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Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for brain metastases: a dosimetric volumetric-modulated arc therapy study

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Abstract

Objective

To develop a feasible volumetric modulated arc therapy (VMAT) treatment in whole brain radiotherapy (WBRT) with a simultaneous integrated boost (SIB) and hippocampal (HP) sparing in 1–5 brain metastases (BMs).

Methods and materials

Ten patients with 20 BMs received a WBRT prescription of 20 Gy, SIB dose on BMs of 40 Gy/5 fractions. PTVWBRT was generated from brain minus BMs-PTVs (PTVSIB) and planning organ at risk volume to HP. All plans were evaluated in: homogeneity index (HI), target coverage (TC), maximum dose to prescription dose ratio (MDPD), prescription isodose to target volume ratio (PITV) and paddick conformity index (CI). We also evaluate D100 %, mean and maximum doses to HP. Planning objectives were for PTVWBRT, D2 % = 25 Gy with acceptable deviation of 26.7 Gy and D98 % ≥ 16.7 Gy; for PTVSIB D95 % ≥ 38 Gy; for HP, D100 % = 6 Gy with acceptable deviation of 6.7 Gy, Dmax = 10.7 Gy with acceptable deviation of 11.3 Gy, a mean dose of 8 Gy.

Results

Mean number of BMs was 2 (range 1–5). Mean values for BMs were volume of PTVSIB = 5.1 ± 4.9 cc, dose to 95 % of PTVSIB 39.3 ± 0.9 Gy, HI 0.083 ± 0.03, TC 0.96 ± 0.24, CI 0.78 ± 0.17. Mean MDPD was 1.06 ± 0.02 and PITV 0.96 ± 0.24. For WBRT, mean target volume was (13.46 ± 2)*102 cc, mean dose to 90 % of PTVWBRT 19.8 ± 0.2 Gy, mean HI 0.42 ± 0.12 and TC 0.78 ± 0.11. Mean and maximum HP doses were 7.7 ± 0.3 Gy and 10.5 ± 0.5 Gy. Mean dose to 100 % of HP volume (D100 %) was 6.7 ± 0.3 Gy.

Conclusions

WBRT plus SIB with HP avoidance with VMAT was feasible. All dosimetric parameters were satisfied for PTVWBRT and PTVSIB.

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Authors and Affiliations

  1. Radiation Oncology Department, Sacro Cuore Hospital, Via Don A.Sempreboni 5, 37024, Negrar, Verona, Italy

    Niccolò Giaj Levra, Gianluisa Sicignano, Alba Fiorentino, Sergio Fersino, Francesco Ricchetti, Rosario Mazzola, Stefania Naccarato, Ruggero Ruggieri & Filippo Alongi

  2. Radiation Oncology School, University of Palermo, Palermo, Italy

    Rosario Mazzola

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  1. Niccolò Giaj Levra
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  2. Gianluisa Sicignano
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Correspondence to Filippo Alongi.

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Giaj Levra, N., Sicignano, G., Fiorentino, A. et al. Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for brain metastases: a dosimetric volumetric-modulated arc therapy study. Radiol med 121, 60–69 (2016). https://doi.org/10.1007/s11547-015-0563-8

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  • DOI: https://doi.org/10.1007/s11547-015-0563-8

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