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Pelvic Ewing sarcomas

Three-dimensional conformal vs. intensity-modulated radiotherapy

Plevine Ewing-Sarkome

Dreidimensionale konformale vs. intensitätsmodulierte Strahlentherapie

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Abstract

Purpose

The goal of the present work was to assess the potential advantage of intensity-modulated radiotherapy (IMRT) over three-dimensional conformal radiotherapy (3D-CRT) planning in pelvic Ewing’s sarcoma.

Patients and methods

A total of 8 patients with Ewing sarcoma of the pelvis undergoing radiotherapy were analyzed. Plans for 3D-CRT and IMRT were calculated for each patient. Dose coverage of the planning target volume (PTV), conformity and homogeneity indices, as well as further parameters were evaluated.

Results

The average dose coverage values for PTV were comparable in 3D-CRT and IMRT plans. Both techniques had a PTV coverage of V95 > 98 % in all patients. Whereas the IMRT plans achieved a higher conformity index compared to the 3D-CRT plans (conformity index 0.79 ± 0.12 vs. 0.54 ± 0.19, p = 0.012), the dose distribution across the target volumes was less homogeneous with IMRT planning than with 3D-CRT planning. This difference was statistically significant (homogeneity index 0.11 ± 0.03 vs. 0.07 ± 0.0, p = 0.035). For the bowel, Dmean and D1%, as well as V2 to V60 were reduced in IMRT plans. For the bladder and the rectum, there was no significant difference in Dmean. However, the percentages of volumes receiving at least doses of 30, 40, 45, and 50 Gy (V30 to V50) were lower for the rectum in IMRT plans. The volume of normal tissue receiving at least 2 Gy (V2) was significantly higher in IMRT plans compared with 3D-CRT, whereas at high dose levels (V30) it was significantly lower.

Conclusion

Compared to 3D-CRT, IMRT showed significantly better results regarding dose conformity (p = 0.012) and bowel sparing at dose levels above 30 Gy (p = 0.012). Thus, dose escalation in the radiotherapy of pelvic Ewing’s sarcoma can be more easily achieved using IMRT.

Zusammenfassung

Ziel

Beurteilung und Evaluation möglicher Vorteile der IMRT (intensitätsmodulierte Radiotherapie) im Vergleich zur 3D-CRT (dreidimensionale konventionelle Radiotherapie) bei der Behandlung von Ewing-Sarkomen im Becken.

Patienten und Methodik

Acht Patienten mit Ewing-Sarkomen im Becken wurden hinsichtlich IMRT und 3D-CRT-Plänen analysiert. Es wurden die Abdeckung des Zielvolumens („planning target volume“, PTV), die Konformitäts- und Homogenitätsindizes sowie weitere Parameter verglichen.

Ergebnisse

Die mittlere PTV-Abdeckung war in den 3D-CRT- und IMRT-Plänen vergleichbar. Beide Techniken zeigten eine PTV-Abdeckung von V95 > 98 % bei allen Patienten. Während IMRT-Pläne im Vergleich zu den 3D-CRT-Plänen einen höheren Konformitätsindex zeigten (Konformitätsindex 0,79 ± 0,12 vs. 0,54 ± 0,19; p = 0,012), resultierten die IMRT-Pläne in niedrigerer Dosishomogenität. Dieser Unterschied war statistisch signifikant (Homogenitätsindex 0,11 ± 0,03 vs. 0,07 ± 0,05; p = 0,035). Für den Darm wurden Dmean und D1% sowie V2 bis V60 in den IMRT-Plänen reduziert. Für die Blase und das Rektum gab es keinen signifikanten Unterschied in der Dmean. Für das Rektum waren jedoch V30 bis V50 in den IMRT-Plänen niedriger. Das Volumen des Normalgewebes, das mit mehr als 2 Gy (V2) bestrahlt wurde, war in den IMRT-Plänen im Vergleich zu den 3D-CRT-Plänen signifikant höher, bei hohen Dosen (V30) jedoch signifikant niedriger.

Schlussfolgerung

Im Vergleich zu den 3D-CRT-Plänen zeigten IMRT-Pläne deutlich bessere Ergebnisse im Hinblick auf die Dosiskonformität (p = 0,012) und die Darmschonung im Dosisbereich ≥ 30 Gy (p = 0,012). Eine Dosiserhöhung kann dadurch in der Strahlentherapie von pelvinen Ewing-Tumoren leichter möglich sein.

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Conflict of interest

On behalf of all authors, the corresponding author states that are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany

    F.S. Mounessi, P. Lehrich, U. Haverkamp, N. Willich & H.T. Eich

  2. Center for Radiation Oncology, Osnabrück, Germany

    T. Bölling

  3. Registry for the Evaluation of Late Side Effects after Radiotherapy in Childhood and Adolescence (RISK), -, -

    N. Willich

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  1. F.S. Mounessi
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Correspondence to F.S. Mounessi.

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Mounessi, F., Lehrich, P., Haverkamp, U. et al. Pelvic Ewing sarcomas. Strahlenther Onkol 189, 308–314 (2013). https://doi.org/10.1007/s00066-012-0304-z

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