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Cancers 2015, 7(2), 617-630; doi:10.3390/cancers7020617

Predictive Risk of Radiation Induced Cerebral Necrosis in Pediatric Brain Cancer Patients after VMAT Versus Proton Therapy

1
Department of Radiation Oncology, Mary Bird Perkins Cancer Center, 4950 Essen Ln., Baton Rouge, LA 70809, USA
2
Department of Physics and Astronomy, Louisiana State University, Nicholson Hall, Tower Dr., Baton Rouge, LA 70810, USA
Current address: Department of Radiation Oncology, Willis Knighton Cancer Center, 2600 Kings Hwy, Shreveport, LA 71103, USA.
*
Author to whom correspondence should be addressed.
Academic Editor: Xiaodong Zhang
Received: 1 January 2015 / Revised: 16 March 2015 / Accepted: 25 March 2015 / Published: 10 April 2015
(This article belongs to the Special Issue Proton Therapy for Cancer)
View Full-Text   |   Download PDF [906 KB, uploaded 10 April 2015]   |  

Abstract

Cancer of the brain and central nervous system (CNS) is the second most common of all pediatric cancers. Treatment of many of these cancers includes radiation therapy of which radiation induced cerebral necrosis (RICN) can be a severe and potentially devastating side effect. Risk factors for RICN include brain volume irradiated, the dose given per fraction and total dose. Thirteen pediatric patients were selected for this study to determine the difference in predicted risk of RICN when treating with volumetric modulated arc therapy (VMAT) compared to passively scattered proton therapy (PSPT) and intensity modulated proton therapy (IMPT). Plans were compared on the basis of dosimetric endpoints in the planned treatment volume (PTV) and brain and a radiobiological endpoint of RICN calculated using the Lyman-Kutcher-Burman probit model. Uncertainty tests were performed to determine if the predicted risk of necrosis was sensitive to positional errors, proton range errors and selection of risk models. Both PSPT and IMPT plans resulted in a significant increase in the maximum dose to the brain, a significant reduction in the total brain volume irradiated to low doses, and a significant lower predicted risk of necrosis compared with the VMAT plans. The findings of this study were upheld by the uncertainty analysis. View Full-Text
Keywords: radiation induced cerebral necrosis; brain cancer; volumetric modulated arc therapy; proton therapy radiation induced cerebral necrosis; brain cancer; volumetric modulated arc therapy; proton therapy
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Freund, D.; Zhang, R.; Sanders, M.; Newhauser, W. Predictive Risk of Radiation Induced Cerebral Necrosis in Pediatric Brain Cancer Patients after VMAT Versus Proton Therapy. Cancers 2015, 7, 617-630.

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