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Tumor-Treating Field Arrays Do Not Reduce Target Volume Coverage for Glioblastoma Radiation Therapy.

Al's Comment:

 This study shows that it is safe to keep the Optune arrays on the scalp during radiation.  The amount of radiation blocked is negligible, opening the door for using Optune during radiation.   Of course we need to see the results of the current trial but the combination of Optune and radiation may make a lot of sense. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290966/ for why! 


Posted on: 02/14/2020

Adv Radiat Oncol. 2019 Aug 28;5(1):62-69. doi: 10.1016/j.adro.2019.08.005. eCollection 2020 Jan-Feb.

Tumor-Treating Field Arrays Do Not Reduce Target Volume Coverage for Glioblastoma Radiation Therapy.

Stachelek GC1, Grimm J1, Moore J1, Huang E1, Spoleti N1, Redmond KJ1, Lim M2, Bettegowda C2, Kleinberg L1.
 
Author information:
1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland.
2. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
Abstract
Purpose:
 
To inform development of procedures for using tumor-treating field arrays (TTFields) during glioblastoma radiation therapy by determining whether the placement and repositioning of arrays affects target volume coverage and cranial skin dose.
Methods and Materials:
 
Radiation plans from 10 consecutive patients treated for glioblastoma were copied to a cranial phantom and reoptimized for phantom anatomy. Dose distributions were then recalculated on 3 additional computed tomographic scans of the phantom with the TTFields electrode arrays placed over distinct locations on the phantom scalp to compare planning target volume (PTV) coverage and skin dose with and without TTFields in place in varying positions. Percent depth dose curves were also measured for radiation beams passing through the electrodes and compared with commonly used bolus material.
Results:
 
The presence of TTFields arrays decreased PTV V97% and D97% by as much as 1.7% and 2.7%, respectively, for a single array position, but this decrease was mitigated by array repositioning. On averaging the 3 array positions, there was no statistically significant difference in any dosimetric parameter of PTV coverage (V95-97%, D95-97%) across all cases compared with no array. Mean increases in skin D1cc and D20cc of 3.1% were calculated for the cohort. Surface dose for TTFields electrodes was less than that with a 5-mm superflab bolus.
Conclusions:
 
Our work demonstrates that placement of TTFields arrays does not significantly affect target volume coverage. We show that repositioning of TTFields arrays, as is required in clinical use, further minimizes any dosimetric changes and eliminates the need for replanning when arrays are moved. A slight, expected bolus effect is observed, but the calculated increases in skin dose are not clinically significant. These data support the development of clinical trials to assess the safety and efficacy of combining concurrent chemoradiotherapy with TTFields therapy for glioblastoma.
 
© 2019 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
PMCID: PMC7004938
PMID: 32051891 

 


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