Abstract
PurposeTo compare the delivery efficiency, plan quality, and planned treatment volume (PTV) and normal brain dosimetry between different Cyberknife planning approaches for multiple brain metastases (MBM), and to evaluate the effects of the number of collimators on the related parameters.MethodsThe study included 18 cases of MBM. The Cyberknife treatment plans were classified as Separate or Combined. For the Separate plan, each lesion was targeted by the collimator auto-selection method (Conformality 2/3 collimators). For the Combined plan, a PTV including all PTVs was targeted by the collimators. Monitor units (MUs), number of nodes and beams, estimated fraction treatment time (EFTT), new conformity index (nCI), dose gradient index (GI), homogeneity index (HI), PTV minimum/maximum dose (Dmax/Dmin), volume doses (D2% and D98%), maximum doses to lenses, optic nerves, and brainstem as well as normal brain 3, 6, 10, and 12 Gy (V3Gy–V12Gy) were compared.ResultsCompared to the Combined plan, the Separate plan had fewer nodes and beams, shorter EFTT, smaller PTV Dmin, normal brain dose, and GI, and larger HI. The Separate plan with 2 collimators also had worse PTV coverage. In the Combined plan, more collimators increased beams, EFTT, GI, and normal brain dose but improved the PTV Dmin. Among treatments based on the Separate approach, there were obvious differences between plans for most of the items except the nCI. Fewer collimators resulted in significantly reduced beams, EFTT, PTV D98%, and normal brain dose with improved GI, although PTV Dmin and MUs were decreased while HI was increased.ConclusionBoth approaches met the requirements for SRS/HFSRT. We found that Separate plans improved treatment efficiency and normal tissue dosimetry.
Highlights
Stereotactic radiosurgery (SRS) and hypo-fractionated stereotactic radiotherapy (HFSRT) are efficient and welltolerated treatment modalities for patients with brain metastases [1, 2]
Among treatments based on the Separate approach, there were obvious differences between plans for most of the items except the new conformity index (nCI)
Fewer collimators resulted in significantly reduced beams, estimated fraction treatment time (EFTT), planned treatment volume (PTV) D98%, and normal brain dose with improved gradient index (GI), PTV Dmin and Monitor units (MUs) were decreased while homogeneity index (HI) was increased
Summary
Stereotactic radiosurgery (SRS) and hypo-fractionated stereotactic radiotherapy (HFSRT) are efficient and welltolerated treatment modalities for patients with brain metastases [1, 2]. In patients with multiple brain metastases (MBM), both techniques have proven effective for reducing neurotoxicity and preserving quality of life [3–5]. SRS and HFSRT can be performed with a Gamma Knife (GK; Elekta AB; Stockholm, Sweden), a Cyberknife robotic radiosurgery system (CK; Accuray, Sunnyvale, CA, USA), or a conventional linear accelerator, and in the treatment of MBM, there may be marked differences in plan quality and delivery efficiency among these devices [6, 7]. The CK has a 6MV accelerator mounted on a robotic arm that is designed to deliver non-isocenter non-coplanar beam arrangements; this is combined with a high-resolution image-guided tracking system to help maximize the accuracy of the treatment. The positions of the nodes are fixed, and the beams vary according to the target
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