TY - JOUR
T1 - Fractionated stereotactic radiotherapy for pediatric patients with retinoblastoma
AU - Higgins, Patrick D.
AU - Gerbi, Bruce J.
AU - Macedon, Mark
AU - Dusenbery, Kathryn E.
PY - 2006
Y1 - 2006
N2 - In this report, we discuss the application of a modified Gill-Thomas-Cosman (GTC) relocatable head frame to enable fractionated stereotactic radiotherapy (SRT) of infants under anesthesia. This system has been used to treat two infants, ages 12 and 18 months, for bilateral retinoblastoma on a Varian 6/100 linear accelerator. The GTC head frame was used to reproducibly position and treat the orbits of these children to between 2520 cGy and 3960 cGy in 180-cGy fractions. A standard head and neck tray, with accompanying thermoplastic mask, was adapted to mount to the head frame to enable these treatments. We found the maximum average deviation in the repeat fixations, as compared with the initial fitting data, to be ±2 mm. The overall average difference and standard deviation in measurement was 0.47 ± 0.63 mm for the first case and 0.19 ± t 0.94 mm for the second case, with a combined average of 0.35 ± 0.79 mm overall from a total of 381 point measurements. The stereotactic treatment plan (Radionics®) incorporated a single isocenter for each orbit and 3 or 4 arcs per isocenter. An intercomparison has been made between this technique and a standard lateral field technique, designed using the stereotactic radiosurgery (SRS) planning system. Dose-volume histograms and corresponding normal tissue complication probabilities (NTCP) based on pediatric bone growth inhibition have been calculated for each method for the orbital bone areas. We found that the NTCP is reduced from 95% or more in the standard treatment method to 16% or less with SRT. Use of the modified head frame provides excellent setup reproducibility, facilitates access to patients for anesthesia, and reduces the chances of a poor cosmetic result in these growing children.
AB - In this report, we discuss the application of a modified Gill-Thomas-Cosman (GTC) relocatable head frame to enable fractionated stereotactic radiotherapy (SRT) of infants under anesthesia. This system has been used to treat two infants, ages 12 and 18 months, for bilateral retinoblastoma on a Varian 6/100 linear accelerator. The GTC head frame was used to reproducibly position and treat the orbits of these children to between 2520 cGy and 3960 cGy in 180-cGy fractions. A standard head and neck tray, with accompanying thermoplastic mask, was adapted to mount to the head frame to enable these treatments. We found the maximum average deviation in the repeat fixations, as compared with the initial fitting data, to be ±2 mm. The overall average difference and standard deviation in measurement was 0.47 ± 0.63 mm for the first case and 0.19 ± t 0.94 mm for the second case, with a combined average of 0.35 ± 0.79 mm overall from a total of 381 point measurements. The stereotactic treatment plan (Radionics®) incorporated a single isocenter for each orbit and 3 or 4 arcs per isocenter. An intercomparison has been made between this technique and a standard lateral field technique, designed using the stereotactic radiosurgery (SRS) planning system. Dose-volume histograms and corresponding normal tissue complication probabilities (NTCP) based on pediatric bone growth inhibition have been calculated for each method for the orbital bone areas. We found that the NTCP is reduced from 95% or more in the standard treatment method to 16% or less with SRT. Use of the modified head frame provides excellent setup reproducibility, facilitates access to patients for anesthesia, and reduces the chances of a poor cosmetic result in these growing children.
KW - Patient fixation
KW - Pediatric radiotherapy
KW - Stereotactic radiotherapy
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U2 - 10.1120/jacmp.v7i2.2161
DO - 10.1120/jacmp.v7i2.2161
M3 - Article
C2 - 17533322
AN - SCOPUS:34548243170
SN - 1526-9914
VL - 7
SP - 9
EP - 17
JO - Journal of Applied Clinical Medical Physics
JF - Journal of Applied Clinical Medical Physics
IS - 2
ER -