerard, G. Hanks, J. -C. Horiot, K. -A. Johansson, T. Möller, J. Purdy, N. Sunt- haralingam, H. Svensson, 1. Introduction, Journal of the International Commission on Radiation Units and Measu- rements, 1–2. 1999;32:1-2.
  • ICRU Report 83: Prescribing, recording, and Reporting Photon Beam İntensity Modulated Radiation Therapy(IM- RT). J ICRU 2010;10:1-106.
  • Monje ML, Mizumatsu S, Fike JR, et al. Irradiation induces- neural precursor-cell dysfunction. Nat Med. 2002;8:955-62.
  • Krayenbuehl J, Martino MD, Guckenberger M, Andrats- chke N. Improved plan quality with automated radiothe- rapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial. Radiation Oncology 2017;12:161.
  • Harth S, Abo-Madyan Y, Zheng L, et al. Estimation of int- racranial failure risk following hippocampal-sparing whole brain radiotherapy. Radiother Oncol. 2013;109:152–8.
  • Gondi V, Tolakanahalli R, Mehta MP, et al. Hippocampals- paring whole brain radiotherapy: a ‘’How-To’’ technique, utilizing helical tomotherapy and LINAC based intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(4):1244-52.
  • Jiang A, Sun W, Zhao F, et al. Dosimetric evaluation of four whole brain radiation therapy approaches with hip- pocampus and inner ear avoidance and simultaneous in- tegrated boost for limited brain metastases. Radiat Oncol 2019;14(1):46.
  • Karunamuni R, Bartsch H, White NS, et al. Dose-dependent cortical thinning after partial brain irradiation in high-gra- de glioma. Int J Radiat Oncol Biol Phys 2016;94:297–304.
  • Corn BW, Yousem DM, Scott CB, et al. White matter chan- ges are correlated significantly with radiation dose. Ob- servations from a randomized doseescalation trial for ma- lignant glioma (radiation therapy oncology group 83-02) Cancer. 1994;74:2828–35.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Hamit Başaran Bu kişi benim

Gökçen İnan Bu kişi benim

Osman Vefa Gül Bu kişi benim

Mürsel Düzova Bu kişi benim

Abdüssamet Hamit Batur Bu kişi benim

Yayımlanma Tarihi 31 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 31 Sayı: 1

Kaynak Göster

Vancouver Başaran H, İnan G, Gül OV, Düzova M, Batur AH. Tüm Beyin Radyoterapisinde YART Tekniği ile Hipokampus Korumalı Planların Dozimetrik Karşılaştırılması. Genel Tıp Derg. 2021;31(1):76-81.