Abstract
PurposeTo investigate the feasibility of a novel dedicated treatment planning solution, to automatically target multiple brain metastases with a single isocenter and multiple inversely-optimized dynamic conformal arcs (DCA), and to benchmark it against the well-established multiple isocenter DCA (MIDCA) and volumetric modulated arc therapy (VMAT) approaches.Material and MethodsTen previously treated patients were randomly selected, each representing a variable number of lesions ranging between 1 to 8. The original MIDCA treatments were replanned with both VMAT and the novel brain metastases tool. The plans were compared by means of Paddick conformity (CI) and gradient index (GI), and the volumes receiving 10 Gy (V10) and 12 Gy (V12).ResultsThe brain metastases software tool generated plans with similar CI (0.65 ± 0.08) as both established treatment techniques while improving the gradient (mean GI = 3.9 ± 1.4). The normal tissue exposure in terms of V10 (48.5 ± 35.9 cc) and V12 (36.3 ± 27.1 cc) compared similarly to the MIDCA technique and surpassed VMAT plans.ConclusionsThe automated brain metastases planning algorithm software is an optimization of DCA radiosurgery by increasing delivery efficiency to the level of VMAT approaches. Improving dose gradients and normal tissue sparing over VMAT, revives DCA as the paradigm for linac-based stereotactic radiosurgery of multiple brain metastases.
Highlights
Radiation therapy has become a popular treatment option in the management of patients with brain metastases
The automated brain metastases planning algorithm software is an optimization of dynamic conformal arcs (DCA) radiosurgery by increasing delivery efficiency to the level of volumetric modulated arc therapy (VMAT) approaches
Improving dose gradients and normal tissue sparing over VMAT, revives DCA as the paradigm for linac-based stereotactic radiosurgery of multiple brain metastases
Summary
Radiation therapy has become a popular treatment option in the management of patients with brain metastases. The role and effectiveness of stereotactic radiosurgery (SRS) alone and in combination with whole brain radiation therapy (WBRT) for the treatment of brain metastases has been evaluated in two randomized clinical trials [1, 2]. Our standard of care for SRS treatments of multiple brain metastases is a multi isocentric set-up, aligning the micro multi-leaf collimator (MLC) around every individual lesion using DCA. This complex time consuming treatment planning translates in extended treatment delivery times, as it requires patient repositioning for every individual metastases
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