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Dosimetric comparison between intensity-modulated radiotherapy and volumetric-modulated arc therapy in hippocampus sparing in brain metastasis treated by whole-brain irradiation and simultaneous integrated boost

Published online by Cambridge University Press:  24 June 2019

Ehab Saad Open the ORCID record for Ehab Saad [Opens in a new window] ,
Khaled Elshahat  and
Hussein Metwally
Ehab Saad*
Affiliation:
Department of Clinical Oncology, and Nuclear Medicine, Cairo University, Egypt Department of Radiation Oncology, Dar Al Fouad Hospital, Egypt
Khaled Elshahat
Affiliation:
Department of Radiation Oncology, Dar Al Fouad Hospital, Egypt Department of Clinical Oncology, Azhar University, Egypt
Hussein Metwally
Affiliation:
Department of Radiation Oncology, Dar Al Fouad Hospital, Egypt Department of Clinical Oncology, Fayoum University, Egypt
*
Author for correspondence: Ehab Saad, Kasr Al Ainy Hospital, Cairo, Egypt. Tel: 00201143650739. Fax: 002023653360. E-mail: ehab.saad239@gmail.com
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Abstract

Background:

While treating brain metastasis with whole-brain radiotherapy incorporating a simultaneous integrated boost (WBRT-SIB), the risk of hippocampus injury is high. The aim of this study is to compare dosimetrically between intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in sparing of hippocampus and organs at risk (OARs) and planning target volume (PTV) coverage.

Methods:

In total, 16 patients presenting with more than one brain metastases were previously treated and then retrospectively planned using VMAT and IMRT techniques. For each patient, a dual-arc VMAT and another IMRT (five beams) plans were created. For both techniques, 30 Gy in 10 fractions was prescribed to the whole brain (WB) minus the hippocampi and 45 Gy in 10 fractions to the tumour with 0·5 cm margin. Dose–volume histogram (DVH), conformity index (CI) and homogeneity index (HI) of PTV, hippocampus mean and maximum dose and other OARs for both techniques were calculated and compared.

Results:

A statistically significant advantage was found in WB-PTV CI and HI with VMAT, compared to IMRT. There were lower hippocampus mean and maximum doses in VMAT than IMRT. The maximum hippocampus dose ranged between 15·5 and 19·2 Gy and between 18·4 and 20·6 Gy in VMAT and IMRT, respectively. The mean dose of the hippocampus ranged between 11·5 and 17·7 Gy and between 13·2 and 18·3 Gy in VMAT and IMRT, respectively.

Conclusion:

Using WBRT-SIB technique, VMAT showed better PTV coverage with less mean and maximum doses to the hippocampus than IMRT. Clinical randomised studies are needed to confirm safety and clinical benefit of WBRT-SIB.

Keywords

brain metastasishippocampus sparingIMRTsimultaneous integrated boost (SIB)VMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 1 , March 2020 , pp. 45 - 51
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Copyright
© Cambridge University Press 2019 

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Footnotes

This study was done in the Department of Radiation Oncology, Dar Al Fouad Hospital, 6th October, Cairo, Egypt.

No source of funding is needed in this study.

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