TY - JOUR
T1 - Optimal Treatment Planning for Skull Base Chordoma
T2 - Photons, Protons, or a Combination of Both?
AU - Torres, Mylin A.
AU - Chang, Eric L.
AU - Mahajan, Anita
AU - Lege, David G.
AU - Riley, Beverly A.
AU - Zhang, Xiaodong
AU - Lii, Ming Fwu
AU - Kornguth, David G.
AU - Pelloski, Christopher E.
AU - Woo, Shiao Y.
PY - 2009/7/15
Y1 - 2009/7/15
N2 - Purpose: We compared dosimetry of proton (PR), intensity modulated radiation therapy (IMRT) photon (PH), and combined PR and IMRT PH (PP) irradiation of skull base chordomas to determine the most optimal technique. Methods and Materials: Computed tomography simulation scans of 5 patients with skull base chordoma were used to generate four treatment plans: an IMRT PH plan with 1-mm planning target volume (PTV; PH1) for stereotactic treatment, an IMRT PH plan with 3-mm PTV (PH3) for routine treatment, a PR plan with beam-specific expansion margins on the clinical target volume, and a PP plan combining PR and PH treatment. All plans were prescribed 74 Gy/Cobalt Gray equivalents (CGE) to the PTV. To facilitate comparison, the primary objective of all plans was 95% or greater PTV prescribed dose coverage. Plans then were optimized to limit dose to normal tissues. Results: PTVs ranged from 4.4 to 36.7 cc in size (mean, 21.6 cc). Mean % PTV receiving 74 Gy was highest in the PP plans (98.4%; range, 96.5-99.2%) and lowest in the PH3 plans (96.1%; range, 95.1-96.7%). PR plans were the least homogeneous and conformal. PH3 plans had the highest mean % volume (V) of brain, brainstem, chiasm, and temporal lobes greater than tolerance doses. The PH1 plans had the lowest brainstem mean % V receiving 67 Gy (V67Gy; 2.3 Gy; range, 0-7.8 Gy) and temporal lobe mean % V65Gy (4.3 Gy; range, 0.1-7.7 Gy). Global evaluation of the plans based on objective parameters revealed that PH1 and PP plans were more optimal than either single-modality PR or PH3 plans. Conclusions: There are dosimetric advantages to using either PH1 or PP plans, with the latter yielding the best target coverage and conformality.
AB - Purpose: We compared dosimetry of proton (PR), intensity modulated radiation therapy (IMRT) photon (PH), and combined PR and IMRT PH (PP) irradiation of skull base chordomas to determine the most optimal technique. Methods and Materials: Computed tomography simulation scans of 5 patients with skull base chordoma were used to generate four treatment plans: an IMRT PH plan with 1-mm planning target volume (PTV; PH1) for stereotactic treatment, an IMRT PH plan with 3-mm PTV (PH3) for routine treatment, a PR plan with beam-specific expansion margins on the clinical target volume, and a PP plan combining PR and PH treatment. All plans were prescribed 74 Gy/Cobalt Gray equivalents (CGE) to the PTV. To facilitate comparison, the primary objective of all plans was 95% or greater PTV prescribed dose coverage. Plans then were optimized to limit dose to normal tissues. Results: PTVs ranged from 4.4 to 36.7 cc in size (mean, 21.6 cc). Mean % PTV receiving 74 Gy was highest in the PP plans (98.4%; range, 96.5-99.2%) and lowest in the PH3 plans (96.1%; range, 95.1-96.7%). PR plans were the least homogeneous and conformal. PH3 plans had the highest mean % volume (V) of brain, brainstem, chiasm, and temporal lobes greater than tolerance doses. The PH1 plans had the lowest brainstem mean % V receiving 67 Gy (V67Gy; 2.3 Gy; range, 0-7.8 Gy) and temporal lobe mean % V65Gy (4.3 Gy; range, 0.1-7.7 Gy). Global evaluation of the plans based on objective parameters revealed that PH1 and PP plans were more optimal than either single-modality PR or PH3 plans. Conclusions: There are dosimetric advantages to using either PH1 or PP plans, with the latter yielding the best target coverage and conformality.
KW - Photons
KW - Protons
KW - Radiation treatment planning
KW - Skull base chordoma
UR - http://www.scopus.com/inward/record.url?scp=67649497869&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67649497869&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2008.09.029
DO - 10.1016/j.ijrobp.2008.09.029
M3 - Article
C2 - 19356861
AN - SCOPUS:67649497869
SN - 0360-3016
VL - 74
SP - 1033
EP - 1039
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -