1
|
O'Neill K, Syed N, Crook T, Dubey S, Potharaju M, Limaye S, Ranade A, Anichini G, Patil D, Datta V, Datar R. Profiling of circulating glial cells for accurate blood-based diagnosis of glial malignancies. Int J Cancer 2024; 154:1298-1308. [PMID: 38146864 DOI: 10.1002/ijc.34827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
Here, we describe a blood test for the detection of glial malignancies (GLI-M) based on the identification of circulating glial cells (CGCs). The test is highly specific for GLI-M and can detect multiple grades (II-IV) and subtypes including gliomas, astrocytomas, oligodendrogliomas, oligoastrocytomas and glioblastomas, irrespective of gender and age. Analytical validation of the test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Real-world performance characteristics of the test were evaluated in four clinical (observational) studies. The test has high analytical sensitivity (95%), specificity (100%) and precision (coefficient of variation [CV] = 13.7% for repeatability and CV = 23.5% for within laboratory precision, both at the detection threshold) and is not prone to interference from common drugs and serum factors. The ability of the test to detect and differentiate GLI-M from non-malignant brain tumours (NBT), brain metastases from primary epithelial malignancies (EPI-M) and healthy individual donors (HD) was evaluated in four clinical cohorts. Across these clinical studies, the test showed 99.35% sensitivity (95% confidence interval [CI]: 96.44%-99.98%) and 100% specificity (95% CI: 99.37%-100%). The performance characteristics of this test support its clinical utility for diagnostic triaging of individuals presenting with intracranial space-occupying lesions (ICSOL).
Collapse
Affiliation(s)
- Kevin O'Neill
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Nelofer Syed
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Timothy Crook
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Sudhir Dubey
- Institute of Neurosciences, Medanta-The Medicity, Gurugram, India
| | - Mahadev Potharaju
- Department of Radiation Oncology, Apollo Speciality Hospitals, Chennai, India
| | - Sewanti Limaye
- Department of Medical and Precision Oncology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | | | - Giulio Anichini
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Darshana Patil
- Department of Research and Innovations, Datar Cancer Genetics, Nasik, India
| | - Vineet Datta
- Department of Research and Innovations, Datar Cancer Genetics, Nasik, India
| | - Rajan Datar
- Department of Research and Innovations, Datar Cancer Genetics, Nasik, India
| |
Collapse
|
2
|
Potharaju M, Mathavan A, Mangaleswaran B, Ghosh S, John R. Delay in adjuvant chemoradiation impacts survival outcome in glioblastoma multiforme patients. Acta Oncol 2020; 59:320-323. [PMID: 31573367 DOI: 10.1080/0284186x.2019.1672893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mahadev Potharaju
- Department of Radiation Oncology, Apollo Cancer Institutes, Chennai, India
| | - Anugraha Mathavan
- Department of Radiation Oncology, Apollo Cancer Institutes, Chennai, India
| | | | - Siddhartha Ghosh
- Department of Neurosurgery, Apollo Cancer Institutes, Chennai, India
| | - Reginald John
- Department of Neurosurgery, Apollo Cancer Institutes, Chennai, India
| |
Collapse
|
3
|
Potharaju M, Mathavan A, Mangaleswaran B, Patil S, John R, Ghosh S, Kalavakonda C, Ghosh M, Verma RS. Clinicopathological Analysis of HIF-1alpha and TERT on Survival Outcome in Glioblastoma Patients: A Prospective, Single Institution Study. J Cancer 2019; 10:2397-2406. [PMID: 31258744 PMCID: PMC6584346 DOI: 10.7150/jca.32909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/28/2019] [Indexed: 12/31/2022] Open
Abstract
Glioblastoma multiforme is a highly malignant and aggressive primary brain tumor with a dismal prognosis. We studied the association of immunohistochemical expression of hypoxia inducible factor-1 alpha (HIF-1α), telomerase reverse transcriptase (TERT), isocitrate dehydrogenase 1 (IDH1) and tumor protein p53 with overall survival (OS) in glioblastoma patients uniformly treated by standard of care, with adequate follow-up. In 87 patient samples studied, 59 were male and 28 were female. The median age was 55 years. The median follow-up was 27.7 months and the median overall survival was 14.9 months. Nuclear staining of HIF-1α was expressed in all samples and scored as strong in 42 (48%) and weak in 45 (52%). Multivariable Cox regression revealed strong HIF-1α expression as an independent poor prognostic factor (Hazard Ratio 2.12, 95% CI 1.20 - 3.74, P = 0.01). There was a statistically significant difference in OS (9.8 months vs. 16.3 months) between the “HIF-1α - strong and TERT - strong” and the “HIF-1α - weak and TERT - weak” patient subgroups, as evaluated by Kaplan-Meier analysis (P = 0.005). In our study, HIF-1α expression was an independent predictor of OS. The subgroup of patients with strong expression of both HIF-1α and TERT had the poorest prognosis.
Collapse
Affiliation(s)
- Mahadev Potharaju
- Department of Radiation Oncology, Apollo Speciality Hospitals, Chennai - 600035, India
| | - Anugraha Mathavan
- Department of Radiation Oncology, Apollo Speciality Hospitals, Chennai - 600035, India
| | | | - Sushama Patil
- Department of Pathology, Apollo Speciality Hospitals, Chennai - 600035, India
| | - Reginald John
- Department of Neurosurgery, Apollo Speciality Hospitals, Chennai - 600035, India
| | - Siddhartha Ghosh
- Department of Neurosurgery, Apollo Speciality Hospitals, Chennai - 600035, India
| | | | - Mitra Ghosh
- Department of Pathology, Apollo Speciality Hospitals, Chennai - 600035, India
| | | |
Collapse
|
4
|
Perumal K, Potharaju M. Predictability of intra-fractional prostate motion. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy434.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
5
|
Potharaju M, Mangaleswaran B, Mathavan A, John R, Thamburaj V, Ghosh S, Ganesh S, Kalvakonda C, Loganathan M, Bapu S, Devi R, Verma RS. Body Mass Index as a Prognostic Marker in Glioblastoma Multiforme: A Clinical Outcome. Int J Radiat Oncol Biol Phys 2018; 102:204-209. [DOI: 10.1016/j.ijrobp.2018.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
|
6
|
Potharaju M, LS R, Sasikumar N, ALI S. Stereotactic body radiotherapy for low and intermediate risk prostate cancer: Four-year outcomes. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Potharaju M, Mathavan A, Mangaleswaran B. Effect of time interval between surgery and radiation therapy initiation in glioblastoma patients on overall survival. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Perumal K, Reddy P, Potharaju M. 369P Impact of glutamine supplements in altering the toxicity profile in head and neck cancer patients receiving concurrent chemoradiotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw587.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Perumal K, Potharaju M. Nature of intrafractional and interfractional prostate motion during stereotactic radiation. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
152 Background: To characterize the intra-fraction and inter-fraction prostate motion as tracked by the X-ray images of the implanted gold fiducials during stereotactic radiotherapy with CyberKnife. The published data have analysed the linear and angular prostate motion intrafraction and interfraction prostate motion among patients. We sought to quantify the same within each patient. Methods: Twenty Five patients with localized prostate cancer treated with CyberKnife radiosurgery between January 2013 and August 2015 were studied retrospectively. A data set constitutes the deviations derived from X-ray images obtained between two consecutive couch motions. Results: Included in the analysis were 3926 data sets. A total of 210 non-coplanar fields were used per fraction. The mean total treatment time for all fields per fraction was 36.13 minutes. The detected and corrected movements over all were in a range of ± 10.1 mm in linear direction (Right: mean 1.1±0.4 mm; Left: mean 1.0±0.6 mm; Superior: mean 0.7±0.3 mm; Inferior: mean 1.6±0.6 mm; Anterior: mean 1.6±0.7 mm; Posterior: mean 0.5±0.3 mm with maximum (max) movement range of Right max 9.9±6.4 mm, Left max 7.1±3.4 mm, Superior max 8.6±5.4 mm, Inferior max 10.1±8.5 mm, Anterior max 9.2±6.5 mm, Posterior max 8.4±2.9 mm) and angular movements were in a range of ± 6.7 deg in all directions (Right Angle: mean 0.6±0.3 deg; Left Angle: mean 0.6±0.3 deg; Head Up(H-U): mean 1.3±0.6 deg; Head Down(H-D): mean 1.4±0.6 deg; Counter-Clockwise movement (CCW): mean 0.7±0.3 deg; Clockwise movement (CW): mean 0.5±0.3 deg with max rotation range of Right angle max 2.4±2 deg, Left angle max 2.7±2 deg, H-U max 10.2±3.5 deg, H-D max 6.7±4.8 deg, CCW 4±2.9 deg, CW max 2.8±2.4 deg). There was an unpredictable change in prostate motion inter-fraction in each patient. But, a unique observation is that a predictable pattern exists for prostate motion intra-fraction within a patient. Change in the linear or angular prostate motion intra-fraction in any direction is not erratic. Conclusions: The linear and rotational prostate motion intra-fraction in any direction has a predictable pattern and any change is gradual and not erratic. The motion shows secular trend during the course of treatment.
Collapse
|
10
|
Perumal K, Patil S, Potharaju M. 119PD Role of EGFR as a prognostic factor in primary glioblastoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv520.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Potharaju M, Subramanaiam R, Venkataraman M, Perumal K, Ramakrishnan B, Vangara R, Reddy S. A Report on the Clinical Outcome after High-Dose Rate (HDR) Brachytherapy as Monotherapy in Early Prostate Cancer. Cureus 2015; 7:e303. [PMID: 26430577 PMCID: PMC4570880 DOI: 10.7759/cureus.303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To report the clinical outcome after a single implant, high dose rate (HDR) brachytherapy in early prostate cancer. MATERIALS AND METHODS All clinically localized prostate cancer patients who underwent high-dose rate (HDR) brachytherapy as monotherapy (no external beam radiotherapy) from February 2006 to September 2011 were analyzed prospectively. Acute and chronic toxicity were assessed as per Common Terminology Criteria for Adverse Events (CTCAE), Version 4.03. Biochemical recurrence was analyzed using the Kaplan Meir method. A log-rank analysis was done to compare the factors affecting the outcome. RESULTS Forty-four patients with organ-confined prostate cancer opted for HDR brachytherapy between February 2006 to September 2011 with a median follow-up of 68 months The five-year biochemical recurrence-free survival (bRFS) rate was 91%. Late Grade 2 genitourinary (GU) toxicity was observed in 9% of patients. The predictors of late Grade 2 GU toxicity were urethra V125 ≥ 0.2 cc (urethral volume receiving ≥ 125% of the prescribed dose) and PTV 150 ≥ 35% ( planning target volume receiving ≥ 150% of the prescribed dose) with p-value = 0.001 and 0.002, respectively. Erectile function was preserved in 72% of the patients who had Grade 0-1 erectile dysfunction before brachytherapy. CONCLUSION HDR brachytherapy in early prostate cancer results in high local control rates with minimal side-effects.
Collapse
|
12
|
Narayanaswamy RK, Potharaju M, Vaidhyswaran AN, Perumal K. Pre-radiotherapy Haemoglobin Level is A Prognosticator in Locally Advanced Head and Neck Cancers Treated with Concurrent Chemoradiation. J Clin Diagn Res 2015; 9:XC14-XC18. [PMID: 26266202 PMCID: PMC4525592 DOI: 10.7860/jcdr/2015/11593.6102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/10/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Radiation plays a major role in treatment of locoregional control of Head and Neck Squamous cell carcinoma (HNSCC). Anaemia is considered a contributor to intra-tumour hypoxia and tumour resistance to ionizing radiation and most evidences are from developed world, we prospectively investigated the exact role of anaemia in treatment outcome of Stage III/IVA HNSCC in our patient population. AIM OF THE STUDY Primary end point: To analyse the Pre-Radiotherapy haemoglobin level and early response of treatment in stage III/IVA HNSCC and to determine the relationship of Pre-Radiotherapy haemoglobin level with other prognostic factors. MATERIALS AND METHODS This non-interventional single blinded randomized study enrolled patients attending the OPD consecutively, who met our eligibility criteria. INCLUSION CRITERIA HNSCC patients of Stage III/IVA aged ≥18 years and ≤ 70 years with ECOG status of 1or 2 and willing for concurrent chemoradiation and at least 6 weeks of follow up. EXCLUSION CRITERIA 1) Previous history of treatment for malignancy or radiation in head and neck site. 2) Patients with other fatal and non-fatal pre-morbid or co-morbid conditions that can affect the outcome or the overall survival. Patients with Pre-radiotherapy haemoglobin status < 10 g/dl were given haematinic support and/or blood transfusion. All patients received concurrent chemotherapy (weekly cisplatin) and radiation in conventionally fractionated dose of 66Gy. Early treatment responses were evaluated with Revised RECIST version 1.1 and Data analysis using SPSS version 17.0. RESULTS Ninety one patients enrolled had mean age of 55.63 (range: 32-69), a median of 56 and mode of 60. Seventy one were males (78%) and 20 females (22%) with a performance status of ECOG 1 in 43 (47%) patients and ECOG 2 in 48 (53%); Pre-RT Hb level of <10.7 g/dl in 38 (42%) patients and ≥10.7 in 53 (58%) patients; Pre-RT Hb level was <12 g/dl in 67 (74%) patients and ≥12 in 24 (26%) patients. Tumour sites were - Nasopharynx 7 (8 %), Oral Cavity 18 (20 %), Oropharynx 32 (35 %), Hypopharynx 23 (25 %) and Larynx 11 (12 %). Twenty five (27%) had Grade 2 mucositis and 66 (73%) had Grade 3 mucositis. Fifty eight (64%) patients completed treatment with NO breaks and 33 (36%) with treatment breaks for ≥5 days. Pre-radiotherapy haemoglobin ≥ 10.7 g/dl (p < 0.001), ECOG performance status (p = 0.0002), Treatment interruptions for > 5 days (p = <0.0001), Mucositis reaction (p = <0.0001) showed statistical significance with outcome of response. CONCLUSION The study found that performance status, pre-RT haemoglobin level, radiotherapy interruptions > 5 days and non-development of grade III mucositis was found to be significantly associated with good loco-regional control. Haemoglobin level ≥10.7 g/dl was associated with better treatment outcome, higher performance status, fewer treatment interruptions and lesser degree of mucositis. Transfusion did not affect the outcome. Definitive conclusions and recommendations need further expansion of our study for better statistical power.
Collapse
Affiliation(s)
| | - Mahadev Potharaju
- Senior Consultant, Department of Radiation Oncology, Apollo Speciality Hospital, Chennai, India
| | - A N Vaidhyswaran
- Senior Consultant, Department of Radiation Oncology, Apollo Speciality Hospital, Chennai, India
| | - Karthikeyan Perumal
- Senior Resident, Department of Radiation Oncology, Apollo Speciality Hospital, Chennai, India
| |
Collapse
|
13
|
Potharaju M, John R, Venkataraman M, Gopalakrishna K, Subramanian B. Stereotactic radiosurgery results in three cases of intramedullary spinal cord arteriovenous malformations. Spine J 2014; 14:2582-8. [PMID: 24534388 DOI: 10.1016/j.spinee.2014.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/03/2014] [Accepted: 02/05/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary spinal cord arteriovenous malformations (AVMs) are rare and have an unfavorable prognosis. We report our experience of treating three symptomatic patients with stereotactic radiosurgery (SRS). The standard treatment for these lesions are embolization or microsurgical resection. There are only a few reports of efficacy of radiosurgery in these cases. PURPOSE To study the efficacy of radiosurgery in intramedullary spinal cord AVM patients, who failed or refused conventional treatment. STUDY SETTING This study reports the results of SRS in 3 cases of intramedullary spinal cord AVMs. PATIENT SAMPLE Three symptomatic patients diagnosed with intramedullary spinal cord AVMs. Two patients underwent embolization previously and one was newly diagnosed. OUTCOME MEASURES The AVM obliteration was assessed by yearly high-resolution magnetic resonance imaging (MRI). Clinical examination was carried out every 6 months. METHODS Three symptomatic patients with intramedullary spinal cord AVMs were treated with SRS using the cyberknife system from January 2010 to May 2011. All the three patients presented with acute neurologic symptoms. Two patients were treated previously with embolization. As per protocol, patients underwent a plain computed tomography (CT), CT angiography, high-resolution MRI, and conventional spinal angiography for radiotherapy planning. The mean target volume was 4.05 cc. The prescribed dose was 21 Gy in three fractions on consecutive days. No special immobilization was done during treatment. Continuous image guidance of the treated area was done using the specialized spine tracking software. Follow-up was done by yearly clinical examination and high-resolution spine MRI after SRS. RESULTS Mean follow-up was 36 months. Follow-up MRI revealed absence of flow voids, suggesting complete obliteration of the AVM in two patients, with significant improvement in neurologic and functional symptoms. The third patient did not show any clinical improvement or deterioration. There was no incidence of hemorrhage after SRS in any patient and the treatment was well tolerated without any significant complications. CONCLUSIONS Stereotactic radiosurgery for intramedullary spinal AVMs appears to be well tolerated and effective in selected cases.
Collapse
Affiliation(s)
- Mahadev Potharaju
- Department of Radiation Oncology, Apollo Speciality Cancer Hospitals, 320, Anna Salai, Chennai 600032, India.
| | - Reginald John
- Department of Neurosurgery, Apollo Speciality Cancer Hospitals, 320, Anna Salai, Chennai 600032, India
| | - Murali Venkataraman
- Department of Medical Physics, Apollo Speciality Cancer Hospitals, 320, Anna Salai, Chennai 600032, India
| | - Kurup Gopalakrishna
- Department of Medical Physics, Apollo Speciality Cancer Hospitals, 320, Anna Salai, Chennai 600032, India
| | - Balaji Subramanian
- Department of Radiation Oncology, Apollo Speciality Cancer Hospitals, 320, Anna Salai, Chennai 600032, India
| |
Collapse
|
14
|
Potharaju M, Murali V, kurup G. Dosimetric comparison of Stereotactic body radiotherapy and Intensity modulated radiotherapy to deliver hypofractionated radiotherapy in organ confined prostate cancer. Cureus 2013. [DOI: 10.7759/cureus.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
15
|
Dutta D, Balaji Subramanian S, Murli V, Sudahar H, Gopalakrishna Kurup PG, Potharaju M. Dosimetric comparison of Linac-based (BrainLAB®) and robotic radiosurgery (CyberKnife ®) stereotactic system plans for acoustic schwannoma. J Neurooncol 2011; 106:637-42. [PMID: 21892741 DOI: 10.1007/s11060-011-0703-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
A dosimetric comparison of linear accelerator (LA)-based (BrainLAB) and robotic radiosurgery (RS) (CyberKnife) systems for acoustic schwannoma (Acoustic neuroma, AN) was carried out. Seven patients with radiologically confirmed unilateral AN were planned with both an LA-based (BrainLAB) and robotic RS (CyberKnife) system using the same computed tomography (CT) dataset and contours. Gross tumour volume (GTV) was contoured on post-contrast magnetic resonance imaging (MRI) scan [planning target volume (PTV) margin 2 mm]. Planning and calculation were done with appropriate calculation algorithms. The prescribed isodose in both systems was considered adequate to cover at least 95% of the contoured target. Plan evaluations were done by examining the target coverage by the prescribed isodose line, and high- and low-dose volumes. Isodose plans and dose volume histograms generated by the two systems were compared. There was no statistically significant difference between the contoured volumes between the systems. Tumour volumes ranged from 380 to 3,100 mm(3). Dose prescription was 13-15 Gy in single fraction (median prescribed isodose 85%). There were no significant differences in conformity index (CI) (0.53 versus 0.58; P = 0.225), maximum brainstem dose (4.9 versus 4.7 Gy; P = 0.935), 2.5-Gy volume (39.9 versus 52.3 cc; P = 0.238) or 5-Gy volume (11.8 versus 16.8 cc; P = 0.129) between BrainLAB and CyberKnife system plans. There were statistically significant differences in organs at risk (OAR) doses, such as mean cochlear dose (6.9 versus 5.4 Gy; P = 0.001), mean mesial temporal dose (2.6 versus 1.7 Gy; P = 0.07) and high-dose (10 Gy) volume (3.2 versus 5.2 cc; P = 0.017). AN patients planned with the CyberKnife system had superior OAR (cochlea and mesial temporal lobe) sparing compared with those planned with the Linac-based system. Further evaluation of these findings in prospective studies with clinical correlation will provide actual clinical benefit from the dosimetric superiority of CyberKnife.
Collapse
Affiliation(s)
- Debnarayan Dutta
- Department of Radiation Oncology, Apollo Speciality Hospital, Chennai, India.
| | | | | | | | | | | |
Collapse
|