Tratamiento del meduloblastoma: comparación entre arcoterapia volumétrica modulada y radioterapia conformada tridimensional
DOI:
https://doi.org/10.37004/sefm/2019.20.2.004Palabras clave:
Meduloblastoma, irradiación craneoespinal, VMAT, dosimetría, radioterapiaResumen
Objetivo: Presentar la viabilidad del tratamiento del meduloblastoma con arcoterapia volumétrica modulada (VMAT) planificada con RayStation para los aceleradores Elekta.
Materiales y métodos: 3 pacientes adultos en posición de decúbito prono tratados mediante radioterapia conformada tridimensional (3DCRT) con haces de 6 MV y 18 MV se replanificaron retrospectivamente con VMAT de 6 MV. La prescripción de dosis fue de 1.8 Gy/fracción. La evaluación de las técnicas se realizó mediante histogramas dosis-volumen e isodosis, además de con índices de conformación (IC) y de homogeneidad (IH).
Resultados: El IC (0.79 ± 0.02) y el IH (0.08 ± 0.02) de la VMAT tienden a ser mejores que los de la 3DCRT (IC = 0.58 ± 0.03 y IH = 0.14 ± 0.07). Para el tejido sano, se observa una disminución de la dosis absorbida máxima y de las sobredosificaciones (VMAT: D1% = 1.76 ± 0.04 Gy/fracción; V107% = 0.05 ± 0.08% frente 3DCRT: D1% = 1.93 ± 0.04 Gy/fracción; V107% = 1.0 ± 0.5%). Los resultados dosimétricos de los órganos de riesgo no muestran ninguna tendencia cuando se compararon ambas técnicas.
Conclusión: La realización del tratamiento del meduloblastoma con VMAT usando RayStation para los aceleradores Elekta es viable. Se consigue una mayor cobertura, homogeneidad y conformación en el volumen blanco, y también se disminuye notablemente las sobredosificaciones en comparación con las planificaciones en 3DCRT.
Citas
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25. Cao F, Ramaseshan R, Corns R, Harrop S, Nuraney N, Steiner P, et al. A three-isocenter jagged-junction IMRT approach for craniospinal irradiation without beam edge matching for field junctions. Int J Radiat Oncol Biol Phys. 2012 Nov;84(3):648–54.
26. Munshi A, Jalali R. A simple technique of supine craniospinal irradiation. Med Dosim. 2008;33(1):1–5.
27. Kiltie AE, Povall JM, Taylor RE. The need for the moving junction in craniospinal irradiation. Br J Radiol. 2000 Jun;73(870):650–4.
28. Parker W, Brodeur M, Roberge D, Freeman C. Standard and nonstandard craniospinal radiotherapy using helical TomoTherapy. Int J Radiat Oncol Biol Phys. 2010 Jul;77(3):926–31.
2. Parker W, Filion E, Roberge D, Freeman CR. Intensity-modulated radiotherapy for craniospinal irradiation: target volume considerations, dose constraints, and competing risks. Int J Radiat Oncol Biol Phys. 2007 Sep;69(1):251–7.
3. Brandes AA, Franceschi E, Tosoni A, Blatt V, Ermani M. Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer. 2007 Nov;110(9):2035–41.
4. Igual Estellés L, Berlanga Charriel P, Cañete Nieto A. Meduloblastoma: mejoría de la supervivencia en las últimas décadas. Experiencia de un centro. An Pediatría [Internet]. 2017;86(1):4–10. Available from: http://www.sciencedirect.com/science/article/pii/S1695403316300091
5. Ramos Aguerri A, Hervás A, Morera R, Montero A, Córdoba S, Corona J, et al. Avances en radio-quimioterapia en tumores cerebrales. Vol. 27, Oncología (Barcelona). scieloes; 2004. p. 71–5.
6. Myers PA, Mavroidis P, Papanikolaou N, Stathakis S. Comparing conformal, arc radiotherapy and helical tomotherapy in craniospinal irradiation planning. J Appl Clin Med Phys. 2014 Sep;15(5):4724.
7. Martínez León MI. Meduloblastoma pediátrico, revisión y puesta al día. Radiologia [Internet]. 2010;53(2):134–45. Available from: http://www.elsevier.es/es-revista-radiologia-119-articulo-meduloblastoma-pediatrico-revision-puesta-al-S0033833810003905
8. Michalski JM, Klein EE, Gerber R. Method to plan, administer, and verify supine craniospinal irradiation. J Appl Clin Med Phys. 2002;3(4):310–6.
9. Selek U, Zorlu F, Hurmuz P, Cengiz M, Turker A, Soylemezoglu F, et al. Craniospinal radiotherapy in adult medulloblastoma. Strahlentherapie und Onkol Organ der Dtsch Rontgengesellschaft . [et al]. 2007 May;183(5):236–40.
10. Huguet F, Haberer-Guillerm S, Monnier L. Radioterapia. EMC - Tratado Med [Internet]. 2014;18(3):1–6. Available from: http://www.sciencedirect.com/science/article/pii/S1636541014681435
11. Delgado JM, Garcia A, Garcia F, Millan E. Fundamentos de Física Médica. Radioterapia externa II: Dosimetría clínica, algoritmos de cálculo, sistemas de planificación y control de calidad. España: SEFM. [Internet]. ADI Servic. Brosed Serreta A, Millán Cebrián E, editors. 2013. Available from: www.sefm.es/userfiles/libros_baeza/fundamentos_fm_v4_web.pdf
12. Fogliata A, Bergstrom S, Cafaro I, Clivio A, Cozzi L, Dipasquale G, et al. Cranio-spinal irradiation with volumetric modulated arc therapy: a multi-institutional treatment experience. Radiother Oncol. 2011 Apr;99(1):79–85.
13. Lee YK, Brooks CJ, Bedford JL, Warrington AP, Saran FH. Development and evaluation of multiple isocentric volumetric modulated arc therapy technique for craniospinal axis radiotherapy planning. Int J Radiat Oncol Biol Phys. 2012 Feb;82(2):1006–12.
14. Zong-Wen S, Shuang-Yan Y, Feng-Lei D, Xiao-Long C, Qinglin L, Meng-Yuan C, et al. Radiotherapy for Adult Medulloblastoma: Evaluation of Helical Tomotherapy, Volumetric Intensity Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy and the Results of Helical Tomotherapy Therapy. Biomed Res Int. 2018;2018:9153496.
15. De Saint-Hubert M, Verellen D, Poels K, Crijns W, Magliona F, Depuydt T, et al. Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy. Phys Med Biol. 2017 Jul;62(13):5293–311.
16. Bedford JL, Lee YK, Saran FH, Warrington AP. Helical volumetric modulated arc therapy for treatment of craniospinal axis. Int J Radiat Oncol Biol Phys. 2012 Jul;83(3):1047–54.
17. Hadley A, Ding GX. A single-gradient junction technique to replace multiple-junction shifts for craniospinal irradiation treatment. Med Dosim. 2014;39(4):314–9.
18. Panandiker AP, Ning H, Likhacheva A, Ullman K, Arora B, Ondos J, et al. Craniospinal Irradiation With Spinal IMRT to Improve Target Homogeneity. Int J Radiat Oncol Biol Phys. 2007;68(5):1402–9.
19. Novario R, Stucchi P, Perna L, Conte L. Radiotherapy treatment verification. Tumori. 1998;84(2):144–9.
20. Fredh A, Scherman JB, Fog LS, Munck af Rosenschold P. Patient QA systems for rotational radiation therapy: a comparative experimental study with intentional errors. Med Phys. 2013 Mar;40(3):31716.
21. Ahnesjo A. Collapsed cone convolution of radiant energy for photon dose calculation in heterogeneous media. Med Phys. 1989;16(4):577–92.
22. Khan FM, Gibbons J, Mihailidis D, Alkhatib H. Khan’s Lectures: Handbook of the Physics of Radiation Therapy [Internet]. Wolters Kl. 2012. Capítulo 13 Páginas: 253-261 Available from: http://books.google.com/books?id=DVkG5-wTrJkC&pgis=1
23. Lee T-F, Ting H-M, Chao P-J, Fang F-M. Dual arc volumetric-modulated arc radiotherapy (VMAT) of nasopharyngeal carcinomas: a simultaneous integrated boost treatment plan comparison with intensity-modulated radiotherapies and single arc VMAT. Clin Oncol (R Coll Radiol). 2012 Apr;24(3):196–207.
24. Zhao L-R, Zhou Y-B, Sun J-G. Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation. Oncol Lett. 2016 May;11(5):3389–94.
25. Cao F, Ramaseshan R, Corns R, Harrop S, Nuraney N, Steiner P, et al. A three-isocenter jagged-junction IMRT approach for craniospinal irradiation without beam edge matching for field junctions. Int J Radiat Oncol Biol Phys. 2012 Nov;84(3):648–54.
26. Munshi A, Jalali R. A simple technique of supine craniospinal irradiation. Med Dosim. 2008;33(1):1–5.
27. Kiltie AE, Povall JM, Taylor RE. The need for the moving junction in craniospinal irradiation. Br J Radiol. 2000 Jun;73(870):650–4.
28. Parker W, Brodeur M, Roberge D, Freeman C. Standard and nonstandard craniospinal radiotherapy using helical TomoTherapy. Int J Radiat Oncol Biol Phys. 2010 Jul;77(3):926–31.
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Publicado
2019-11-29
Cómo citar
Manjón García, C., Morillo Macías, V. ., & López Tarjuelo, J. . (2019). Tratamiento del meduloblastoma: comparación entre arcoterapia volumétrica modulada y radioterapia conformada tridimensional . Revista De Física Médica, 20(2), 33–46. https://doi.org/10.37004/sefm/2019.20.2.004
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