title: Cranio-spinal irradiation with volumetric modulated arc therapy: a multi-institutional treatment experience.
abstract: OBJECTIVE
  To report the treatment of cranio-spinal irradiation (CSI) with volumetric modulated arc therapy (RapidArc) in adults and a child.
  
  
  METHODS
  Five patients from 5 institutions were treated with CSI using RapidArc technology. Patient age varied between 7 and 45 years. The lengths of the planning target volumes (PTV) and dose prescriptions ranged from 54.6 to 78.4 cm, and from 12 to 36 Gy, respectively. Different arc arrangements were used, with two or three isocentres, from two to six modulated arcs, for patient positioned either in prone (n=3) or supine position (n=2). Doses to PTV, organs at risk and non-target tissue are reported for each of the five patients. Data concerning imaging strategy and pre-treatment quality assurance are also reported.
  
  
  RESULTS
  The mean conformity index CI(95%) was 1.05 ± 0.05 (range: 1.00, 1.13). Mean doses to the lenses, lungs, heart, and kidneys were, respectively, 7.6 ± 1.6, 6.6 ± 3.0, 5.7 ± 2.3, and 6.1 ± 2.1 Gy, keeping those value acceptably low. Mean non-target tissue dose was 21.0 ± 3.8% (5.6 ± 1.8 Gy, range: 3.0-8.1 Gy). All patients were successfully planned and treated with RapidArc.
  
  
  CONCLUSIONS
  RapidArc techniques achieved highly conformal treatment plans for 5 adults or paediatric patients. Beam-on time was short, and RapidArc plans were satisfactorily delivered to all presented patients.
authors.affiliation: Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. afc@iosi.ch
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Stefan
authors.initials: S
authors.lastname: Bergström
authors.forename: Ines
authors.initials: I
authors.lastname: Cafaro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clivio
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Dipasquale
authors.forename: Per
authors.initials: P
authors.lastname: Hållström
authors.forename: Pietro
authors.initials: P
authors.lastname: Mancosu
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.forename: Giorgia
authors.initials: G
authors.lastname: Nicolini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Parietti
authors.forename: Gianfranco A
authors.initials: GA
authors.lastname: Pesce
authors.forename: Antonella
authors.initials: A
authors.lastname: Richetti
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.forename: Eugenio
authors.initials: E
authors.lastname: Vanetti
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002648:Child; D016371:Cranial Irradiation / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D056888:Patient Positioning; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome