Reduction of Patient Dose in Radiation Therapy for the Brain Tumors by Using 2-Dimensional Vertex or Oblique Vertex Beam Technique

  • Kim, Il-Han (Dept. of Therapeutic Radiology, Seoul National University College of Medicine) ;
  • Chie, Eui-Kyu (Dept. of Therapeutic Radiology, Seoul National University College of Medicine) ;
  • Park, Charn-Il (Dept. of Therapeutic Radiology, Seoul National University College of Medicine)
  • Published : 2003.09.30


Up-front irradiation technique as 3-dimensional conformation, or intensity modulation has kept large proportion of brain tumors from being complicated with acute radiation reactions in the normal tissue during or shortly after radiotherapy. For years, we've cannot help but counting on 2-D vertex beam technique to reduce acute reactions in the brain tumor patients because we're not equipped with 3-dimensional planning system. We analyzed its advantages and limitations in the clinical application. From 1998 to 2001, vertex or oblique vertex beams were applied to 35 patients with primary brain tumor and 25 among them were eligible for this analysis. Vertex(V) plans were optimized on the reconstructed coronal planes. As the control, we took the bilateral opposed techniques(BL) otherwise being applied. We compared the volumes included in 105% to 50% isodose lines of each plan. We also measured the radiation dose at various extracranial sites with TLD. With vertex techniques, we reduced the irradiated volumes of contralateral hemisphere and prevented middle ear effusion at contralateral side. But the low dose volume increased outside 100%; the ratio of V to BL in irradiated volume included in 100%, 80%, 50% was 0.55+/-0.10, 0.61+/-0.10, and 1.22+/-0.21, respectively. The hot area within 100% isodose line almost disappeared with vertex plan; the ratio of V to BL in irradiated volume included in 103%, 105%, 108% was 0.14+/-0.14, 0.05./-0.17, 0.00, respectively. The dose distribution within 100% isodose line became more homogeneous; the ratio of volume included in 103% and 105% to 100% was 0.62+/-0.14 and 0.26+/-0.16 in BL whereas was 0.16+/-0.16 and 0.02+/-0.04 in V. With the vertex techniques, extracranial dose increased up to $1{\sim}3%$ of maximum dose in the head and neck region except submandibular area where dose ranged 1 to 21%. From this data, vertex beam technique was quite effective in reduction of unnecessary irradiation to the contralateral hemispheres, integral dose, obtaining dose homogeneity in the clinical target. But it was associated with volume increment of low dose area in the brain and irradiation toward the head and neck region otherwise being not irradiated at all. Thus, this 2-D vertex technique can be a useful quasi-conformal method before getting 3-D apparatus.


  1. DeVita, Jr. VT, Hellman S, Rosenberg S. Cancer. Lippincott Williams & Wilkins, Philadelphia (2001)
  2. Gunderson LL, Tepper JE, Clinical Radiation Oncology, Churchill Livingstone, New York(2000)
  3. Perez CA, Brady LW. Radiation Oncology, Lippincott-Raven, Philadelphia (1998)
  4. Kaye AH, Laws Jr ER. Brain Tumors, Churchill Livingstone, Tokyo (1995)
  5. Green DM, DAngio Gj. Late Effects of Treatment for Childhood Cancer, Willey-Liss, A John Wiley & Sons, Inc, New York (1990)
  6. Reisinger SA, Palta J, Tupchong L. Vertex field verification in the treatment of central nervous system neoplasm. Int J Radiat Oncol Biol Phys 23:429-432 (1992)
  7. Mendenhall WM, Marcus Jr RB, Mendelhall NP. Verification of vertex fields for radiotherapy of brain tumors. Int J Radiat Oneal Biol Phys 28:556-557 (1994)
  8. Bentel GC Patient Positioning and Immobilization in Radiation Oncology. McGraw-Hill, New York, 71-75 (1999)