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Feasibility of extreme dose escalation for glioblastoma multiforme using 4π radiotherapy

Overview of attention for article published in Radiation Oncology, November 2014
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Title
Feasibility of extreme dose escalation for glioblastoma multiforme using 4π radiotherapy
Published in
Radiation Oncology, November 2014
DOI 10.1186/s13014-014-0239-x
Pubmed ID
Authors

Dan Nguyen, Jean-Claude M Rwigema, Victoria Y Yu, Tania Kaprealian, Patrick Kupelian, Michael Selch, Percy Lee, Daniel A Low, Ke Sheng

Abstract

BackgroundGlioblastoma multiforme (GBM) frequently recurs at the same location after radiotherapy. Further dose escalation using conventional methods is limited by normal tissue tolerance. 4¿ non-coplanar radiotherapy has recently emerged as a new potential method to deliver highly conformal radiation dose using the C-arm linacs. We aim to study the feasibility of very substantial GBM dose escalation while maintaining normal tissue tolerance using 4¿.Methods11 GBM patients previously treated with volumetric modulated arc therapy (VMAT/RapidArc) on the NovalisTxTM platform to a prescription dose of either 59.4 Gy or 60 Gy were included. All patients were replanned with 30 non-coplanar beams using a 4¿ radiotherapy platform, which inverse optimizes both beam angles and fluence maps. Four different prescriptions were used including original prescription dose and PTV (4¿PTVPD), 100 Gy to the PTV and GTV (4¿PTV100Gy), 100 Gy to the GTV only while maintaining prescription dose to the rest of the PTV (4¿GTV100Gy), and a 5 mm margin expansion plan (4¿PTVPD+5mm). OARs included in the study are the normal brain (brain ¿ PTV), brainstem, chiasm, spinal cord, eyes, lenses, optical nerves, and cochleae.ResultsThe 4¿ plans resulted in superior dose gradient indices, as indicated by >20% reduction in the R50, compared to the clinical plans. Among all of the 4¿ cases, when compared to the clinical plans, the maximum and mean doses were significantly reduced (p¿<¿0.05) by a range of 47.01-98.82% and 51.87-99.47%, respectively, or unchanged (p¿>¿0.05) for all of the non-brain OARs. Both the 4¿PTVPD and 4¿ GTV100GYplans reduced the mean normal brain mean doses.Conclusions4¿ non-coplanar radiotherapy substantially increases the dose gradient outside of the PTV and better spares critical organs. Dose escalation to 100 Gy to the GTV or additional margin expansion while meeting clinical critical organ dose constraints is feasible. 100 Gy to the PTV result in higher normal brain doses but may be tolerated when delivered in proportionally increased treatment fractions. Therefore, 4¿ non-coplanar radiotherapy on C-arm gantry may provide an accessible tool to improve the outcome of GBM radiotherapy through extreme dose escalation.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 51 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Denmark 1 2%
Unknown 50 98%

Demographic breakdown

Readers by professional status Count As %
Other 11 22%
Student > Ph. D. Student 6 12%
Student > Bachelor 5 10%
Student > Master 5 10%
Student > Doctoral Student 4 8%
Other 11 22%
Unknown 9 18%
Readers by discipline Count As %
Medicine and Dentistry 21 41%
Physics and Astronomy 5 10%
Engineering 4 8%
Neuroscience 4 8%
Nursing and Health Professions 3 6%
Other 2 4%
Unknown 12 24%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 November 2014.
All research outputs
#15,310,081
of 22,770,070 outputs
Outputs from Radiation Oncology
#1,039
of 2,049 outputs
Outputs of similar age
#153,290
of 262,837 outputs
Outputs of similar age from Radiation Oncology
#29
of 77 outputs
Altmetric has tracked 22,770,070 research outputs across all sources so far. This one is in the 22nd percentile – i.e., 22% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,049 research outputs from this source. They receive a mean Attention Score of 2.7. This one is in the 38th percentile – i.e., 38% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 262,837 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 32nd percentile – i.e., 32% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 77 others from the same source and published within six weeks on either side of this one. This one is in the 46th percentile – i.e., 46% of its contemporaries scored the same or lower than it.