Early in vivo radiation damage quantification for pediatric craniospinal irradiation using longitudinal MRI for intensity modulated proton therapy Journal Article


Authors: Chang, C. W.; Goette, M.; Kadom, N.; Wang, Y.; Wynne, J.; Wang, T.; Liu, T.; Esiashvili, N.; Zhou, J.; Eaton, B. R.; Yang, X.
Article Title: Early in vivo radiation damage quantification for pediatric craniospinal irradiation using longitudinal MRI for intensity modulated proton therapy
Abstract: Purpose: Proton vertebral body sparing craniospinal irradiation (CSI) treats the thecal sac while avoiding the anterior vertebral bodies in an effort to reduce myelosuppression and growth inhibition. However, robust treatment planning needs to compensate for proton range uncertainty, which contributes unwanted doses within the vertebral bodies. This work aimed to develop an early in vivo radiation damage quantification method using longitudinal magnetic resonance (MR) scans to quantify the dose effect during fractionated CSI. Methods and Materials: Ten pediatric patients were enrolled in a prospective clinical trial of proton vertebral body sparing CSI, in which they received 23.4 to 36 Gy. Monte Carlo robust planning was used, with spinal clinical target volumes defined as the thecal sac and neural foramina. T1/T2-weighted MR scans were acquired before, during, and after treatments to detect a transition from hematopoietic to less metabolically active fatty marrow. MR signal intensity histograms at each time point were analyzed and fitted by multi-Gaussian models to quantify radiation damage. Results: Fatty marrow filtration was observed in MR images as early as the fifth fraction of treatment. Maximum radiation-induced marrow damage occurred 40 to 50 days from the treatment start, followed by marrow regeneration. The mean damage ratios were 0.23, 0.41, 0.59, and 0.54, corresponding to 10, 20, 40, and 60 days from the treatment start. Conclusions: We demonstrated a noninvasive method for identifying early vertebral marrow damage based on radiation-induced fatty marrow replacement. The proposed method can be potentially used to quantify the quality of CSI vertebral sparing and preserve metabolically active hematopoietic bone marrow. © 2023 The Author(s)
Keywords: adolescent; child; clinical article; preschool child; school child; intensity modulated radiation therapy; radiation dose; nuclear magnetic resonance imaging; prospective study; bone marrow; bone marrow suppression; in vivo study; radiation injury; prediction; time; simulation; regeneration; radiation dose fractionation; quantitative analysis; medulloblastoma; germ cell tumor; non invasive procedure; hematologic disease; histogram; monte carlo method; clinical target volume; lumbar spine; craniospinal irradiation; vertebra body; pineoblastoma; proton therapy; acute myeloid leukemia; filtration; human; male; female; article; atypical teratoid rhabdoid tumor; neuroradiologist; pediatric patient; radiation dose response; t2 weighted imaging; pediatric radiologist
Journal Title: Advances in Radiation Oncology
Volume: 8
Issue: 5
ISSN: 2452-1094
Publisher: Elsevier Inc.  
Date Published: 2023-09-01
Start Page: 101267
Language: English
DOI: 10.1016/j.adro.2023.101267
PROVIDER: scopus
PMCID: PMC10318210
PUBMED: 37408668
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus
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  1. Tonghe Wang
    51 Wang