title: Craniospinal irradiation using a forward planned segmented field technique.
abstract: Craniospinal irradiation is technically demanding due to the complex shape of the planning target volume (PTV). Radiotherapy treatment techniques have evolved over time as imaging and radiotherapy treatment technology have improved. However, most are variations on a class solution utilizing a prone patient position with two shaped lateral cranial portals and a matched posterior spinal portal with moving junctions. Major areas of difficulty remain with the accurate definition of the PTV and achieving a homogeneous dose within it, especially at the junctions. We describe a three-dimensionally (3D) planned craniospinal radiation technique that permits rapid image acquisition with reduced localization time, simplified spinal PTV definition and standardized cranial PTV definition. Improved dose homogeneity within the PTV is achieved by use of a segmented "field-in-field" technique (forward planned intensity-modulated radiotherapy (IMRT)) in place of customized compensators. This has negated the requirement for constructing physical compensators. Autosequencing for field delivery enables the junction to be "moved" during a single fraction and reduces the overall treatment time, an important consideration when treating very young patients.
authors.affiliation: Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Wilkinson
authors.forename: J
authors.initials: J
authors.lastname: Lewis
authors.forename: G P
authors.initials: GP
authors.lastname: Lawrence
authors.forename: H H
authors.initials: HH
authors.lastname: Lucraft
authors.forename: E
authors.initials: E
authors.lastname: Murphy
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D016543:Central Nervous System Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D006801:Humans; D008527:Medulloblastoma / Q000000981:diagnostic imaging / Q000532:radiotherapy; D010315:Particle Accelerators; D016684:Prone Position; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D014057:Tomography, X-Ray Computed / Q000379:methods