Epithelioid hemangioendothelioma of the spine treated with RapidArc volumetric-modulated radiotherapy.
Radiotherapy for epithelioid hemangioendothelioma (EHE) using volumetric intensity-modulated arc radiotherapy (VMAT). A 48-year-old woman was referred for curative irradiation of a vertebral EHE after failure of surgery. A comparison between VMAT and conventional conformal tridimensional (3D) dosimetry was performed and potential advantage of VMAT for sparing critical organs from irradiation's side effects was discussed. The total delivered dose on the planning target volume was 54 Gy in 27 fractions. The patient was finally treated with VMAT. The tolerance was excellent. There was no acute toxicity, including no increase in pain. With a follow-up of 18 months, no delayed toxicity was reported. The clinical response consisted of a decrease in the dorsal pain. The Dmax for the spinal cord was reduced from 55 Gy (3D-radiotherapy [RT]) (which would be an unacceptable dose to the spine because of the risk of myelopathy) to 42.8 Gy (VMAT), which remains below the recommended dose threshold (45 Gy). The dose delivered to 20% of organ volume (D20) was reduced from 47 Gy (3D-RT) to 3 Gy (VMAT) for the spinal cord. The study shows that VMAT allows the delivery of curative treatment for vertebral EHEs because of critical organ sparing.
Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France.
Jean-Baptiste
JB
Guy
Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France.
Jane-Chloé
JC
Trone
Department of Radiation Oncology, HIA du Val de Grâce, Paris, France.
Cyrus
C
Chargari
Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France.
Alexander Tuan
AT
Falk
Department of Physics, Institut de Cancérologie de la Loire, St Priest en Jarez, France.
Mustapha
M
Khodri
Department of Radiotherapy, Institut de Cancérologie de la Loire, St Priest en Jarez, France. Electronic address: nicolas.magne@icloire.fr.
Nicolas
N
Magné
D018323:Hemangioendothelioma, Epithelioid / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D013125:Spinal Neoplasms / Q000532:radiotherapy*
Conformational radiotherapy; Epithelioid hemangioendothelioma; Radioembolization; Volumetric intensity-modulated arc therapy