Abstract
PurposeThis study aims to compare stereotactic radiosurgery (SRS) planning of epilepsy that complies with Radiosurgery or Open Surgery for Epilepsy (ROSE) guidelines in GammaKnife, non‐coplanar conformal (NCC) plan in Eclipse, dynamic conformal arc (DCA) plan in Brainlab, and a volumetric modulated arc therapy (VMAT) plan in Eclipse.MethodsTwenty plans targeting Mesial temporal lobe epilepsy (MTLE) was generated using GammaKnife, Eclipse with 20 NCC beams, Brainlab with 5 DCA, and Eclipse VMAT with 4 arcs observing ROSE trial guidelines. Multivariate analysis of variance and Wilcoxon signed‐rank test were used to compare dosimetric data of the plans and perform pairwise comparison, respectively.ResultsThe plans obeyed the recommended prescription isodose volume (PIV) within 5.5–7.5 cc and maximum doses to brainstem, optic apparatus (OA) of 10 and 8 Gy, respectively, for a prescription dose of 24 Gy. The volumes of the target were in the range 4.0–7.4 cc. Mean PIV, maximum dose to brainstem, OA were 6.5 cc, 10 Gy, 7.9 Gy in GammaKnife; 7.2 cc, 6.1 Gy, 4.5 Gy in Eclipse NCC; 7.2 cc, 6.4 Gy, 5.7 Gy in Brainlab DCA; and 5.2 cc, 8.4 Gy, 6.1 Gy in Eclipse VMAT plans, respectively. Multivariate analysis of variance showed significant differences among the 4 SRS planning techniques (P‐values < 0.01).ConclusionsAmong the 4 SRS planning methods, VMAT with least PIV and acceptable maximum doses to brainstem and OA showed highest compliance with ROSE trial. Having the most conformal dose distribution and least dose inhomogeneity, VMAT scored higher than GK, Eclipse NCC, and Brainlab DCA plans.
Highlights
Epilepsy is the 4th most common neurological disorder in the United States with an annual incidence of more than 150,000
We present here a comparison study on stereotactic radiosurgery (SRS) plans in Gamma Knife (GK) for treatment of epilepsy against highly non‐coplanar conformal (NCC) plan in Eclipse, dynamic conformal arc (DCA) plan in Brainlab, and a volumetric modulated arc therapy (VMAT) plan in Eclipse echoing the Radiosurgery or Open Surgery for Epilepsy (ROSE) trial planning guidelines and dose constraints
It was observed that 0 mm plan could spare the OARs and stay within the prescribed range for prescription isodose volume (PIV) but has poor target coverage (TC)
Summary
Epilepsy is the 4th most common neurological disorder in the United States with an annual incidence of more than 150,000. Stereotactic laser amygdalo‐hippocampotomy accomplishes ablation of the seizure focus with real‐time magnetic resonance thermal imaging in a minimally invasive approach that eliminates intensive care unit stay.[2] For a subgroup of MTLE patients with medical contraindications to surgery, stereotactic radiosurgery (SRS) has emerged as an alternative therapy in the selective ablation.[3,4] not quite as effective compared to anterior temporal lobectomy (ATL), the preliminary results were supportive of the efficacy of SRS for select cases of MTLE. The Radiosurgery or Open Surgery for Epilepsy (ROSE) clinical trial was designed to compare the effectiveness of Gamma Knife (GK) radio surgery with lobectomy in patients with pharmaco‐resistant MTLE.[5,6] The final outcome analysis of ROSE trial suggests that both SRS and ATL have effectiveness and reasonable safety for MTLE, but ATL has an advantage in the number of seizure remission.[7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
