Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T14:06:27.640Z Has data issue: false hasContentIssue false
  • English
  • Français

The potential role of modern radiotherapy techniques in the treatment of malignant spinal cord compression: a dose planning study

Published online by Cambridge University Press:  30 September 2015

Lotte S. Fog ,
Deborah Schut ,
Per Sjøgren  and
Marianne C. Aznar
Lotte S. Fog*
Affiliation:
Section of Radiation Therapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
Deborah Schut
Affiliation:
Section of Radiation Therapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
Per Sjøgren
Affiliation:
Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
Marianne C. Aznar
Affiliation:
Section of Radiation Therapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark Denmark and Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark
*
Correspondence to: Lotte S. Fog, Section of Radiation Therapy, Department of Oncology, Rigshospitalet, Blegdamsvej, 2100 Copenhagen, Denmark. Tel: 45 3545 8951. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

To investigate the doses given to the kidneys and the small intestines for three radiation therapy techniques [anterior–posterior (APPA) fields, three fields and volumetric-modulated arc therapy (VMAT)] for spinal cord compression (SCC) patients with metastatic disease in the lower thoracic or lumbar spine and to monitor the time spent by clinicians and dose planners.

Introduction

Radiation therapy is one of the main treatment modalities for SCC. Typical palliative radiation therapy techniques have used APPA fields or a three-field technique.

However, as delivery techniques have evolved dramatically over the past decades, VMAT has gained wide acceptance. VMAT allows for a dose reduction in the organs at risk. Such a dose reduction may result in less toxicity.

The use of the VMAT technique may require more time for contouring and planning compared with the APPA and three-field techniques. Any potential dosimetric benefit of VMAT must not be outweighed by large amounts of extra time spent by clinicians and dose planners.

Materials and methods

For 20 patients treated with radiation therapy for SCC at our hospital, we created a VMAT plan, and the more traditionally used APPA and three-field plans. The mean kidney doses and the volume of bowel, which received 20 Gy, were extracted for each plan. The correlations between parameters for three techniques were determined.

Furthermore, the time required for contouring targets for five patients; and the time required to plan five patients, was recorded.

Results

VMAT lead to the most conformal distributions: the high-dose areas were restricted to the target volume, whereas the healthy tissue, especially the bowel, received a lower dose. In contrast, the APPA plan lead to a larger volume of bowel being irradiated, whereas the three-field technique spared the bowel at the expense of a higher dose to the kidneys.

The average contouring time was 16 minutes, the average planning time was 38 minutes.

Conclusion

Patients treated for SCC in the lower thoracic or lumbar region may benefit from VMAT treatment, as it reduces the dose to the bowel and kidneys compared with APPA or three-field treatments.

Keywords

conformalIMRTpalliativeradiotherapyspinal cord compression
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 4 , December 2015 , pp. 418 - 424
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Rades, D, Stalpers, L J, Hulshof, M Cet al. Comparison of 1×8 Gy and 10×3 Gy for functional outcome in patients with metastatic spinal cord compression. Int J Radiat Oncol Biol Phys 2005; 62 (2): 514–518.CrossRefGoogle Scholar
2.Rades, D, Stalpers, L J, Veninga, Tet al. Evaluation of functional outcome and local control after radiotherapy for metastatic spinal cord compression in patients with prostate cancer. J Urol 2006; 175 (2): 552–556.CrossRefGoogle ScholarPubMed
3.Maranzano, E, Latini, P, Checcaglini, Fet al. Radiation therapy in metastatic spinal cord compression. A prospective analysis of 105 consecutive patients. Cancer 1991; 67 (5): 1311–1317.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
4.Nutting, C, Dearnaley, D P, Webb, S. Intensity modulated radiation therapy: a clinical review. Br J Radiol 2000; 73 (869): 459–469.CrossRefGoogle ScholarPubMed
5.Kjaer-Kristoffersen, F, Ohlhues, L, Medin, Jet al. Rapidarc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol 2009; 48 (2): 227–232.CrossRefGoogle ScholarPubMed
6.Maranzano, E, Bellavita, R, Rossi, Ret al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. J Clin Oncol 2005; 23 (15): 3358–3365.CrossRefGoogle ScholarPubMed
7.Maranzano, E, Latini, P, Perrucci, Eet al. Short-course radiotherapy (8 Gy×2) in metastatic spinal cord compression: an effective and feasible treatment. Int J Radiat Oncol Biol Phys 1997; 38 (5): 1037–1044.CrossRefGoogle Scholar
8.Kavanagh, B D, Pan, C C, Dawson, L Aet al. Radiation dose–volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys 2010; 76 (3): S101–S107.CrossRefGoogle ScholarPubMed
9.Joiner, M, van der Kogel, A. Basic clinical radiobiology, 4th edition. Hodder Arnold, London, 2009.CrossRefGoogle Scholar
10.Ferlay, J, Steliarova-Foucher, E, Lortet-Tieulent, Jet al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49 (6): 1374–1403.CrossRefGoogle ScholarPubMed
11.Maranzano, E, Latini, P, Beneventi, Set al. Radiotherapy without steroids in selected metastatic spinal cord compression patients. A phase II trial. Am J Clin Oncol 1996; 19 (2): 179–183.CrossRefGoogle ScholarPubMed
12.Shaffer, R, Nichol, A M, Vollans, Eet al. A comparison of volumetric modulated arc therapy and conventional intensity-modulated radiotherapy for frontal and temporal high-grade gliomas. Int J Radiat Oncol Biol Phys 2010; 76 (4): 1177–1184.CrossRefGoogle ScholarPubMed
13.Zhang, G G, Ku, L, Dilling, T Jet al. Volumetric modulated arc planning for lung stereotactic body radiotherapy using conventional and unflattened photon beams: a dosimetric comparison with 3D technique. Radiat Oncol 2011; 6: 152.CrossRefGoogle Scholar
14.Wolff, D, Stieler, F, Welzel, Get al. Volumetric modulated arc therapy (VMAT) vs. serial tomotherapy, step-and-shoot IMRT and 3D-conformal RT for treatment of prostate cancer. Radiother Oncol 2009; 93 (2): 226–233.CrossRefGoogle ScholarPubMed
15.Oliver, M, Ansbacher, W, Beckham, W A. Comparing planning time, delivery time and plan quality for IMRT, rapidarc and tomotherapy. J Appl Clin Med Phys 2009; 10 (4): 117–131.CrossRefGoogle ScholarPubMed
16.Craft, D L, Hong, T S, Shih, H Aet al. Improved planning time and plan quality through multicriteria optimization for intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2012; 82 (1): e83–e90.CrossRefGoogle ScholarPubMed