Abstract
We undertook a structured review of stereotactic radiosurgery (SRS) using linear particle accelerator (linac) equipment, focusing on volumetric modulated arc therapy (VMAT) technology, and frameless image-guided radiotherapy (IGRT), for the treatment of brain metastases. We analyzed the role of linac SRS and its clinical applications, exploring stereotactic localization. Historically, there was a shift from fixed frames to frameless approaches, moving toward less invasive treatments. Thus, we reviewed the concepts of VMAT for multiple-target applications, comparing its dosimetric and technical features to those of other available techniques. We evaluated relevant technical issues and discussed the planning parameters that have gained worldwide acceptance to date. Thus, we reviewed the current literature on the clinical aspects of SRS, especially its main indications and how the advantages of VMAT may achieve clinical benefits in such scenarios. Finally, we reported our institutional results on IGRT-VMAT for SRS treatments for patients with multiple brain metastases.
Highlights
Stereotactic radiosurgery (SRS) is a type of external conformal radiation therapy that uses special equipment to tridimensionally position the patient with higher precision than conventional methods, enabling the accurate delivery of single large doses of radiation to small tumors [1]
Among the techniques that use more than one isocenter as dynamic conformal arc therapy (DCAT) and 3DCRT, volumetric modulated arc therapy (VMAT) plans were equivalent to or better than the other two in conformity index (CI)—the authors mentioned that the quality of coverage by VMAT plans was superior and the total treatment time was reduced by 49%
It was evident that rotations ≥2◦ reduced coverage below 95% of planning target volume (PTV) volume receiving 95% of prescription
Summary
Stereotactic radiosurgery (SRS) is a type of external conformal radiation therapy that uses special equipment to tridimensionally position the patient with higher precision than conventional methods, enabling the accurate delivery of single large doses of radiation to small tumors [1]. Considering the treatment time, target coverage quality and dose conformity, single-isocenter VMAT seems to be advantageous in multiple brain metastases. Because of relatively low time requirements and similar dosimetric results to the aforementioned techniques, image-guided SRS-VMAT plans seem to be a powerful tool for treating multiple brain metastases with a single isocenter. For dose prescriptions of 17, 18, and 20 Gy, our (RTOG-CI) and V12Gy, as mentioned before, are comprised inside the interval of values reported by TABLE 1 | Arc geometry set by Yuan et al [40] for SRS-VMAT (single-isocenter) plans on treatment of multiple brain metastases. We can conclude by analyzing these findings that our results are compatible with the scarce literature
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