Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors Journal Article
| Authors: | Katsoulakis, E.; Solomon, S. B.; Maybody, M.; Housman, D.; Niyazov, G.; Riaz, N.; Lovelock, M.; Spratt, D. E.; Erinjeri, J. P.; Thornton, R. H.; Yamada, Y. |
| Article Title: | Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors |
| Abstract: | Background: To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy.Methods: Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure.Results: The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80-1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7-32). The median dose prescribed was 2400 cGy in one fraction (range, 2100-3000 in 3 fractions). The mean GTV Dmin and PTV Dmin pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel Dmax (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and Dmax by 25% (0.022).Conclusions: TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while minimizing dose to OARs. © 2013 Katsoulakis et al.; licensee BioMed Central Ltd. |
| Keywords: | adult; clinical article; aged; intensity modulated radiation therapy; treatment planning; radiation dose; nuclear magnetic resonance imaging; computer assisted tomography; tumor volume; medical record review; retrospective study; kidney carcinoma; sarcoma; prescription; kidney; dosimetry; radiosurgery; iohexol; image guidance; radiation dose distribution; chordoma; intestine; rectum; catheter; organ displacement |
| Journal Title: | Radiation Oncology |
| Volume: | 8 |
| ISSN: | 1748-717X |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2013-06-24 |
| Start Page: | 150 |
| Language: | English |
| DOI: | 10.1186/1748-717x-8-150 |
| PROVIDER: | scopus |
| PMCID: | PMC3702493 |
| PUBMED: | 23800073 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 December 2013" - "Source: Scopus" |
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