Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?

I do try to be mindful of scalp dose for partial brain VMAT, mainly to reduce the risk of alopecia. If feasible, I generally try to keep the scalp/skin max dose around 39 Gy to D0.03 cc or lower. That said, I would prioritize target coverage and overall plan quality if there is a tradeoff. In my pra...

In addition to Dr. @Dr. First Last's planning guidance, another helpful resource to inform planning is this detailed study from MSKCC, which attempts to model the dose dependence of alopecia grade based on radiation exposure (Phillips et al., PMID 32756880). Based on their data, they estimate a 50% ...

This may be an interesting or even controversial aside. My personal observation of brain tumors treated with protons is that geographic alopecia is more significant because the skin sparing is less, regardless of the radiation type, when you treat with only a small number of static fields. Same with...

I have been using VMAT for 8 years to treat brain tumors, and permanent alopecia is rarely a complication in patients treated with doses of >50 Gy. For that reason, I personally do not use a scalp OAR constraint when planning a course of partial brain radiation. Prior to the adoption of VMAT, the oc...