Abstract
Background and purpose
Stereotactic radiosurgery with an adapted linear accelerator (linac-SRS) is an established therapy option for brain metastases, benign brain tumors, and arteriovenous malformations. We intended to investigate whether the dosimetric quality of treatment plans achieved with a CyberKnife (CK) is at least equivalent to that for linac-SRS with circular or micromultileaf collimators (microMLC).
Patients and methods
A random sample of 16 patients with 23 target volumes, previously treated with linac-SRS, was replanned with CK. Planning constraints were identical dose prescription and clinical applicability. In all cases uniform optimization scripts and inverse planning objectives were used. Plans were compared with respect to coverage, minimal dose within target volume, conformity index, and volume of brain tissue irradiated with ≥ 10 Gy.
Results
Generating the CK plan was unproblematic with simple optimization scripts in all cases. With the CK plans, coverage, minimal target volume dosage, and conformity index were significantly better, while no significant improvement could be shown regarding the 10 Gy volume. Multiobjective comparison for the irradiated target volumes was superior in the CK plan in 20 out of 23 cases and equivalent in 3 out of 23 cases. Multiobjective comparison for the treated patients was superior in the CK plan in all 16 cases.
Conclusion
The results clearly demonstrate the superiority of the irradiation plan for CK compared to classical linac-SRS with circular collimators and microMLC. In particular, the average minimal target volume dose per patient, increased by 1.9 Gy, and at the same time a 14 % better conformation index seems to be an improvement with clinical relevance.
Zusammenfassung
Hintergrund und Zielsetzung
Stereotaktische Radiochirurgie mit einem adaptierten Linearbeschleuniger (Linac-SRS) ist eine erfolgreiche und etablierte Therapieoption für Hirnmetastasen, benigne Hirntumoren und arteriovenöse Malformationen. Ziel war es, zu untersuchen, ob die mit einem CyberKnife (CK) erreichbare dosimetrische Planqualität mindestens gleichwertig ist wie bei der Linac-SRS mit Rundkollimatoren und mit Mikro-Multileafkollimatoren (microMLC).
Patienten und Methoden
Eine repräsentative Stichprobe von 16 Patienten mit 23 Zielvolumen, die mit Linac-SRS behandelt wurden, wurde am CK nachgeplant. Randbedingungen waren gleiche Dosisverschreibung und klinische Applizierbarkeit. In allen Fällen wurden einheitliche Optimierungsskripte und Optimierungsziele verwendet. Der Planvergleich erfolgte im Rahmen der multikriteriellen Entscheidungstheorie. Entscheidungskriterien waren Coverage, minimale Dosis im Zielvolumen, Konformitätsindex und Volumen des mit mehr als 10 Gy bestrahlten Hirngewebes.
Ergebnisse
Die Erzeugung der CK-Pläne war in allen Fällen ohne Probleme mit einfachen Optimierungsskripten möglich. Bei den CK-Plänen waren Coverage, minimale Zielvolumendosis und Konformitätsindex signifikant und das 10-Gy-Volumen nicht signifikant besser als bei den Linac-SRS-Plänen. Der multikriterielle Vergleich für die bestrahlten Zielvolumen zeigte eine Überlegenheit der CK-Pläne in 20 von 23 Fällen und in 3 von 23 Fällen eine Gleichwertigkeit. Der multikriterielle Vergleich für die behandelten Patienten ergab eine Überlegenheit der CK-Pläne in allen 16 Fällen.
Schlussfolgerung
Im Ergebnis zeigt der Vergleich die deutliche Überlegenheit der Bestrahlungspläne für das CK gegenüber der klassischen Linac-SRS mit Rundkollimatoren und auch mit microMLC. Speziell die im Mittel pro Patient um 1,9 Gy höhere minimale Zielvolumendosis bei gleichzeitig um 14 % besserem Konformitätsindex erscheint als Verbesserung von klinischer Relevanz.
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H. Treuer, M. Hoevels, K. Luyken, V. Visser-Vandewalle, J. Wirths, M. Kocher, and M. Ruge state that there are no conflicts of interest.
The accompanying manuscript does not include studies on humans or animals.
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Treuer, H., Hoevels, M., Luyken, K. et al. Intracranial stereotactic radiosurgery with an adapted linear accelerator vs. robotic radiosurgery. Strahlenther Onkol 191, 470–476 (2015). https://doi.org/10.1007/s00066-014-0786-y
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DOI: https://doi.org/10.1007/s00066-014-0786-y
Keywords
- Brain neoplasms
- Neoplasm metastasis
- Arteriovenous malformations
- Radiotherapy planning, computer-assisted
- Radiosurgery