title: Decreasing temporal lobe dose with five-field intensity-modulated radiotherapy for treatment of pituitary macroadenomas.
abstract: OBJECTIVE
  To compare temporal lobe dose delivered by three pituitary macroadenoma irradiation techniques: three-field three-dimensional conformal radiotherapy (3D-CRT), three-field intensity-modulated radiotherapy (3F IMRT), and a proposed novel alternative of five-field IMRT (5F IMRT).
  
  
  METHODS
  Computed tomography-based external beam radiotherapy planning was performed for 15 pituitary macroadenoma patients treated at New York University between 2002 and 2007 using: 3D-CRT (two lateral, one midline superior anterior oblique [SAO] beams), 3F IMRT (same beam angles), and 5F IMRT (same beam angles with additional right SAO and left SAO beams). Prescription dose was 45 Gy. Target volumes were: gross tumor volume (GTV) = macroadenoma, clinical target volume (CTV) = GTV, and planning target volume = CTV + 0.5 cm. Structure contouring was performed by two radiation oncologists guided by an expert neuroradiologist.
  
  
  RESULTS
  Five-field IMRT yielded significantly decreased temporal lobe dose delivery compared with 3D-CRT and 3F IMRT. Temporal lobe sparing with 5F IMRT was most pronounced at intermediate doses: mean V25Gy (% of total temporal lobe volume receiving ≥25 Gy) of 13% vs. 28% vs. 29% for right temporal lobe and 14% vs. 29% vs. 30% for left temporal lobe for 5F IMRT, 3D-CRT, and 3F IMRT, respectively (p < 10(-7) for 5F IMRT vs. 3D-CRT and 5F IMRT vs. 3F IMRT). Five-field IMRT plans did not compromise target coverage, exceed normal tissue dose constraints, or increase estimated brain integral dose.
  
  
  CONCLUSIONS
  Five-field IMRT irradiation technique results in a statistically significant decrease in the dose to the temporal lobes and may thus help prevent neurocognitive sequelae in irradiated pituitary macroadenoma patients.
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, New York, USA.
authors.forename: Preeti K
authors.initials: PK
authors.lastname: Parhar
authors.forename: Tamara
authors.initials: T
authors.lastname: Duckworth
authors.forename: Parinda
authors.initials: P
authors.lastname: Shah
authors.forename: J Keith
authors.initials: JK
authors.lastname: DeWyngaert
authors.forename: Ashwatha
authors.initials: A
authors.lastname: Narayana
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
authors.forename: Jinesh N
authors.initials: JN
authors.lastname: Shah
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D010911:Pituitary Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013702:Temporal Lobe / Q000528:radiation effects*; D047368:Tumor Burden