Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy
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 contribut...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109423000969 |
| _version_ | 1797814378192437248 |
|---|---|
| author | Chih-Wei Chang, PhD Matt Goette, PhD Nadja Kadom, MD Yinan Wang, MD Jacob Wynne, MD Tonghe Wang, PhD Tian Liu, PhD Natia Esiashvili, MD Jun Zhou, PhD Bree R. Eaton, MD Xiaofeng Yang, PhD |
| author_facet | Chih-Wei Chang, PhD Matt Goette, PhD Nadja Kadom, MD Yinan Wang, MD Jacob Wynne, MD Tonghe Wang, PhD Tian Liu, PhD Natia Esiashvili, MD Jun Zhou, PhD Bree R. Eaton, MD Xiaofeng Yang, PhD |
| author_sort | Chih-Wei Chang, PhD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T08:06:49Z |
| format | Article |
| id | doaj.art-f05a0355a49340f7a372e84a92ee981c |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-03-13T08:06:49Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-f05a0355a49340f7a372e84a92ee981c2023-06-01T04:36:42ZengElsevierAdvances in Radiation Oncology2452-10942023-09-0185101267Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton TherapyChih-Wei Chang, PhD0Matt Goette, PhD1Nadja Kadom, MD2Yinan Wang, MD3Jacob Wynne, MD4Tonghe Wang, PhD5Tian Liu, PhD6Natia Esiashvili, MD7Jun Zhou, PhD8Bree R. Eaton, MD9Xiaofeng Yang, PhD10Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, GeorgiaDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New YorkDepartment of Radiation Oncology, Mount Sinai Medical Center, New York, New YorkDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GeorgiaDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia; Corresponding authors: Bree R. Eaton, MD; and Xiaofeng Yang, PhDDepartment of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia; Corresponding authors: Bree R. Eaton, MD; and Xiaofeng Yang, PhDPurpose: 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.http://www.sciencedirect.com/science/article/pii/S2452109423000969 |
| spellingShingle | Chih-Wei Chang, PhD Matt Goette, PhD Nadja Kadom, MD Yinan Wang, MD Jacob Wynne, MD Tonghe Wang, PhD Tian Liu, PhD Natia Esiashvili, MD Jun Zhou, PhD Bree R. Eaton, MD Xiaofeng Yang, PhD Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy Advances in Radiation Oncology |
| title | Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy |
| title_full | Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy |
| title_fullStr | Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy |
| title_full_unstemmed | Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy |
| title_short | Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy |
| title_sort | early in vivo radiation damage quantification for pediatric craniospinal irradiation using longitudinal mri for intensity modulated proton therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2452109423000969 |
| work_keys_str_mv | AT chihweichangphd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT mattgoettephd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT nadjakadommd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT yinanwangmd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT jacobwynnemd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT tonghewangphd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT tianliuphd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT natiaesiashvilimd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT junzhouphd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT breereatonmd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy AT xiaofengyangphd earlyinvivoradiationdamagequantificationforpediatriccraniospinalirradiationusinglongitudinalmriforintensitymodulatedprotontherapy |