3D X-Ray CSI Treatment for CNS Malignancies - Essay Sample

Introduction

It is a treatment of the central nervous system malignancies. It involves three dimensional x-rays with a standard approach. Low megavoltage photons are usually used. Toxicities resulted are usually reduced or removed by reducing CSI dosages for patients with low risks. In other instances, patients who are younger require delayed CSI (Parker and Freeman, 2006). Adolescents need VBSipCSI dose in enhancement of the top cervical spine, thoracic spine, and lumber spine levels. Secondly, simulated dose of ipCSI is given without VBS. It is also vital to administer a target volume 1 of CTV1 that at times requires whole intracranial space and contouring of the entire thecal sac.

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It has an average risk of medulloblastoma at 30.6 Gy in case there is poor prognosis germ cell tumors. On the other hand, 36.0 Gy is for a high risk medulloblastoma. They boost irradiation towards the part of the spinal region (Athiyaman and Athiyaman, 2014). It is, however, complex and has to be done within ten days of surgery for positive results. Craniospinal treatment involves risky procedures that call for informed consent.

Field and volume placement in the procedure is aided by the fusion of the pre-operative MRI and the planning CT. Treatment is usually in two phases, where children below 15 are treated with 23.4 Gy on the Craniospinal axis and 30.6 Gy on the primary tumor. Older ones are treated with 36 Gy on the Craniospinal axis and 18 Gy on the tumor bed (Noble et al., 2017). The second phase mainly involves boosting the tumor bed to 54 Gy. All procedures guiding the spinal and cranial fields have to be followed strictly. However, there is a need to note that excessive radiations are likely to damage other structures that were not part of the treatment.

The patient is placed in a supine position. They are them fixed to be in a vacuum form body immobilizer as well as given head mask irradiator (Science Direct, 2020). The positioning is enhanced by the use of standard fractionation. Dosage depends on the age of the patient. Giving patients a dosage of 6 Gy can result in a permanent menopause in women since the irradiation can reach the ovaries (Science Direct, 2020). For younger women it can lead to a permanent sterility.

References

Athiyaman, H., & Athiyaman, Mayilvaganan, D. S. (2014). A simple planning technique of craniospinal irradiation in the Eclipse treatment planning system. Journal of Medical Physics/Association of Medical Physicists of India, 39(4), 251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258734/

Noble, D. J., Ajithkumar, T., Lambert, J., Gleeson, I., Williams, M. V., & Jefferies, S. J. (2017). Highly conformal craniospinal radiotherapy techniques can underdose the cranial clinical target volume if leptomeningeal extension through skull base exit foramina is not contoured. Clinical Oncology, 29(7), 439-447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479365/pdf/main.pdf

Parker, W. A., & Freeman, C. R. (2006). A simple technique for craniospinal radiotherapy in the supine position. Radiotherapy and oncology, 78(2), 217-222. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.111.1895&rep=rep1&type=pdf

Science Direct. (2020). Craniospinal Irradiation - an overview | ScienceDirect Topics. Sciencedirect.com. Retrieved 29 March 2020, from https://www.sciencedirect.com/topics/nursing-and-health-professions/craniospinal-irradiation.