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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 97-102

Fractionated stereotactic radiosurgery with volumetric modulated arc therapy (Rapid Arc) for reradiation in recurrent high grade gliomas


1 Department of Radiation Oncology, Max Cancer Centre, Max Hospital, Saket, India
2 Department of Neurosurgery, Max Hospital, Saket, New Delhi, India
3 Department of Medical Physics, Max Cancer Centre, Max Hospital, Saket, India

Correspondence Address:
Anil K Anand
Department of Radiation Oncology, Max Cancer Centre, Max Hospital, 2, Press Enclave Road, Saket, New Delhi - 110 017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131403

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Background: To evaluate 'Rapid Arc (RA)' technique for delivering fractionated stereotactic radiosurgery (FSRS) in patients with recurrent high grade gliomas (HGGs) for minimizing the dose to previously radiated high dose brain volume. Materials and Methods: Between April 2010 and February 2011, 16 consecutive patients with recurrent HGGs and previously treated with intensity modulated radiation therapy (IMRT) and Temozolamide received FSRS. The median time between IMRT and FSRS was 10.72 months. FSRS to a dose of 30 Gy in a median of 5 fractions was delivered to the recurrent tumor (gross tumor volume [GTV]). Brain volume around the GTV and previously treated to a mean dose >50 Gy was delineated as "Avoidance Volume (AV)." Patients were planned with both RA and Dynamic Conformal Arc (DCA) to achieve minimum dose to AV. Dose received by GTV, AV, rest of the normal brain (brain minus PTV) and conformity index (CI) and heterogenecity index (HI) were compared by the two techniques. Results: At a median follow up of 7.33 months, median progression free and overall survival was 6.4 and 9.3 months, respectively. Mean dose to AV was significantly lower with RA as compared with DCA (10.8 Gy vs. 15.5 Gy, P - 0.0001) with no significant difference in the dose delivered to GTV. No patient developed radiation necrosis. Conclusion: As compared with DCA, RA delivered significantly less dose to previously radiated high dose brain volume. It may contribute to minimizing the risk of radionecrosis with stereotactic radiosurgery (SRS) in patients with recurrent HGG.

Abstract in Chinese

分次立体定向放疗应用体积调制的弧治疗(快速弧)对复发高级别神经胶质瘤的再放疗 背景:评价“快速弧(RA)”技术应用于复发高级别神经胶质瘤(HGGs)的立体定向放疗(FSRS),最大程度减少已受过放疗大脑的剂量。 材料和方法:收集2010.4~2011.2,16例连续的HGGs复发病例,他们以往接受过调强放疗(IMRT),复发后再次接受立体定向放疗(FSRS)。平均间隔时间为10.72个月。FSRS给予30Gy/5F剂量(中位数),照射复发肿瘤(GTV)。GTV周围先前照射的平均剂量>50Gy的大脑组织勾画为“回避区(AV)”。运用快速弧(RA)和动态适形弧(DCA),使病人AV区剂量最小化。GTV,AV,剩余大脑剂量,适形指数(CI)和不均匀指数(HI)在两种技术中分别比较。 结果:随访7.33个月(中位数),无进展时间和总生存时间分别为6.4个月和9.3个月(中位数)。AV平均剂量:RA明显低于DCA(10.8Gy vs. 15.5Gy, P=0.001),GTV剂量无明显差异。没有病人发生放射性脑坏死。 结论:RA与DCA比较,先前照射过的脑组织剂量明显降低。在复发高级别神经胶质瘤病人中应用立体定向放疗可有助于最大程度减少放射性坏死的风险。 关键词:分次立体定向放疗,复发高级别神经胶质瘤,再放疗



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