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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Published on: February 6, 2019

Intensity-modulated radiotherapy plan optimisation for skull base lesions: practical class solutions for dose

V J Estall1, D Eaton, K E Burton

  • 1PeterMac Cancer Centre, East Melbourne, VIC, Australia. vanessa.estall@petermac.org

Clinical Oncology (Royal College of Radiologists (Great Britain))
|February 26, 2010
PubMed
Summary
This summary is machine-generated.

Intensity-modulated radiotherapy for skull base meningioma can safely escalate dose to 60 Gy using 2.5 mm multileaf collimator (MLC) technology and five to seven beams. This approach requires balancing improved plan quality with increased treatment times due to higher segmentation.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Neurosurgery

Background:

  • Skull base meningiomas require precise radiotherapy for effective treatment.
  • Dose escalation in intensity-modulated radiotherapy (IMRT) planning for skull base tumors presents unique challenges.
  • Optimizing IMRT planning is crucial for improving outcomes while minimizing toxicity.

Purpose of the Study:

  • To determine optimal IMRT planning strategies for dose escalation in skull base tumors.
  • To evaluate the impact of multileaf collimator (MLC) width and beam arrangement on plan quality.
  • To identify practical solutions for delivering 60 Gy in 30 fractions to skull base meningiomas.

Main Methods:

  • Twenty skull base meningioma cases were re-planned using IMRT.
  • Variations included beam number (3, 5, 7, 9), beam arrangement (coplanar vs. non-coplanar), and MLC width (2.5 mm vs. 10 mm).
  • Plan quality was assessed using planning target volume V(95%), equivalent uniform dose (EUD), and integral dose.

Main Results:

  • A 2.5 mm MLC significantly improved V(95%) (22.8%), EUD (3.7 Gy), and reduced integral dose (13.4 Gy) compared to a 10 mm MLC.
  • Increasing beams from 3 to 5 and 5 to 7 improved V(95%) and integral dose, but further increases to 9 beams showed no benefit.
  • No significant differences were observed based on beam arrangement (coplanar vs. non-coplanar).
  • Segmentation increased substantially with smaller MLCs and more beams.

Conclusions:

  • A 2.5 mm MLC and 5-7 beams are effective for dose escalation up to 60 Gy in skull base IMRT.
  • These parameters offer practical planning solutions for achieving high-dose radiotherapy.
  • Increased treatment time due to higher segmentation must be considered when implementing these advanced planning techniques.