Three-field and four-field techniques of Three-Dimensional Conformal Radiotherapy (3DCRT) for lumber vertebral marrow metastasis treatment

Abstract

Author(s): Wisam Nghaimesh Tuaib, Ruwaidah Abd Aalameer Mussttaf, Ali Ahmed Al-Najjar, Nabaa Mohammed Ali*, Ali khamees Al-Tuwayrish, Jaigan L and Duaa Ali Salih

Background: The occurrence of metastases in the vertebral bone marrow is a palliative sign of malignant malignancies. This research aimed to compare the three-field and four-field techniques for 3D conformal radiation. The primary objective was to measure and compare the Conformation Index (CI), the Homogeneity Index (HI), and the Gradient Index (GI), as well as to investigate the radiation dosage absorbed by high-risk organs such as the spinal cord and kidneys.

Materials and Methods: Under the supervision of an oncologist, forty patients diagnosed with lumbar vertebral marrow metastasis tumors underwent CT simulation as part of their radiotherapy treatment. The acquired CT scans were then used with the Monaco v5.3 Treatment Planning System to generate delineations and treatment plans (TPS). Elekta's developed agility linear accelerator was used for the administration of radiotherapy. Two plan types were created for comparison: the three-field method and the four-field approach.

Results: The statistical analysis of lumber vertebral marrow metastatic tumors using the PTV 95%, PTV 105%, and PTV 2% criteria demonstrates that the four-field approach is better than the three-field technique. The four-field process delivers a higher maximum and means dosage to the tumor volume for PTVs of 95%, 105%, and 2%. However, the two systems have no substantial difference for the 95 percent PTV minimum dosage. These findings imply that the four-field method may be a more successful therapeutic option for individuals with malignancies that have spread to the spinal marrow. More study is required to verify these results and investigate other variables that may impact treatment outcomes. According to the findings of the investigation, the four-field approach was considerably superior to the three-field technique for the Homogeneity Index (HI) and Gradient Index (GI), while there was no significant difference for the Conformity Index (CI). Both approaches adhered to their designs. The research implies that the four-field strategy may be more successful at protecting the spinal cord, whereas the three-field technique protects the kidneys.

Conclusion: According to our results, the four-field strategy is more successful than the three-field technique in reducing radiation dosage to the spinal cord. In contrast, the three-field strategy is more successful than the four-field technique for protecting the kidneys. The four-field planning approach is superior for attaining a homogeneous dose distribution in the lumbar spinal bone metastases target volume.

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