open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-08-22
Get Citation

Radiotherapy for the treatment of pituitary adenomas: A dosimetric comparison of three planning techniques

Rubi Ramos-Prudencio, Sandra Ileana Pérez-Álvarez, Christian Haydée Flores-Balcazar, Mayra Angélica de León-Alfaro, José Alfredo Herrera-González, Jonathan Elizalde-Cabrera, Johnatan Rubalcava-Ortega, Lissett Espinoza-Alvarado, Ricardo Iván Balderrama-Ibarra
DOI: 10.1016/j.rpor.2020.04.020
·
Rep Pract Oncol Radiother 2020;25(4):586-593.

open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-08-22

Abstract

Aim

Our goal was to compare conformal 3D (C3D) radiotherapy (RT), modulated intensity RT (IMRT), and volumetric modulated arc therapy (VMAT) planning techniques in treating pituitary adenomas.

Background

RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR).

Materials and methods

We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI).

Results

Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF.

Conclusions

Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.

Abstract

Aim

Our goal was to compare conformal 3D (C3D) radiotherapy (RT), modulated intensity RT (IMRT), and volumetric modulated arc therapy (VMAT) planning techniques in treating pituitary adenomas.

Background

RT is important for managing pituitary adenomas. Treatment planning advances allow for higher radiation dosing with less risk of affecting organs at risk (OAR).

Materials and methods

We conducted a 5-year retrospective review of patients with pituitary adenoma treated with external beam radiation therapy (C3D with flattening filter, flattening filter-free [FFF], IMRT, and VMAT). We compared dose-volume histogram data. For OARs, we recorded D2%, maximum, and mean doses. For planning target volume (PTV), we registered V95%, V107%, D95%, D98%, D50%, D2%, minimum dose, conformity index (CI), and homogeneity index (HI).

Results

Fifty-eight patients with pituitary adenoma were included. Target-volume coverage was acceptable for all techniques. The HI values were 0.06, IMRT; 0.07, VMAT; 0.08, C3D; and 0.09, C3D FFF (p < 0.0001). VMAT and IMRT provided the best target volume conformity (CI, 0.64 and 0.74, respectively; p < 0.0001). VMAT yielded the lowest doses to the optic pathway, lens, and cochlea. The position of the neck in extreme flexion showed that it helps in planning mainly with VMAT by allowing only one arc to be used and achieving the desired conformity, decreasing the treatment time, while allowing greater protection to the organs of risk using C3D, C3DFFF.

Conclusions

Our results confirmed that EBRT in pituitary adenomas using IMRT, VMAT, C3D, C3FFF provide adequate coverage to the target. VMAT with a single arc or incomplete arc had a better compliance with desired dosimetric goals, such as target coverage and normal structures dose constraints, as well as shorter treatment time. Neck extreme flexion may have benefits in treatment planning for better preservation of organs at risk. C3D with extreme neck flexion is an appropriate treatment option when other treatment techniques are not available.

Get Citation

Keywords

Pituitary adenomas; Conformal radiotherapy; IMRT; VMAT; C3D; CI; CT; CTV; DVH; EBRT; ESAPI; FF; FFF; CFRT; GTV; HI; IMRT; MRI; OAR; PTV; RION; RT; SRS; VMAT

About this article
Title

Radiotherapy for the treatment of pituitary adenomas: A dosimetric comparison of three planning techniques

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 4 (2020)

Pages

586-593

Published online

2020-07-01

DOI

10.1016/j.rpor.2020.04.020

Bibliographic record

Rep Pract Oncol Radiother 2020;25(4):586-593.

Keywords

Pituitary adenomas
Conformal radiotherapy
IMRT
VMAT
C3D
CI
CT
CTV
DVH
EBRT
ESAPI
FF
FFF
CFRT
GTV
HI
IMRT
MRI
OAR
PTV
RION
RT
SRS
VMAT

Authors

Rubi Ramos-Prudencio
Sandra Ileana Pérez-Álvarez
Christian Haydée Flores-Balcazar
Mayra Angélica de León-Alfaro
José Alfredo Herrera-González
Jonathan Elizalde-Cabrera
Johnatan Rubalcava-Ortega
Lissett Espinoza-Alvarado
Ricardo Iván Balderrama-Ibarra

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl