- Email: [email protected]
In Reply to Dr. Bauman
Letters to the Editor
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Fig. 2. Dose distributions calculated with Dynamic Arc, Helical Tomotherapy, and Rapid Arc respectively. ABHIRAMI HALLOCK, M.D. GLENN BAUMAN, M.D., F.R.C.P.C Department of Radiation Oncology JEFF CHEN, PH.D., F.C.C.P.M. SLAV YARTSEV, PH.D. Department of Physics and Engineering London Regional Cancer Program London Health Sciences Centre University of Western Ontario London, ON, Canada doi:10.1016/j.ijrobp.2009.12.049 1. Lagerwaard FJ, van der Hoorn EA, Verbakel WF, et al. Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 2009;75:253–259. 2. Bauman G, Yartsev S, Fisher B, et al. Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol 2007;30:38–44. 3. Wong E, Chen JZ, Greenland J. Intensity-modulated arc therapy simplified. Int J Radiat Oncol Biol Phys 2002;53:222–235.
ity of our patients undergoing RapidArc therapy are being treated for multiple brain metastases. At our center, patients with a single brain metastasis are generally treated by using radiosurgery without upfront whole-brain radiotherapy. The only patient treated for a single lesion in our report on multiple brain metastases had previously undergone neurosurgery for removal of a second lesion, for which postoperative whole-brain radiotherapy was indicated. As the authors acknowledged in their response, inverse planning using techniques such as RapidArc will likely be more efficient for such patients. We do not dismiss the authors’ conclusion that there are multiple technological solutions to the scenario of treating brain metastases with a combination of whole-brain radiotherapy and simultaneous integrated boost. However, the main message from our article was the description and evaluation of RapidArc as a new tool for quick and straightforward planning and treatment delivery in patients with multiple brain metastases. FRANK J. LAGERWAARD, M.D., PH.D. ELLES A. VAN DER HOORN WILKO F. VERBAKEL, PH.D. CORNELIS J. HAASBEEK, M.D. BEN J. SLOTMAN, M.D., PH.D. SURESH SENAN, M.R.C.P., F.R.C.R., PH.D. Department of Radiation Oncology VU University Medical Center Amsterdam Amsterdam, The Netherlands
IN REPLY TO DR. BAUMAN
doi:10.1016/j.ijrobp.2009.12.050
To the Editor: We thank Dr. Bauman and colleagues for their interest in our study of whole-brain radiotherapy with simultaneous integrated boosts to multiple brain metastases, using RapidArc (1). In their response, the authors compare helical tomotherapy, RapidArc, and a forward dynamic arc boost technique for treating a patient with a single brain metastasis (2, 3). If we understand their approach correctly, it is based on combining two opposed lateral fields with forward intensity-modulated radiotherapy (IMRT) planning in combination with a single dynamic conformal arc. Although the authors suggest that broadly similar plans can be achieved in a patient with a solitary brain metastasis, we should stipulate that the major-
1. Lagerwaard FJ, van der Hoorn EA, Verbakel WF, et al. Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 2009;75:253–259. 2. Bauman G, Yartsev S, Fisher B, et al. Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol 2007;30:38–44. 3. Wong E, Chen JZ, Greenland J. Intensity-modulated arc therapy simplified. Int J Radiat Oncol Biol Phys 2002;53:222–235.
965
Fig. 2. Dose distributions calculated with Dynamic Arc, Helical Tomotherapy, and Rapid Arc respectively. ABHIRAMI HALLOCK, M.D. GLENN BAUMAN, M.D., F.R.C.P.C Department of Radiation Oncology JEFF CHEN, PH.D., F.C.C.P.M. SLAV YARTSEV, PH.D. Department of Physics and Engineering London Regional Cancer Program London Health Sciences Centre University of Western Ontario London, ON, Canada doi:10.1016/j.ijrobp.2009.12.049 1. Lagerwaard FJ, van der Hoorn EA, Verbakel WF, et al. Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 2009;75:253–259. 2. Bauman G, Yartsev S, Fisher B, et al. Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol 2007;30:38–44. 3. Wong E, Chen JZ, Greenland J. Intensity-modulated arc therapy simplified. Int J Radiat Oncol Biol Phys 2002;53:222–235.
ity of our patients undergoing RapidArc therapy are being treated for multiple brain metastases. At our center, patients with a single brain metastasis are generally treated by using radiosurgery without upfront whole-brain radiotherapy. The only patient treated for a single lesion in our report on multiple brain metastases had previously undergone neurosurgery for removal of a second lesion, for which postoperative whole-brain radiotherapy was indicated. As the authors acknowledged in their response, inverse planning using techniques such as RapidArc will likely be more efficient for such patients. We do not dismiss the authors’ conclusion that there are multiple technological solutions to the scenario of treating brain metastases with a combination of whole-brain radiotherapy and simultaneous integrated boost. However, the main message from our article was the description and evaluation of RapidArc as a new tool for quick and straightforward planning and treatment delivery in patients with multiple brain metastases. FRANK J. LAGERWAARD, M.D., PH.D. ELLES A. VAN DER HOORN WILKO F. VERBAKEL, PH.D. CORNELIS J. HAASBEEK, M.D. BEN J. SLOTMAN, M.D., PH.D. SURESH SENAN, M.R.C.P., F.R.C.R., PH.D. Department of Radiation Oncology VU University Medical Center Amsterdam Amsterdam, The Netherlands
IN REPLY TO DR. BAUMAN
doi:10.1016/j.ijrobp.2009.12.050
To the Editor: We thank Dr. Bauman and colleagues for their interest in our study of whole-brain radiotherapy with simultaneous integrated boosts to multiple brain metastases, using RapidArc (1). In their response, the authors compare helical tomotherapy, RapidArc, and a forward dynamic arc boost technique for treating a patient with a single brain metastasis (2, 3). If we understand their approach correctly, it is based on combining two opposed lateral fields with forward intensity-modulated radiotherapy (IMRT) planning in combination with a single dynamic conformal arc. Although the authors suggest that broadly similar plans can be achieved in a patient with a solitary brain metastasis, we should stipulate that the major-
1. Lagerwaard FJ, van der Hoorn EA, Verbakel WF, et al. Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 2009;75:253–259. 2. Bauman G, Yartsev S, Fisher B, et al. Simultaneous infield boost with helical tomotherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol 2007;30:38–44. 3. Wong E, Chen JZ, Greenland J. Intensity-modulated arc therapy simplified. Int J Radiat Oncol Biol Phys 2002;53:222–235.