open access

Vol 19, No 5 (2014)
Original research articles
Published online: 2014-09-01
Submitted: 2013-06-20
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Corticospinal tract-sparing intensity-modulated radiotherapy treatment planning

Hiroshi Igaki, Akira Sakumi, Akitake Mukasa, Kuniaki Saito, Akira Kunimatsu, Yoshitaka Masutani, Shunya Hanakita, Kenji Ino, Akihiro Haga, Keiichi Nakagawa, Kuni Ohtomo
DOI: 10.1016/j.rpor.2014.01.002
·
Rep Pract Oncol Radiother 2014;19(5):310-316.

open access

Vol 19, No 5 (2014)
Original research articles
Published online: 2014-09-01
Submitted: 2013-06-20

Abstract

Aim

To establish intensity-modulated radiotherapy (IMRT) planning procedures that spare the corticospinal tract by integrating diffusion tensor tractography into the treatment planning software.

Background

Organs at risk are generally contoured according to the outline of the organ as demonstrated by CT or MRI. But a part of the organ with specific function is difficult to protect, because such functional part of the organ cannot be delineated on CT or conventional sequence of MRI.

Methods

Diagnostic and treatment planning images of glioblastoma patients who had been treated by conventional 3-dimensional conformal radiotherapy were used for re-planning of IMRT. Three-dimensional fiber maps of the corticospinal tracts were created from the diffusion tensors obtained from the patients before the surgery, and were blended with the anatomical MR images (i.e. gadolinium-enhanced T1-weighted images or T2-weighted images). DICOM-formatted blended images were transferred and fused to the planning CT images. Then, IMRT plans were attempted.

Results

The corticospinal tracts could be contoured as organs at risk (OARs), because the blended images contained both anatomical information and fiber-tract maps. Other OARs were contoured in a way similar to that of ordinary IMRT planning. Gross tumor volumes, clinical target volumes, planning target volumes, and other OARs were contoured on the treatment planning software, and IMRT plans were made.

Conclusions

IMRT plans with diminished doses to the corticospinal tract were attained. This technique enabled us to spare specific neuron fibers as OARs which were formerly “invisible” and to reduce the probability of late morbidities.

Abstract

Aim

To establish intensity-modulated radiotherapy (IMRT) planning procedures that spare the corticospinal tract by integrating diffusion tensor tractography into the treatment planning software.

Background

Organs at risk are generally contoured according to the outline of the organ as demonstrated by CT or MRI. But a part of the organ with specific function is difficult to protect, because such functional part of the organ cannot be delineated on CT or conventional sequence of MRI.

Methods

Diagnostic and treatment planning images of glioblastoma patients who had been treated by conventional 3-dimensional conformal radiotherapy were used for re-planning of IMRT. Three-dimensional fiber maps of the corticospinal tracts were created from the diffusion tensors obtained from the patients before the surgery, and were blended with the anatomical MR images (i.e. gadolinium-enhanced T1-weighted images or T2-weighted images). DICOM-formatted blended images were transferred and fused to the planning CT images. Then, IMRT plans were attempted.

Results

The corticospinal tracts could be contoured as organs at risk (OARs), because the blended images contained both anatomical information and fiber-tract maps. Other OARs were contoured in a way similar to that of ordinary IMRT planning. Gross tumor volumes, clinical target volumes, planning target volumes, and other OARs were contoured on the treatment planning software, and IMRT plans were made.

Conclusions

IMRT plans with diminished doses to the corticospinal tract were attained. This technique enabled us to spare specific neuron fibers as OARs which were formerly “invisible” and to reduce the probability of late morbidities.

Get Citation

Keywords

Intensity-modulated radiotherapy; Diffusion tensor tractography; Corticospinal tract; Malignant glioma; Organ at risk

About this article
Title

Corticospinal tract-sparing intensity-modulated radiotherapy treatment planning

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 19, No 5 (2014)

Pages

310-316

Published online

2014-09-01

DOI

10.1016/j.rpor.2014.01.002

Bibliographic record

Rep Pract Oncol Radiother 2014;19(5):310-316.

Keywords

Intensity-modulated radiotherapy
Diffusion tensor tractography
Corticospinal tract
Malignant glioma
Organ at risk

Authors

Hiroshi Igaki
Akira Sakumi
Akitake Mukasa
Kuniaki Saito
Akira Kunimatsu
Yoshitaka Masutani
Shunya Hanakita
Kenji Ino
Akihiro Haga
Keiichi Nakagawa
Kuni Ohtomo

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