PMC8247706_01
Left precentral gyrus metastatic small cell lung cancer lesion on axial T1-weighted MRI with gadolinium contrast before (a) and 3 months after (b) pulsed reduced dose-rate radiotherapy.
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F1
Magnetic resonance imaging (MRI) revealed a growing peripherally enhancing 1.2 cm mass (0.8 cm 2 months prior) in the left precentral gyrus that had previously received linear-accelerator-based stereotactic radiosurgery (SRS) to 20 Gy 9 months prior (with 99% coverage of the target volume), a new left cerebellar 0.4 cm lesion, and a growing left posterior temporal/medial occipital 0.6 cm lesion (0.4 cm 2 months prior) [Figure 1].
Case 1 cancer diagnosis and treatment timeline.
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F2
Left precentral motor cortex lesion re-treatment plan with dose-volume histogram. This patient was re-treated with 35 Gy in 100 fractions, over the course of 3 weeks, to her surgical cavity of her left precentral gyrus lesion. Pulsed reduced dose-rate radiotherapy was used with TomoHDA  Planning Station Version 5.1.1.6, and 97% of the target volume received 35 Gy. The colors in the top of the figure correspond to isodose distributions, with orange corresponding to the volume receiving 35Gy (100% dose area). The dose-volume histogram relates radiation dose to tissue volume and includes both the target structure as well as organs at risk.
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F3
TomoHDA  Planning Station Version 5.1.1.6 (Accuray Inc., Sunnyvale, CA, USA) was used [Figure 3]. [Figure 4] provides a cumulative dose-volume histogram on the organs at risk along with the PRDR targets based on the treatments to the brain using MIM software (MIM Software Inc., Cleveland, OH, USA).
Comprehensive dose-volume histogram based on a summation of the patient's previous radiation treatments detailed in Figure 2 on the organs at risk along with the pulsed reduced dose-rate radiotherapy targets based on the treatments to the brain, compiled using MIM software (MIM Software Inc., Cleveland, OH, USA). The colors in the figure correspond to the volumes as shown in the key receiving doses of radiation.
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F4
TomoHDA  Planning Station Version 5.1.1.6 (Accuray Inc., Sunnyvale, CA, USA) was used [Figure 3]. [Figure 4] provides a cumulative dose-volume histogram on the organs at risk along with the PRDR targets based on the treatments to the brain using MIM software (MIM Software Inc., Cleveland, OH, USA).
PMC8247706_02
Case 2 cancer diagnosis and treatment timeline.
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F5
[Figure 5] provides a flowchart summary of this case.
Glioblastoma multiforme at T11-12 seen on T1-weighted axial magnetic resonance image with gadolinium contrast before (a) and 1 month after (b) pulsed reduced dose-rate radiotherapy.
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F6
MRI thoracic spine revealed a recurrent thoracic lesion 2.2 x 1 x 0.8 cm [Figure 6].
Thoracic spinal glioblastoma multiforme re-treatment plan with dose-volume histogram. This patient was re-treated with 50 Gy in 250 fractions, over the course of 6 weeks, to his recurrent thoracic lesion. Pulsed reduced dose-rate radiotherapy was used with TomoHDATM Planning Station Version 5.1.1.6, and 99% of the target volume received 50 Gy. The colors in the top of the figure correspond to isodose distributions for the treatment target in the thoracic spine, with orange corresponding to the volume receiving 50 Gy (100% dose area). Organs at risk are delineated in the top of the figure as well. The dose-volume histogram relates radiation dose to tissue volume and includes both the target structure as well as organs at risk.
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F7
TomoHDA  Planning Station Version 5.1.1.6 (Accuray Inc., Sunnyvale, CA, USA) was used [Figure 7].
Comprehensive dose-volume histogram based on a summation of the patient's previous radiation treatments detailed in Figure 5 on the organs at risk along with the pulsed reduced dose-rate radiotherapy targets based on the treatments to the brain, compiled using MIM software (MIM Software Inc., Cleveland, OH, USA). The colors in the figure correspond to the volumes as shown in the key receiving doses of radiation.
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F8