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. 2020 Nov 24;10:531344. doi: 10.3389/fonc.2020.531344

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Copyright © 2020 Dale, Molinelli, Vischioni, Vitolo, Bonora, Magro, Mairani, Hasegawa, Ohno, Dahl, Valvo and Fossati

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Transversal sections of D _{LEM I}-optimized treatment plans applying brainstem (green contour) constraints of D _{LEM I|1%} <30 Gy (RBE) in plan (A) or D _{LEM I|0.7 cm³} <38 Gy (RBE) and D _{LEM|0.1 cm³} <46 Gy (RBE) in plan B). The dose constraint levels are illustrated by dark blue, light blue, and light green isodose, respectively. Plans were subsequently recalculated to D _MKM (A′, B′). Red isodose in plan (A, B) represents 95% of the target dose (70.4 Gy (RBE) in D _{LEM I}). Note the improved dose coverage to the CTV (red contour) and to the part of the CTV in which the tumor recurred (yellow contour) in plan B compared with plan A. Dose to the brainstem remains compliant with the constraints defined by Shirai et al. when evaluated in D _MKM (B′).