Cranio-Spinal Irradiation in low-middle income setting: A dosimetric comparison and literature review

IF 2.5 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiography Pub Date : 2024-10-01 DOI:10.1016/j.radi.2024.09.065

W. Kaabia , A. Yousfi , T. Boussaid , N. Bouzid , G.E.F. Noubbigh , S. Yahyaoui , M. Besbes , S. Zarraa , C. Nasr

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Abstract

Introduction

Volumetric modulated arc therapy (VMAT) is a relatively new treatment technique in the middle-east and north African region. More so, is its application for cranio-spinal irradiation (CSI). We report the experience of this implementation in Tunisia, by comparing dosimetric outcomes between VMAT and Three-Dimensional Conformal Radiotherapy (3DCRT) and evaluating their efficiency in terms of treatment delivery time.

Methods

We conducted an in-silico dosimetric study, on 29 patients treated with CSI. Patients treated with 3DCRT were replanned in VMAT and vice-versa. Doses to target volumes (TV) and organs at risk (OAR) were collected from the Treatment Planning System (TPS). Recorded treatment time was extracted from the TPS and beam-on-times were calculated.

Results

VMAT provided higher TV coverage for CSI PTV (V95 % = 97.4 % vs 93.4 %, p < 0.001) and for boost PTV (96.3 % vs 93.4 %, p = 0.005). VMAT demonstrated better conformity (0.97 vs 0.93) and homogeneity (0.1 vs 0.26) indexes (p < 0.001). Both techniques met constraints for OAR, but neither achieved recommended limits for the skin, lens, or pituitary gland. VMAT showed lower maximum doses for the majority of OAR and achieved lower mean doses to the cochlea, parotids, heart, oesophagus, pancreas and bladder. However, it resulted in higher low doses to non-target tissue (V5Gy = 45.6 % vs 27.5 %, p < 0.001). Recorded treatment time was longer with VMAT compared to 3DCRT (1387 vs 683 s; p < 0.001), as well as the beam-on-time (453 and 162 s, p < 0.001).

Conclusion

VMAT offered improved TV coverage, conformity, and homogeneity. It protected some OAR better. This came at the expense of higher low-dose exposure to non-target tissue. Treatment times were longer with VMAT.

Implications for practice

Our study suggests the feasibility of implementing VMAT for CSI in low-middle-income countries. Follow-up is required to study the clinical translation of the dosimetric outcomes of VMAT.

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在中低收入环境中进行颅脊照射：剂量学比较和文献综述

导言容积调制弧治疗（VMAT）在中东和北非地区是一种相对较新的治疗技术。它在颅脊照射（CSI）中的应用更是如此。我们通过比较 VMAT 和三维适形放射治疗（3DCRT）的剂量测定结果，并评估它们在治疗时间方面的效率，报告了突尼斯的实施经验。采用 3DCRT 治疗的患者在 VMAT 中进行了重新扫描，反之亦然。治疗计划系统（TPS）收集了靶体积（TV）和危险器官（OAR）的剂量。结果VMAT为CSI PTV（V95 % = 97.4 % vs 93.4 %，p < 0.001）和boost PTV（96.3 % vs 93.4 %，p = 0.005）提供了更高的TV覆盖率。VMAT 的一致性（0.97 对 0.93）和均匀性（0.1 对 0.26）指数更佳（p < 0.001）。两种技术都符合 OAR 的限制，但都没有达到皮肤、晶状体或垂体的建议限制。VMAT 对大多数 OAR 的最大剂量较低，对耳蜗、腮腺、心脏、食道、胰腺和膀胱的平均剂量也较低。不过，它对非目标组织造成的低剂量更高（V5Gy = 45.6 % vs 27.5 %，p < 0.001）。与 3DCRT 相比，VMAT 的记录治疗时间更长（1387 秒 vs 683 秒；p < 0.001），光束照射时间也更长（453 秒和 162 秒，p < 0.001）。它能更好地保护一些 OAR。但其代价是非靶组织受到的低剂量照射更多。我们的研究表明，在中低收入国家对 CSI 实施 VMAT 是可行的。需要进行后续跟踪，以研究 VMAT 剂量学结果的临床转化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiography RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.70

自引率

34.60%

发文量

169

审稿时长

63 days

期刊介绍： Radiography is an International, English language, peer-reviewed journal of diagnostic imaging and radiation therapy. Radiography is the official professional journal of the College of Radiographers and is published quarterly. Radiography aims to publish the highest quality material, both clinical and scientific, on all aspects of diagnostic imaging and radiation therapy and oncology.