title: Hair-sparing whole brain radiotherapy with volumetric arc therapy in patients treated for brain metastases: dosimetric and clinical results of a phase II trial.
abstract: OBJECTIVE
  To report the dosimetric results and impact of volumetric arc therapy (VMAT) on temporary alopecia and hair-loss related quality of life (QOL) in whole brain radiotherapy (WBRT).
  
  
  METHODS
  The potential of VMAT-WBRT to reduce the dose to the hair follicles was assessed. A human cadaver was treated with both VMAT-WBRT and conventional opposed field (OF) WBRT, while the subcutaneously absorbed dose was measured by radiochromic films and calculated by the planning system. The impact of these dose reductions on temporary alopecia was examined in a prospective phase II trial, with the mean score of hair loss at 1 month after VMAT-WBRT (EORTC-QOL BN20) as a primary endpoint and delivering a dose of 20 Gy in 5 fractions. An interim analysis was planned after including 10 patients to rule out futility, defined as a mean score of hair loss exceeding 56.7. A secondary endpoint was the global alopecia areata severity score measured with the "Severity of Alopecia Tool" (SALT) with a scale of 0 (no hair loss) to 100 (complete alopecia).
  
  
  RESULTS
  For VMAT-WBRT, the cadaver measurements demonstrated a dose reduction to the hair follicle volume of 20.5% on average and of 41.8% on the frontal-vertex-occipital medial axis as compared to OF-WBRT. In the phase II trial, a total of 10 patients were included before the trial was halted due to futility. The EORTC BN20 hair loss score following WBRT was 95 (SD 12.6). The average median dose to the hair follicle volume was 12.6 Gy (SD 0.9), corresponding to a 37% dose reduction compared to the prescribed dose. This resulted in a mean SALT-score of 75.
  
  
  CONCLUSIONS
  Compared to OF-WBRT, VMAT-WBRT substantially reduces hair follicle dose. These dose reductions could not be related to an improved QOL or SALT score.
authors: Annemieke
authors: A
authors: De Puysseleyr
authors: Joris
authors: J
authors: Van De Velde
authors: Bruno
authors: B
authors: Speleers
authors: Tom
authors: T
authors: Vercauteren
authors: Anneleen
authors: A
authors: Goedgebeur
authors: Tom
authors: T
authors: Van Hoof
authors: Tom
authors: T
authors: Boterberg
authors: Wilfried
authors: W
authors: De Neve
authors: Carlos
authors: C
authors: De Wagter
authors: Department of Radiotherapy and Experimental Cancer Research, Ghent University, De Pintelaan 185, Ghent, Belgium. piet.ost@ugent.be.
authors: Piet
authors: P
authors: Ost
mesh_terms: D000368:Aged; D000505:Alopecia / Q000209:etiology / Q000517:prevention & control*; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006197:Hair / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*