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Pract Radiat Oncol. 2019 Sep 19. pii: S1879-8500(19)30272-3. doi: 10.1016/j.prro.2019.09.008. [Epub ahead of print]

Radiation Therapy for Pediatric Brain Tumors using Robotic Radiation Delivery System and Intensity Modulated Proton Therapy.

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Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address:
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.



This study recruited two centers with expertise in treating pediatric brain tumors with robotic radiation delivery system photon therapy and proton therapy, respectively, to study the plan quality and the dose deposition characteristics of robotic radiation delivery system photon and intensity modulated proton therapy (IMPT) plans.


A total of 18 patients clinically treated with robotic radiation delivery system were planned with intensity-modulated-proton-therapy (IMPT). Cases were planned per the standard of care of each institution but, respected the same planning objectives. The comparison was performed in three aspects: the plan quality, dose fall-off characteristics around target volume and the volume of high, intermediate, and low dose bath.


All robotic radiation delivery system and IMPT plans meet the planning objectives. However, IMPT significantly reduces the maximum dose of the OARs away from the planning target volume (PTV) such as cochlea and eye (P< 0.05) and the mean dose of normal brain (P<0.05). No statistical significant difference is observed in the maximum dose of the optical pathway and brain stem. Robotic radiation delivery system plans demonstrate a sharper dose fall-off within 5-mm around the PTV (P<0.05) while IMPT significantly lower the doses to the normal tissue that are beyond 10-mm away from the PTV (P<0.05). The robotic radiation delivery system offers smaller high-dose-bath while the IMPT offers a smaller low-dose-bath (P<0.05). However, the difference of the intermediate dose is not statistically significant.


In general, robotic radiation delivery system plans exhibit reduced high dose exposure to normal tissue while IMPT plans have considerably smaller volumes of low dose exposure with differences in medium range dose bath increasingly favoring protons as tumor size increases.


IMPT; Pediatric; Planning; Proton Therapy; Radiation therapy; Robotic radiation delivery system


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