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Wang J, Zheng Q, Wang Y, Wang C, Xu S, Ju Z, Pan L, Bai J, Liu Y, Qu B, Dai X. Dosimetric comparison of ZAP-X, Gamma Knife, and CyberKnife stereotactic radiosurgery for single brain metastasis. BMC Cancer 2024; 24:936. [PMID: 39090564 PMCID: PMC11295608 DOI: 10.1186/s12885-024-12710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE To evaluate the dosimetric characteristics of ZAP-X stereotactic radiosurgery (SRS) for single brain metastasis by comparing with two mature SRS platforms. METHODS Thirteen patients with single brain metastasis treated with CyberKnife (CK) G4 were selected retrospectively. The prescription dose for the planning target volume (PTV) was 18-24 Gy for 1-3 fractions. The PTV volume ranged from 0.44 to 11.52 cc.Treatment plans of thirteen patients were replanned using the ZAP-X plan system and the Gamma Knife (GK) ICON plan system with the same prescription dose and organs at risk (OARs) constraints. The prescription dose of PTV was normalized to 70% for both ZAP-X and CK, while it was 50% for GK. The dosimetric parameters of three groups included the plan characteristics (CI, GI, GSI, beams, MUs, treatment time), PTV (D2, D95, D98, Dmin, Dmean, Coverage), brain tissue (volume of 100%-10% prescription dose irradiation V100%-V10%, Dmean) and other OARs (Dmax, Dmean),all of these were compared and evaluated. All data were read and analyzed with MIM Maestro. One-way ANOVA or a multisample Friedman rank sum test was performed, where p < 0.05 indicated significant differences. RESULTS The CI of GK was significantly lower than that of ZAP-X and CK. Regarding the mean value, ZAP-X had a lower GI and higher GSI, but there was no significant difference among the three groups. The MUs of ZAP-X were significantly lower than those of CK, and the mean value of the treatment time of ZAP-X was significantly shorter than that of CK. For PTV, the D95, D98, and target coverage of CK were higher, while the mean of Dmin of GK was significantly lower than that of CK and ZAP-X. For brain tissue, ZAP-X showed a smaller volume from V100% to V20%; the statistical results of V60% and V50% showed a difference between ZAP-X and GK, while the V40% and V30% showed a significant difference between ZAP-X and the other two groups; V10% and Dmean indicated that GK was better. Excluding the Dmax of the brainstem, right optic nerve and optic chiasm, the mean value of all other OARs was less than 1 Gy. For the brainstem, GK and ZAP-X had better protection, especially at the maximum dose. CONCLUSION For the SRS treating single brain metastasis, all three treatment devices, ZAP-X system, CyberKnife G4 system, and GammaKnife system, could meet clinical treatment requirements. The newly platform ZAP-X could provide a high-quality plan equivalent to or even better than CyberKnife and Gamma Knife, with ZAP-X presenting a certain dose advantage, especially with a more conformal dose distribution and better protection for brain tissue. As the ZAP-X systems get continuous improvements and upgrades, they may become a new SRS platform for the treatment of brain metastasis.
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Affiliation(s)
- Jinyuan Wang
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Qingzeng Zheng
- Department of Radiotherapy, Beijing Geriatric Hospital, Beijing, 100095, China
| | - Yanping Wang
- Department of Radiation Oncology, Hebei Yizhou Cancer Hospital, Zhuozhou, 072750, China
| | - Chengcheng Wang
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Shouping Xu
- National Cancer Center, National Clincal Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhongjian Ju
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Jingmin Bai
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Yunmo Liu
- Department of Neurosurgery, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Baolin Qu
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Xiangkun Dai
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
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Koetsier KS, Oud M, de Klerck E, Hensen EF, van Vulpen M, van Linge A, Paul van Benthem P, Slagter C, Habraken SJ, Hoogeman MS, Méndez Romero A. Cochlear-optimized treatment planning in photon and proton radiosurgery for vestibular schwannoma patients. Clin Transl Radiat Oncol 2023; 43:100689. [PMID: 37867612 PMCID: PMC10585330 DOI: 10.1016/j.ctro.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Objective To investigate the potential to reduce the cochlear dose with robotic photon radiosurgery or intensity-modulated proton therapy planning for vestibular schwannomas. Materials and Methods Clinically delivered photon radiosurgery treatment plans were compared to five cochlear-optimized plans: one photon and four proton plans (total of 120). A 1x12 Gy dose was prescribed. Photon plans were generated with Precision (Cyberknife, Accuray) with no PTV margin for set-up errors. Proton plans were generated using an in-house automated multi-criterial planning system with three or nine-beam arrangements, and applying 0 or 3 mm robustness for set-up errors during plan optimization and evaluation (and 3 % range robustness). The sample size was calculated based on a reduction of cochlear Dmean > 1.5 Gy(RBE) from the clinical plans, and resulted in 24 patients. Results Compared to the clinical photon plans, a reduction of cochlear Dmean > 1.5 Gy(RBE) could be achieved in 11/24 cochlear-optimized photon plans, 4/24 and 6/24 cochlear-optimized proton plans without set-up robustness for three and nine-beam arrangement, respectively, and in 0/24 proton plans with set-up robustness. The cochlea could best be spared in cases with a distance between tumor and cochlea. Using nine proton beams resulted in a reduced dose to most organs at risk. Conclusion Cochlear dose reduction is possible in vestibular schwannoma radiosurgery while maintaining tumor coverage, especially when the tumor is not adjacent to the cochlea. With current set-up robustness, proton therapy is capable of providing lower dose to organs at risk located distant to the tumor, but not for organs adjacent to it. Consequently, photon plans provided better cochlear sparing than proton plans.
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Affiliation(s)
- Kimberley S. Koetsier
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Michelle Oud
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik de Klerck
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | | | - Anne van Linge
- Department of Otorhinolaryngology and Head & Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Paul van Benthem
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, the Netherlands
| | - Cleo Slagter
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Steven J.M. Habraken
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Mischa S. Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - A. Méndez Romero
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
- HollandPTC, Delft, the Netherlands
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Paddick I, Mott J, Bedford J, Filatov P, Grishchuk D, Orchin G, Houston P, Eaton DJ. Benchmarking Tests of Contemporary SRS Platforms: Have Technological Developments Resulted in Improved Treatment Plan Quality? Pract Radiat Oncol 2023; 13:e451-e459. [PMID: 37290672 DOI: 10.1016/j.prro.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Stereotactic radiosurgery treatment delivery can be performed with a range of devices, each of which have evolved over recent years. We sought to evaluate the differences in performance of contemporary stereotactic radiosurgery platforms and also to compare them with earlier platform iterations from a previous benchmarking study. METHODS AND MATERIALS The following platforms were selected as "state of the art" in 2022: Gamma Knife Icon (GK), CyberKnife S7 (CK), Brainlab Elements (Elekta VersaHD and Varian TrueBeam), Varian Edge with HyperArc (HA), and Zap-X. Six benchmarking cases were used from a 2016 study. To reflect the evolution of increasing numbers of metastases treated per patient, a 14-target case was added. The 28 targets among the 7 patients ranged from 0.02 to 7.2 cc in volume. Participating centers were sent images and contours for each patient and asked to plan them to the best of their ability. Although some variation in local practice was allowed (eg, margins), groups were asked to prescribe a specified dose to each target and tolerance doses to organs at risk were agreed upon. Parameters compared included coverage, selectivity, Paddick conformity index, gradient index (GI), R50%, efficiency index, doses to organs at risk, and planning and treatment times. RESULTS Mean coverage for all targets ranged from 98.2% (Brainlab/Elekta) to 99.7% (HA-6X). Paddick conformity index values ranged from 0.722 (Zap-X) to 0.894 (CK). GI ranged from a mean of 3.52 (GK), representing the steepest dose gradient, to 5.08 (HA-10X). The GI appeared to follow a trend with beam energy, with the lowest values from the lower energy platforms (GK, 1.25 MeV; Zap-X, 3 MV) and the highest value from the highest energy (HA-10X). Mean R50% values ranged from 4.48 (GK) to 5.98 (HA-10X). Treatment times were lowest for C-arm linear accelerators. CONCLUSIONS Compared with earlier studies, newer equipment appears to deliver higher quality treatments. CyberKnife and linear accelerator platforms appear to give higher conformity whereas lower energy platforms yield a steeper dose gradient.
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Affiliation(s)
- Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Judith Mott
- Northern Centre for Cancer Care, Department of Radiotherapy Physics, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Petr Filatov
- Department of Medical Physics, GenesisCare, Oxford, United Kingdom
| | - Diana Grishchuk
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gavin Orchin
- Beatson West of Scotland Cancer Centre, Department of Radiotherapy Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - Peter Houston
- Beatson West of Scotland Cancer Centre, Department of Medical Physics, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
| | - David J Eaton
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
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Comparison between the HyperArc™ technique and the CyberKnife® technique for stereotactic treatment of brain metastases. Cancer Radiother 2023; 27:136-144. [PMID: 36797159 DOI: 10.1016/j.canrad.2022.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 02/16/2023]
Abstract
PURPOSE The purpose of this study was to compare the planimetric capacities between HyperArc™-based stereotactic radiosurgery and robotic radiosurgery system-based planning using CyberKnife® M6 for single and multiple cranial metastases. MATERIALS AND METHODS We evaluated 51 treatment plans for cranial metastases, including 30 patients with a single lesion and 21 patients with multiple lesions, treated with the CyberKnife® M6. These treatment plans were optimized using the HyperArc™ (HA) system with the TrueBeam. The comparison of the quality of the treatment plans between the two treatment techniques (CyberKnife and HyperArc) was performed using the Eclipse treatment planning system. Dosimetric parameters were compared for target volumes and organs at risk. RESULTS Coverage of the target volumes was equivalent between the two techniques, whereas median Paddick conformity index and median gradient index for all target volumes were 0.9 and 3.4, respectively for HyperArc plans, and 0.8 and 4.5 for CyberKnife plans (P<0.001). The median dose of gross tumor volume (GTV) for HyperArc and CyberKnife plans were 28.4 and 28.8, respectively. Total brain V18Gy and V12Gy-GTVs were 11cm3 and 20.2cm3 for HyperArc plans versus 18cm3 and 34.1cm3 for CyberKnife plans (P<0.001). CONCLUSION The HyperArc provided better brain sparing, with a significant reduction in V12Gy and V18Gy, associated with a lower gradient index, whereas the CyberKnife gave a higher median GTV dose. The HyperArc technique seems to be more appropriate for multiple cranial metastases and for large single metastatic lesions.
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Mendez C, Gete E. Volume staging for arteriovenous malformation SRS treatment using VMAT. J Appl Clin Med Phys 2022; 23:e13815. [PMID: 36354977 PMCID: PMC9797165 DOI: 10.1002/acm2.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/25/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Volume staging involves dividing the target volume into smaller parts and treating each part separately. In this study, the feasibility of volume-staged stereotactic radiosurgery (VS-SRS) on a linear accelerator using volumetric modulated arc therapy (VMAT) and a frameless patient positioning system is investigated. Ten patients, previously treated with hypofractionated stereotactic radiotherapy with arteriovenous malformation (AVM) sized from 1.6 to 4.0 cm in diameter, were selected. VS-SRS plans were created with the VMAT technique on the Varian Eclipse treatment planning system (TPS) using the TrueBeam STx linear accelerator. For each patient, an AVM-VMAT set was planned with the AVM as the target and a PTV-VMAT set using the (PTV = AVM+1 mm) as the target. All targets were divided into two sub-volumes. The TPS data from the AVM-VMAT plans was compared to Gamma Knife (GK) VS-SRS plan data available in the literature. The AVM-VMAT and PTV-VMAT plans were compared to investigate the effect of a 1 mm PTV margin on normal brain (NB) dose. End-to-end testing was performed using a GaFchromic EBT3 film and point-dose measurements. Dosimetric effects of multiple setups were investigated through film-to-film comparisons. Median target dose coverage, NB V12Gy , and conformity index for the AVM-VMAT plans were 97.5%, 17 cm3 , and 0.8, respectively. PTV-VMAT plans attained comparable target dose coverage, but the average NB V12Gy increased by 48.9% when compared to the AVM-VMAT plans. Agreement of point-dose measurements with TPS calculations was -0.6% when averaged over all patients. Gamma analysis passing rates were above 90% for all film-to-film comparisons (2%/1 mm criteria), and for the film to TPS comparison (5%/1 mm). This work suggests that VMAT is capable of producing VS-SRS plans with similar dose falloff characteristics as GK plans. NB dose depends on PTV margin size, and two-stage treatment setups do not appear to contribute additional uncertainty to treatment delivery.
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Affiliation(s)
- Claudia Mendez
- Department of Physics and AstronomyUniversity of British ColumbiaVancouverBritish ColumbiaCanada,BC Cancer, Abbotsford CenterAbbotsfordBritish ColumbiaCanada
| | - Ermias Gete
- BC Cancer, Vancouver CenterVancouverBritish ColumbiaCanada
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Calvo-Ortega JF, Moragues-Femenía S, Laosa-Bello C, Hermida-López M, Pozo-Massó M, Zamora-Pérez A. Monte Carlo-based independent dose verification of radiosurgery HyperArc plans. Phys Med 2022; 102:19-26. [PMID: 36037748 DOI: 10.1016/j.ejmp.2022.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the feasibility of using the free PRIMO Monte Carlo software for independent dose check of cranial SRS plans designed with the Varian HyperArc (HA) technique. MATERIALS AND METHODS In this study, the PRIMO Monte Carlo software v. 0.3.64.1800 was used with the phase-space files (v. 2, Feb. 27, 2013) provided by Varian for 6 MV flattening-filter-free (FFF) photon beams from a Varian TrueBeam linear accelerator (linac), equipped with a Millennium 120 multileaf collimator (MLC). This configuration was validated by comparing the percentage depth doses (PDDs), lateral profiles and relative output factors (OFs) simulated in a water phantom against measurements for field sizes from 1 × 1 to 40 × 40 cm2. The agreement between simulated and experimental relative dose curves was evaluated using a global (G) gamma index analysis. In addition, the accuracy of PRIMO to model the MLC was investigated (dosimetric leaf gap, tongue and groove, leaf transmission and interleaf leakage). Thirty-five HA SRS plans computed in the Eclipse treatment planning system (TPS) were simulated in PRIMO. The Acuros XB algorithm v. 16.10 (dose to medium) was used in Eclipse. Sixty targets with diameters ranging from 6 to 33 mm were included. Agreement between the dose distributions given by Eclipse and PRIMO was evaluated in terms of 3D global gamma passing rates (GPRs) for the 2 %/2 mm criteria. RESULTS Average GPR greater than 95 % with the 2 %(G)/1 mm criteria were obtained over the PDD and profiles of each field size. Differences between PRIMO calculated and measured OFs were within 0.5 % in all fields, except for the 1 × 1 cm2 with a discrepancy of 1.5 %. Regarding the MLC modeling in PRIMO, an agreement within 3 % was achieved between calculated and experimental doses. Excellent agreement between PRIMO and Eclipse was found for the 35 HA plans. The 3D global GPRs (2 %/2 mm) for the targets and external patient contour were 99.6 % ± 1.1 % and 99.8 % ± 0.5 %, respectively. CONCLUSIONS According to the results described in this study, the PRIMO Monte Carlo software, in conjunction with the 6X FFF Varian phase-space files, can be used as secondary dose calculation software to check stereotactic radiosurgery plans from Eclipse using the HyperArc technique.
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Affiliation(s)
- Juan-Francisco Calvo-Ortega
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain; Servicio de Oncología Radioterápica, Hospital Quirónsalud, Málaga, Spain.
| | | | - Coral Laosa-Bello
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
| | - Marcelino Hermida-López
- Marcelino Hermida-López. Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miguel Pozo-Massó
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
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Kuo CY, Liu WH, Chou YC, Li MH, Tsai JT, Huang DYC, Lin JC. To Optimize Radiotherapeutic Plans for Superior Tumor Coverage Predicts Malignant Glioma Prognosis and Normal Tissue Complication Probability. J Clin Med 2022; 11:jcm11092413. [PMID: 35566538 PMCID: PMC9099532 DOI: 10.3390/jcm11092413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Radiotherapy (RT) provides a modern treatment to enhance the malignant glioma control rate. The purpose of our study was to determine the effect of tumor coverage on disease prognosis and to predict optimal RT plans to achieve a lower normal tissue complication probability (NTCP). Methods: Ten malignant-glioma patients with tumors adjacent to organs at risk (OARs) were collected. The patients were divided into two groups according to adequate coverage or not, and prognosis was analyzed. Then, using intensity-modulated radiation therapy (IMRT), volume-modulated arc therapy (VMAT), and helical tomotherapy (TOMO) to simulate new treatment plans for 10 patients, the advantages of these planning systems were revealed for subsequent prediction of NTCP. Results: The results of clinical analysis indicated that overall survival (p = 0.078) between the adequate and inadequate groups showed no differences, while the adequate group had better recurrence-free survival (p = 0.018) and progression-free survival (p = 0.009). TOMO had better CI (p < 0.001) and also predicted a lower total-irradiated dose to the normal brain (p = 0.001) and a lower NTCP (p = 0.027). Conclusions: The TOMO system provided optimal therapeutic planning, reducing NTCP and achieving better coverage. Combined with the clinical results, our findings suggest that TOMO can make malignant glioma patients close to OARs achieve better disease control.
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Affiliation(s)
- Chun-Yuan Kuo
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (C.-Y.K.); (M.-H.L.); (J.-T.T.)
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Cheng-Kung Road, Taipei 11490, Taiwan;
- Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (C.-Y.K.); (M.-H.L.); (J.-T.T.)
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (C.-Y.K.); (M.-H.L.); (J.-T.T.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - David YC Huang
- Department of Medical Physics, Duke University, Durham, NC 27708, USA;
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (C.-Y.K.); (M.-H.L.); (J.-T.T.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-2-22490088; Fax: +886-2-22484822
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Régis J, Merly L, Balossier A, Baumstarck K, Hamdi H, Mariani S, Delsanti C, Vincent M, Nigoul JM, Beltaifa Y, Muracciole X. Mask-Based versus Frame-Based Gamma Knife ICON Radiosurgery in Brain Metastases: A Prospective Randomized Trial. Stereotact Funct Neurosurg 2021; 100:86-94. [PMID: 34933308 DOI: 10.1159/000519280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiosurgery is performed with a diversity of instruments relying usually either on a stereotactic frame or a mask for patient head fixation. Comfort and safety efficacy of the 2 systems have never been rigorously evaluated and compared. MATERIAL AND METHOD Between February 2016 and January 2017, 58 patients presenting with nonsmall cell lung cancer brain metastases have been treated by Gamma Knife radiosurgery (GKS) with random use of a frame or a mask for fixation were included patients older than 18, with <5 brain metastases (at the exclusion of brainstem and optic pathway's locations) and no earlier history of radiotherapy. The primary outcome measure was the pain scale assessment (PSA) at the beginning of the GKS procedure. RESULTS The PSA at the beginning of the GKS procedure was not different between the 2 groups. The PSA at the day before GKS, before magnetic resonance imaging, just after frame application, and the day after radiosurgery (departure) has shown no difference between the 2 groups. At the end of the radiosurgery itself (just after frame or mask removal) and 1 h after, the mean pain scale was higher in patients treated with the frame (p < 0.05 and p < 0.001, respectively) but 2 patients were not able to tolerate the mask discomfort and had to be treated with frame. Tumor control and morbidity probability were demonstrated to be no difference between the 2 groups in this population of patients with BM not in highly functional area. The median of the extra dose to the body due to the cone-beam computed tomography was 7.5 mGy with a maximum of 35 mGy in patients treated with a mask fixation (null in the others treated with frame). Mask fixation was associated to longer treatment time although the beam on time was not different between the 2 groups. CONCLUSION In selected patients, with brain oligo-metastases out of critical location, single-dose mask-based GKS can be done with a comfort and a safety efficacy comparable to frame-based GKS. There seems to be no clear patient data that confirm the value of the mask system with regards to comfort.
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Affiliation(s)
- Jean Régis
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Louise Merly
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Anne Balossier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Karine Baumstarck
- Department of Biostatistic, Aix Marseille University, Marseille, France
| | - Hussein Hamdi
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Sarah Mariani
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Christine Delsanti
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Marion Vincent
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Jean Marc Nigoul
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Yassin Beltaifa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Xavier Muracciole
- Department of Radiotherapy, Aix Marseille University, Marseille, France
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Hellerbach A, Eichner M, Rueß D, Luyken K, Hoevels M, Judge M, Baues C, Ruge M, Kocher M, Treuer H. Impact of prescription isodose level and collimator selection on dose homogeneity and plan quality in robotic radiosurgery. Strahlenther Onkol 2021; 198:484-496. [PMID: 34888732 PMCID: PMC9038902 DOI: 10.1007/s00066-021-01872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Purpose In stereotactic radiosurgery (SRS), prescription isodoses and resulting dose homogeneities vary widely across different platforms and clinical entities. Our goal was to investigate the physical limitations of generating dose distributions with an intended level of homogeneity in robotic SRS. Methods Treatment plans for non-isocentric irradiation of 4 spherical phantom targets (volume 0.27–7.70 ml) and 4 clinical targets (volume 0.50–5.70 ml) were calculated using Sequential (phantom) or VOLOTM (clinical) optimizers (Accuray, Sunnyvale, CA, USA). Dose conformity, volume of 12 Gy isodose (V12Gy) as a measure for dose gradient, and treatment time were recorded for different prescribed isodose levels (PILs) and collimator settings. In addition, isocentric irradiation of phantom targets was examined, with dose homogeneity modified by using different collimator sizes. Results Dose conformity was generally high (nCI ≤ 1.25) and varied little with PIL. For all targets and collimator sets, V12Gy was highest for PIL ≥ 80% and lowest for PIL ≤ 65%. The impact of PIL on V12Gy was highest for isocentric irradiation and lowest for clinical targets (VOLOTM optimization). The variability of V12Gy as a function of collimator selection was significantly higher than that of PIL. V12Gy and treatment time were negatively correlated. Plans utilizing a single collimator with a diameter in the range of 70–80% of the target diameter were fastest, but showed the strongest dependence on PIL. Conclusion Inhomogeneous dose distributions with PIL ≤ 70% can be used to minimize dose to normal tissue. PIL ≥ 90% is associated with a marked and significant increase in off-target dose exposure. Careful selection of collimators during planning is even more important. Supplementary Information The online version of this article (10.1007/s00066-021-01872-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexandra Hellerbach
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Markus Eichner
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Daniel Rueß
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Klaus Luyken
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Michael Judge
- Faculty of Medicine and University Hospital Cologne, Institute of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Christian Baues
- Faculty of Medicine and University Hospital Cologne, Institute of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Martin Kocher
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Harald Treuer
- Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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10
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Menon SV, P R, Bhasi S, Gopalakrishnan Z, B S, K S, Nair RK. Dosimetric comparison and validation of Eclipse Anisotropic Analytical Algorithm (AAA) and AcurosXB (AXB) algorithms in RapidArc-based radiosurgery plans of patients with solitary brain metastasis. Med Dosim 2021; 47:e7-e12. [PMID: 34740518 DOI: 10.1016/j.meddos.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/02/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Stereotactic radiosurgery (SRS) is increasingly being used to manage solitary or multiple brain metastasis. This study aims to compare and validate Anisotropic Analytical Algorithm (AAA) and AcurosXB (AXB) algorithms of Eclipse Treatment Planning System (TPS) in RapidArc-based SRS plans of patients with solitary brain metastasis. Twenty patients with solitary brain metastasis who have been already treated with RapidArc SRS plans calculated using AAA plans were selected for this study. These plans were recalculated using AXB algorithm keeping the same arc orientations, multi-leaf collimator apertures, and monitor units. The two algorithms were compared for target coverage parameters, isodose volumes, plan quality metrics, dose to organs at risk and integral dose. The dose calculated by the TPS using AAA and AXB algorithms was validated against measured dose for all patient plans using an in-house developed cylindrical phantom. An Exradin A14SL ionization chamber was positioned at the center of this phantom to measure the in-field dose. NanoDot Optically Stimulated Luminescent Dosimeters (OSLDs) (Landauer Inc.) were placed at distances 3.0 cm, 4.0 cm, 5.0 cm, and 6.0 cm respectively from the center of the phantom to measure the non-target dose. In addition, the planar dose distribution was measured using amorphous silicon aS1000 Electronic Portal Imaging Device. The measured 2D dose distribution was compared against AAA and AXB estimated 2D distribution using gamma analysis. All results were tested for significance using the paired t-test at 5% level of significance. Significant differences between the AAA and AXB plans were found only for a few parameters analyzed in this study. In the experimental verification using cylindrical phantom, the difference between the AAA calculated dose and the measured dose was found to be highly significant (p < 0.001). However, the difference between the AXB calculated dose and the measured dose was not significant (p = 0.197). The difference between AAA/AXB calculated and measured at non-target locations was statistically insignificant at all four non-target locations and the dose calculated by both AAA and AXB algorithms shows a strong positive correlation with the measured dose. The results of the gamma analysis show that the AXB calculated planar dose is in better agreement with measurements compared to the AAA. Even though the results of the dosimetric comparison show that the differences are mostly not significant, the measurements show that there are differences between the two algorithms within the target volume. The AXB algorithm may be therefore more accurate in the dose calculation of VMAT plans for the treatment of small intracranial targets. For non-target locations either algorithm can be used for the estimation of dose accounting for their limitations in non-target dose estimations.
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Affiliation(s)
- Sharika Venugopal Menon
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India; Centre for Research and Evaluation, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - Raghukumar P
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.
| | - Saju Bhasi
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Zhenia Gopalakrishnan
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Sarin B
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Shilpa K
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Raghuram K Nair
- SUT Royal Hospital, Ulloor, Thiruvananthapuram, Kerala, India
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11
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Ho HW, Yang CC, Lin HM, Chen HY, Huang CC, Wang SC, Lin YW. The new SRS/FSRT technique HyperArc for benign brain lesions: a dosimetric analysis. Sci Rep 2021; 11:21029. [PMID: 34702859 PMCID: PMC8548509 DOI: 10.1038/s41598-021-00381-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
To evaluate the potential benefit of HyperArc (HA) fractionated stereotactic radiotherapy (FSRT) for the benign brain lesion. Sixteen patients with a single deep-seated, centrally located benign brain lesion treated by CyberKnife (CK, G4 cone-based model) were enrolled. Treatment plans for HA with two different optimization algorithms (SRS NTO and ALDO) and coplanar RapidArc (RA) were generated for each patient to meet the corresponding treatment plan criteria. These four FSRT treatment plans were divided into two groups—the homogeneous delivery group (HA-SRS NTO and coplanar RA) and the inhomogeneous delivery group (HA-ALDO and cone-based CK)—to compare for dosimetric outcomes. For homogeneous delivery, the brain V5, V12, and V24 and the mean brainstem dose were significantly lower with the HA-SRS NTO plans than with the coplanar RA plans. The conformity index, high and intermediate dose spillage, and gradient radius were significantly better with the HA-SRS NTO plans than with the coplanar RA plans. For inhomogeneous delivery, the HA-ALDO exhibited superior PTV coverage levels to the cone-based CK plans. Almost all the doses delivered to organs at risk and dose distribution metrics were significantly better with the HA-ALDO plans than with the cone-based CK plans. Good dosimetric distribution makes HA an attractive FSRT technique for the treatment of benign brain lesions.
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Affiliation(s)
- Hsiu-Wen Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsiu-Man Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsiao-Yun Chen
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chun-Chiao Huang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Chang Wang
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Wei Lin
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan.
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12
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Biltekin F, Yazici G. Dosimetric comparison and secondary malignancy risk estimation for linac-based and robotic stereotactic radiotherapy in uveal melanoma. Med Dosim 2021; 46:364-369. [PMID: 34011456 DOI: 10.1016/j.meddos.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/24/2022]
Abstract
It was aimed to investigate the dosimetric differences among linac-based and robotic stereotactic radiotherapy (SRT) techniques for the treatment of uveal melanoma and to evaluate secondary malignancy risks for these different SRT techniques. Ten patients who received robotic SRT with CyberKnife were retrospectively included in this study. A total dose of 54 Gy in three fractions was prescribed to the planning target volume (PTV). For each patient, non-coplanar micro-multileaf collimator based dynamic conformal arc (DCA), intensity-modulated radiotherapy (IMRT) and circular cone based DCA (cDCA) plans were generated. During the analysis dose-volume histogram (DVH) parameters, homogeneity index, new conformity index, the volume received more than or equal to 30% and 50% of the prescribed dose were compared. Additionally, secondary malignancy risk for each technique was estimated using the risk factors recommended by The International Commission on Radiological Protection. Robotic SRT plans provided a high degree of conformity within the PTV and better normal tissue sparing compared to linac-based treatment plans. However, dose distribution was more heterogeneous in robotic SRT plans than that in linac-based techniques. Estimated secondary malignancy risk was also found as 3.4%, 1.4%, 1.4% and 1.6% for robotic SRT and linac-based IMRT, DCA, cDCA plans, respectively. Treatment parameters of uveal melanoma patients planned with robotic SRT had superior conformity and organ-at-risk (OAR) sparing compared with those planned with the linac-based system. However, estimated secondary malignancy risk was almost two-times higher in robotic SRT than that in linac-based techniques.
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Affiliation(s)
- Fatih Biltekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Gozde Yazici
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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13
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Hermida-López M, Sánchez-Artuñedo D, Rodríguez M, Brualla L. Monte Carlo simulation of conical collimators for stereotactic radiosurgery with a 6 MV flattening-filter-free photon beam. Med Phys 2021; 48:3160-3171. [PMID: 33715167 DOI: 10.1002/mp.14837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Conical collimators, or cones, are tertiary collimators that attach to a radiotherapy linac and are suited for the stereotactic radiosurgery treatment of small brain lesions. The small diameter of the most used cones makes difficult the acquisition of the dosimetry data needed for the commissioning of treatment planning systems. Although many publications report dosimetric data of conical collimators for stereotactic radiosurgery, most of the works use different setups, which complicates comparisons. In other cases, the cone output factors reported do not take into account the effect of the small cone diameter on the detector response. Finally, few data exist on the dosimetry of cones with flattening-filter-free (FFF) beams from modern linac models. This work aims at obtaining a dosimetric characterization of the conical collimators manufactured by Brainlab AG (Munich, Germany) in a 6 MV FFF beam from a TrueBeam STx linac (Varian Medical Systems). METHODS Percentage depth dose curves, lateral dose profiles and cone output factors were obtained using Monte Carlo simulations for the cones with diameters of 4, 5, 6, 7.5, 8, 10, 12.5, 15, 17.5, 20, 25, and 30 mm. The simulation of the linac head was carried out with the PRIMO Monte Carlo software, and the simulations of the cones and the water phantom were run with the general-purpose Monte Carlo code PENELOPE. The Monte Carlo model was validated by comparing the simulation results with measurements performed for the cones of 4, 5, and 7.5 mm of diameter using a stereotactic field diode, a microDiamond detector and EBT3 radiochromic film. In addition, for those cones, simulations and measurements were done for comparison purposes, by reproducing the experimental setups from the available publications. RESULTS The experimental data acquired for the cones of 4, 5, and 7.5 mm validated the developed Monte Carlo model. The simulations accurately reproduced the experimental depths of maximum dose and the dose ratio at 20- and 10-cm depth (PDD20/10 ). A good agreement was obtained between simulated and experimental lateral dose profiles: The differences in the full-width at half-maximum were smaller than 0.2 mm, and the differences in the penumbra 80%-20% were smaller than 0.25 mm. The difference between the simulated and the average of the experimental output factors for the cones of 4, 5, and 7.5 mm of diameter was 0.0%, 0.0%, and 3.0%, respectively, well within the statistical uncertainty of the simulations (4.4% with coverage factor k = 2). It was also found that the simulated cone output factors agreed within 2% with the average of output factors reported in the literature for a variety of setup conditions, detectors, beam qualities, and cone manufacturers. CONCLUSION A Monte Carlo model of cones for stereotactic radiosurgery has been developed and validated. The cone dosimetry dataset obtained in this work, consisting of percentage depth doses, lateral dose profiles and output factors, is useful to benchmark data acquired for the commissioning of cone-based radiosurgery treatment planning systems.
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Affiliation(s)
- Marcelino Hermida-López
- Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain
| | - David Sánchez-Artuñedo
- Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain
| | - Miguel Rodríguez
- Centro Médico Paitilla, Calle 53 y ave. Balboa, Panama City, Panama.,Instituto de Investigaciones Científicas y de Alta Tecnología, INDICASAT-AIP, City of Knowledge, Building 219, Panama City, Panama
| | - Lorenzo Brualla
- West German Proton Therapy Centre Essen (WPE), Hufelandstr. 55, Essen, 45147, Germany.,West German Cancer Centre (WTZ), Hufelandstr. 55, Essen, 45147, Germany.,Faculty of Medicine, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany
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14
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Srivastava SP, Jani SS, Pinnaduwage DS, Yan X, Rogers L, Barranco FD, Barani IJ, Sorensen S. Treatment planning system and beam data validation for the ZAP-X: A novel self-shielded stereotactic radiosurgery system. Med Phys 2021; 48:2494-2510. [PMID: 33506520 DOI: 10.1002/mp.14740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/04/2020] [Accepted: 01/16/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the treatment planning system (TPS) performance of the ZAP-X stereotactic radiosurgery (SRS) system through nondosimetric, dosimetric, and end-to-end (E2E) tests. METHODS A comprehensive set of TPS commissioning and validation tests was developed using published guidelines. Nondosimetric validation tests included information transfer, computed tomography-magnetic resonance (CT-MR) image registration, structure/contouring, geometry, dose tools, and CT density. Dosimetric validation included comparisons between TPS and water tank/Solid Water measurements for various geometries and beam arrangements and end-to-end (E2E) tests. Patient-specific quality assurance was performed with an ion chamber in the Lucy phantom and with Gafchromic EBT3 film in the CyberKnife head phantom. RadCalc was used for independent verification of monitor units. Additional E2E tests were performed using the RPC Gamma Knife thermoluminescent dosimeter (TLD) phantom, MD Anderson SRS head phantom, and PseudoPatient gel phantom for independent absolute dose verification. RESULTS CT-MR image registrations with known translational and rotational offsets were within tolerance (<0.5 × maximum voxel dimension). Slice thickness and distance accuracy were within 0.1 mm, and volume accuracy was within 0 to 0.11 cm3 . Treatment planning system volume measurement uncertainty was within 0.1 to 0.4 cm3 . Ion chamber point-dose measurements for a single beam in a water phantom agreed to TPS-calculated values within ±4% for collimator diameters 10 to 25 mm, and ±6% for 7.5 mm, for all measured depths (7, 50, 100, 150, and 200 mm). In homogeneous Solid Water, point-dose measurements agreed to within ±4% for cones sizes 7.5 to 25 mm. With 1-cm high/low density inserts, measurements were within ±4.2% for cone sizes 10 to 25 mm. Film-based E2E using 4/5-mm cones resulted in a gamma passing rate (%GP) of 99.8% (2%/1.5 mm). Point-dose measurements in a Lucy phantom with an ion chamber using 36 beams distributed along three noncoplanar arcs agreed to within ±4% for cone sizes 10 to 25 mm. The RPC Gamma Knife TLD phantom yielded passing results with a measured-to-expected TLD dose ratio of 1.02. The MD Anderson SRS head phantom yielded passing results, with 4% TLD agreement and %GP of 95%/93% (5%/3 mm) for coronal/sagittal film planes. The RTsafe gel phantom gave %GP of >95% (5%/2 mm) for all four targets. For our first 58 patients, film-based patient-specific quality assurance has resulted in an average %GP of 98.7% (range, 94-100%) at 2%/2 mm. CONCLUSIONS Core ZAP-X features were found to be functional. On the basis of our results, point-dose and planar measurements were in agreement with TPS calculations using multiple phantoms and setup geometries, validating the ZAP-X TPS beam model for clinical use.
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Affiliation(s)
- Shiv P Srivastava
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Shyam S Jani
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Dilini S Pinnaduwage
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiangsheng Yan
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Leland Rogers
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - F David Barranco
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Igor J Barani
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen Sorensen
- Department of Radiation Oncology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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15
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Spaniol M, Mai S, Zakrzewski T, Ehmann M, Stieler F. Inverse planning in Gamma Knife radiosurgery: A comparative planning study. Phys Med 2021; 82:269-278. [PMID: 33706117 DOI: 10.1016/j.ejmp.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the advantages of inverse planning using a prerelease version of Leksell Gamma Knife® (LGK) Lightning (Elekta AB, Sweden) compared to manual forward planning. METHODS Thirty-eight patients with metastases (MET, n = 15), vestibular schwannomas (VS, n = 11) and meningiomas (MEN, n = 12), treated with LGK Icon™ at our institution, were analyzed retrospectively. For each case, an inverse (inv) and inverse full coverage (fc) treatment plan was generated using LGK Lightning and compared to the clinical plans. Several dosimetry and efficiency characteristics were compared for each indication. The mean, median difference and interquartile range were reported and the significance was assessed with a paired-sample Wilcoxon test (significance level < 0.05). Further, the inter operator variability was analyzed for multiple users. RESULTS Inv and fc treatment plans show improved target coverage (up to 3.6%) for all analyzed paradigms. For inv plans, the selectivity is enhanced (MET: 2.9%; VS: 1.8%; MEN: 1%) and the organ at risk doses are significantly reduced (VS: up to 4.5%; MEN: up to 17.5%). For inv and fc plans, the beam on time (BOT) is shortened (MET: up to 7.9%; benign tumors: 49.5%). The inter operator variability analysis shows similar treatment plan quality with small differences in plan efficiency (difference in BOT: 1-3.3 min). CONCLUSIONS LGK Lightning allows to generate improved LGK treatment plans regarding plan quality with reduced BOT compared to manual forward plans. The inter operator variability showed that multiple users with different experiences can generate similar treatment plan quality using LGK Lightning.
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Affiliation(s)
- Manon Spaniol
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Sabine Mai
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tonja Zakrzewski
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florian Stieler
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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16
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Evaluation of the influence of susceptibility-induced magnetic field distortions on the precision of contouring intracranial organs at risk for stereotactic radiosurgery. Phys Imaging Radiat Oncol 2021; 15:91-97. [PMID: 33458332 PMCID: PMC7807629 DOI: 10.1016/j.phro.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
45 data sets (18 on a 1.5 T MR and 27 on a 3 T MR) were evaluated for susceptibility induced distortions. Maximum distortions of up to 1.7 mm were found for organs at risk in standard diagnostic settings. Median distortions ranged between 0.1 and 0.2 mm for all organs at risk. Active shimming was estimated to reduce distortions by a factor of 2.3 to 2.9. A safety margin of 1 mm would have encompassed 99.8% of the distortions.
Background and purpose Magnetic resonance imaging (MRI) is a crucial factor in optimal treatment planning for stereotactic radiosurgery. To further the awareness of possible errors in MRI, this work aimed to investigate the magnitude of susceptibility induced MRI distortions for intracranial organs at risk (OARs) and test the effectiveness of actively shimming these distortions. Materials and methods Distortion maps for 45 exams of 42 patients (18 on a 1.5 T MRI scanner, 27 on a 3 T MRI scanner) were calculated based on a high-bandwidth double-echo gradient echo sequence. The investigated OARs were brainstem, chiasm, eyes, and optic nerves. The influence of active shimming was investigated by comparing unshimmed 1.5 T data with shimmed 3 T data and comparing the results to a model based prediction. Results The median distortion for the different OARs was found to be between 0.13 and 0.18 mm for 1.5 T and between 0.11 and 0.13 mm for 3 T. The maximum distortion was found to be between 1.3 and 1.7 mm for 1.5 T and between 1.1 and 1.4 mm for 3 T. The variation of values was much higher for 1.5 T than for 3 T across all investigated OARs. Active shimming was found to reduce distortions by a factor of 2.3 to 2.9 compared to the expected values. Conclusions Using a safety margin for OARs of 1 mm would have encompassed 99.8% of the distortions. Since distortions are inversely proportional to the readout bandwidth, they can be further reduced by increasing the bandwidth. Additional error sources like gradient nonlinearities need to be addressed separately.
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17
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Combs SE, Baumert BG, Bendszus M, Bozzao A, Brada M, Fariselli L, Fiorentino A, Ganswindt U, Grosu AL, Lagerwaard FL, Niyazi M, Nyholm T, Paddick I, Weber DC, Belka C, Minniti G. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol 2020; 156:80-94. [PMID: 33309848 DOI: 10.1016/j.radonc.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. MATERIAL AND METHODS A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation. RESULTS All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented. CONCLUSIONS This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Alessandro Bozzao
- Dipartimento NESMOS, Università Sapienza Roma, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Michael Brada
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti, Italy
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Faculty, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany
| | - Frank L Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, The Netherlands
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy.
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18
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Hoegen P, Lang C, Akbaba S, Häring P, Splinter M, Miltner A, Bachmann M, Stahl-Arnsberger C, Brechter T, El Shafie RA, Weykamp F, König L, Debus J, Hörner-Rieber J. Cone-Beam-CT Guided Adaptive Radiotherapy for Locally Advanced Non-small Cell Lung Cancer Enables Quality Assurance and Superior Sparing of Healthy Lung. Front Oncol 2020; 10:564857. [PMID: 33363005 PMCID: PMC7756078 DOI: 10.3389/fonc.2020.564857] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the potential of cone-beam-CT (CB-CT) guided adaptive radiotherapy (ART) for locally advanced non-small cell lung cancer (NSCLC) for sparing of surrounding organs-at-risk (OAR). Materials and Methods In 10 patients with locally advanced NSCLC, daily CB-CT imaging was acquired during radio- (n = 4) or radiochemotherapy (n = 6) for simulation of ART. Patients were treated with conventionally fractionated intensity-modulated radiotherapy (IMRT) with total doses of 60–66 Gy (pPlan) (311 fraction CB-CTs). OAR were segmented on every daily CB-CT and the tumor volumes were modified weekly depending on tumor changes. Doses actually delivered were recalculated on daily images (dPlan), and voxel-wise dose accumulation was performed using a deformable registration algorithm. For simulation of ART, treatment plans were adapted using the new contours and re-optimized weekly (aPlan). Results CB-CT showed continuous tumor regression of 1.1 ± 0.4% per day, leading to a residual gross tumor volume (GTV) of 65.3 ± 13.4% after 6 weeks of radiotherapy (p = 0.005). Corresponding PTVs decreased to 83.7 ± 7.8% (p = 0.005). In the actually delivered plans (dPlan), both conformity (p = 0.005) and homogeneity (p = 0.059) indices were impaired compared to the initial plans (pPlan). This resulted in higher actual lung doses than planned: V20Gy was 34.6 ± 6.8% instead of 32.8 ± 4.9% (p = 0.066), mean lung dose was 19.0 ± 3.1 Gy instead of 17.9 ± 2.5 Gy (p = 0.013). The generalized equivalent uniform dose (gEUD) of the lung was 18.9 ± 3.1 Gy instead of 17.8 ± 2.5 Gy (p = 0.013), leading to an increased lung normal tissue complication probability (NTCP) of 15.2 ± 13.9% instead of 9.6 ± 7.3% (p = 0.017). Weekly plan adaptation enabled decreased lung V20Gy of 31.6 ± 6.2% (−3.0%, p = 0.007), decreased mean lung dose of 17.7 ± 2.9 Gy (−1.3 Gy, p = 0.005), and decreased lung gEUD of 17.6 ± 2.9 Gy (−1.3 Gy, p = 0.005). Thus, resulting lung NTCP was reduced to 10.0 ± 9.5% (−5.2%, p = 0.005). Target volume coverage represented by conformity and homogeneity indices could be improved by weekly plan adaptation (CI: p = 0.007, HI: p = 0.114) and reached levels of the initial plan (CI: p = 0.721, HI: p = 0.333). Conclusion IGRT with CB-CT detects continuous GTV and PTV changes. CB-CT-guided ART for locally advanced NSCLC is feasible and enables superior sparing of healthy lung at high levels of plan conformity.
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Affiliation(s)
- Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Clemens Lang
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Medical Physics in Radiotherapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Radiation Oncology, Mainz University Hospital, Mainz, Germany
| | - Peter Häring
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Medical Physics in Radiotherapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mona Splinter
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,Medical Physics in Radiotherapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annette Miltner
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marion Bachmann
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Thomas Brechter
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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19
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Jacob J, Reyns N, Valéry CA, Feuvret L, Simon JM, Mazeron JJ, Jenny C, Cuttat M, Maingon P, Pasquier D. Radiotherapy of non-tumoral refractory neurological pathologies. Cancer Radiother 2020; 24:523-533. [PMID: 32859467 DOI: 10.1016/j.canrad.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
Intracranial radiotherapy has been improved, primarily because of the development of stereotactic approaches. While intracranial stereotactic body radiotherapy is mainly indicated for treatment of benign or malignant tumors, this procedure is also effective in the management of other neurological pathologies; it is delivered using GammaKnife® and linear accelerators. Thus, brain arteriovenous malformations in patients who are likely to experience permanent neurological sequelae can be managed by single session intracranial stereotactic body radiotherapy, or radiosurgery, in specific situations, with an advantageous benefit/risk ratio. Radiosurgery can be recommended for patients with disabling symptoms, which are poorly controlled by medication, such as trigeminal neuralgia, and tremors, whether they are essential or secondary to Parkinson's disease. This literature review aims at defining the place of intracranial stereotactic body radiotherapy in the management of patients suffering from non-tumoral refractory neurological pathologies. It is clear that the multidisciplinary collaboration of experienced teams from Neurosurgery, Neurology, Neuroradiology, Radiation Oncology and Medical Physics is needed for the procedures using high precision radiotherapy techniques, which deliver high doses to locations near functional brain areas.
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Affiliation(s)
- J Jacob
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - N Reyns
- Centre Hospitalier Régional Universitaire de Lille, Department of Neurosurgery and Neuro-Oncology, Neurosurgery service, 2, avenue Oscar-Lambret, 59000 Lille, France; Lille University, Inserm, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, 1, avenue Oscar-Lambret, 59000 Lille, France
| | - C-A Valéry
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Neurosurgery, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-M Simon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Jenny
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Cuttat
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Medical Physics, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Maingon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles-Foix, Department of Radiation Oncology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Pasquier
- Centre Oscar-Lambret, Academic Department of Radiation Oncology, 3, rue Frédéric-Combemale, 59000 Lille, France; Lille University, Centre de Recherche en Informatique, Signal et Automatique de Lille, CRIStAL UMR 9189, Scientific Campus, bâtiment Esprit, avenue Henri-Poincaré, 59655 Villeneuve-d'Ascq, France
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20
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Cao H, Xiao Z, Zhang Y, Kwong T, Danish SF, Weiner J, Wang X, Yue N, Dai Z, Kuang Y, Bai Y, Nie K. Dosimetric comparisons of different hypofractionated stereotactic radiotherapy techniques in treating intracranial tumors > 3 cm in longest diameter. J Neurosurg 2020; 132:1024-1032. [PMID: 30901747 DOI: 10.3171/2018.12.jns181578] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to compare the dosimetric quality of hypofractionated stereotactic radiosurgery in treating sizeable brain tumors across the following treatment platforms: GammaKnife (GK) Icon, CyberKnife (CK) G4, volumetric modulated arc therapy (VMAT) on the Varian TrueBeam STx, double scattering proton therapy (DSPT) on the Mevion S250, and intensity modulated proton therapy (IMPT) on the Varian ProBeam. METHODS In this retrospective study, stereotactic radiotherapy treatment plans were generated for 10 patients with sizeable brain tumors (> 3 cm in longest diameter) who had been treated with VMAT. Six treatment plans, 20-30 Gy in 5 fractions, were generated for each patient using the same constraints for each of the following radiosurgical methods: 1) GK, 2) CK, 3) coplanar arc VMAT (VMAT-C), 4) noncoplanar arc VMAT (VMAT-NC), 5) DSPT, and 6) IMPT. The coverage; conformity index; gradient index (GI); homogeneity index; mean and maximum point dose of organs at risk; total dose volume (V) in Gy to the normal brain for 2 Gy (V2), 5 Gy (V5), and 12 Gy (V12); and integral dose were compared across all platforms. RESULTS Among the 6 techniques, GK consistently produced a sharper dose falloff despite a greater central target dose. GK gave the lowest GI, with a mean of 2.7 ± 0.1, followed by CK (2.9 ± 0.1), VMAT-NC (3.1 ± 0.3), and VMAT-C (3.5 ± 0.3). The highest mean GIs for the proton beam treatments were 3.8 ± 0.4 for DSPT and 3.9 ± 0.4 for IMPT. The GK consistently targeted the lowest normal brain volume, delivering 5 to 12 Gy when treating relatively smaller- to intermediate-sized lesions (less than 15-20 cm3). Yet, the differences across the 6 modalities relative to GK decreased with the increase of target volume. In particular, the proton treatments delivered the lowest V5 to the normal brain when the target size was over 15-20 cm3 and also produced the lowest integral dose to the normal brain regardless of the target size. CONCLUSIONS This study provides an insightful understanding of dosimetric quality from both photon and proton treatment across the most advanced stereotactic radiotherapy platforms.
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Affiliation(s)
- Hongbin Cao
- 1Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyan Xiao
- 2Proton Therapy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yin Zhang
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Tiffany Kwong
- 4Department of Radiological Science, University of California Irvine, Irvine, California
| | - Shabbar F Danish
- 5Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph Weiner
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Xiao Wang
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ning Yue
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Zhitao Dai
- 6Department of Radiation Oncology, Shanghai Hospital, The Second Military Medical University, Shanghai, China; and
| | - Yu Kuang
- 7Department of Medical Physics, University of Nevada, Las Vegas, Nevada
| | - Yongrui Bai
- 1Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ke Nie
- 3Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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21
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Menon SV, Paramu R, Bhasi S, Gopalakrishnan Z, Bhaskaran S, Nair RK. Dosimetric comparison of iPlan Ⓡ Pencil Beam (PB) and Monte Carlo (MC) algorithms in stereotactic radiosurgery/radiotherapy (SRS/SRT) plans of intracranial arteriovenous malformations. Med Dosim 2020; 45:225-234. [PMID: 32001069 DOI: 10.1016/j.meddos.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/11/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
Stereotactic radiosurgery/radiotherapy (SRS/SRT) is a hypofractionated treatment where accurate dose calculation is of prime importance. The accuracy of the dose calculation depends on the treatment planning algorithm. This study is a retrospective dosimetric comparison of iPlanⓇ Monte Carlo (MC) and Pencil Beam (PB) algorithms in SRS/SRT plans of cranial arteriovenous malformations (AVMs). PB plans of 60 AVM patients who were already treated using 6 MV photons from a linear accelerator were selected and divided into 2 groups. Group-I consists of 30 patients who have undergone embolization procedure with high density OnyxⓇ prior to radiosurgery whereas Group-II had 30 patients who did not have embolization. These plans were recalculated with MC algorithm while keeping parameters like beam orientation, multileaf collimator (MLC) positions, MLC margin, prescription dose, and monitor units constant. Several treatment coverage parameters, isodose volumes, plan quality metrics, dose to organs at risk, and integral dose were used for comparing the 2 algorithms. The isodose distribution generated by the 2 algorithms was also compared with gamma analysis using 1%/1 mm criterion. The difference between the 2 groups as well as the differences in dose calculation by PB and MC algorithms were tested for significance using independent t-test and paired t-test respectively at 5% level of significance. The results of the independent t-test showed that there is no significant difference between the Group-I and Group-II patients for PB as well as MC algorithm due to the presence of high density embolization material. However, results of the paired t-test showed that the differences between the PB and MC algorithms were significant for several parameters analyzed in both groups of patients. The gamma analysis results also showed differences in the dose calculated by the 2 algorithms especially in the low dose regions. The significant differences between the 2 algorithms are probably due to the incorrect representation of the loss of lateral charged particle equilibrium and lateral broadening of small photon beams by PB algorithm. MC algorithms are generally considered not essential for dose calculations for target volumes located in the brain. This study demonstrates PB algorithm may not be sufficiently accurate to predict dose distributions for small fields where there is loss of LCPE. The lateral broadening due to the loss of LCPE as predicted by the MC algorithm could be the main reason for significant differences in the parameters compared. Hence, an accurate MC algorithm if available may prove valuable for intracranial SRS treatment planning of such benign lesions where the long life expectancy of patients makes accurate dosimetry critical.
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Affiliation(s)
- Sharika Venugopal Menon
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India.
| | - Raghukumar Paramu
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Saju Bhasi
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Zhenia Gopalakrishnan
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Sarin Bhaskaran
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Raghuram Kesavan Nair
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
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22
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Tuleasca C, Régis J, Levivier M. Letter: A Retrospective Cohort Study of Longitudinal Audiologic Assessment in Single and Fractionated Stereotactic Radiosurgery for Vestibular Schwannoma. Neurosurgery 2019; 85:E1125-E1126. [PMID: 31511894 DOI: 10.1093/neuros/nyz371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Constantin Tuleasca
- Department of Clinical Neurosciences Neurosurgery Service and Gamma Knife Center Lausanne University Hospital (CHUV) Lausanne, Switzerland.,University of Lausanne (Unil) Faculty of Biology and Medicine (FBM) Lausanne, Switzerland.,Signal Processing Laboratory (LTS 5) Ecole Polytechnique Fédérale de Lausanne (EPFL) Lausanne, Switzerland.,Sorbonne Université Faculté de Médecine Paris, France.,Assistance Publique-Hôpitaux de Paris Hôpitaux Universitaires Paris-Sud Centre Hospitalier Universitaire Bicêtre Service de Neurochirurgie Paris, France
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit Assistance-Publique, Hôpitaux de Marseille Centre Hospitalier Universitaire La Timone Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences Neurosurgery Service and Gamma Knife Center Lausanne University Hospital (CHUV) Lausanne, Switzerland.,University of Lausanne (Unil) Faculty of Biology and Medicine (FBM) Lausanne, Switzerland
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23
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Deora H, Tripathi M. Hearing loss after radiosurgery-blame it on Cochlear dose or the radiation tool! Radiat Oncol 2019; 14:186. [PMID: 31666089 PMCID: PMC6822357 DOI: 10.1186/s13014-019-1390-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/04/2019] [Indexed: 11/10/2022] Open
Abstract
While sudden hearing loss after stereotactic radiosurgery has been demonstrated in some cases a recent article by Linge et al. and have demonstrated the need for further discussion on this topic. We attempt to delineate the fact that the type of dosing regimen or technology used will not affect the hearing or radio-graphical control outcomes and thus should not be a consideration while administering treatment. Also we discuss the role of location of the lesion and vascularity and potential new therapies for this unexpected outcome after radiosurgery.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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24
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Narayanasamy G, Morrill S, Cousins D, Liu J, Deshazer G, Garner W, Galhardo E, Serletis D, Penagaricano J. Radiosurgery for mesial temporal lobe epilepsy following ROSE trial guidelines - A planning comparison between Gamma Knife, Eclipse, and Brainlab. J Appl Clin Med Phys 2019; 20:134-141. [PMID: 31532068 PMCID: PMC6806476 DOI: 10.1002/acm2.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose This 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. Methods Twenty 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. Results The 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). Conclusions Among 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.
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Affiliation(s)
- Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Morrill
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David Cousins
- College Of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua Liu
- College Of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Garron Deshazer
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Wesley Garner
- College Of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Edvaldo Galhardo
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Demitre Serletis
- Section of Neurosurgery, Children's Hospital & Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jose Penagaricano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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25
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Levivier M, Carrillo RE, Charrier R, Martin A, Thiran JP. A real-time optimal inverse planning for Gamma Knife radiosurgery by convex optimization: description of the system and first dosimetry data. J Neurosurg 2019; 129:111-117. [PMID: 30544294 DOI: 10.3171/2018.7.gks181572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors developed a new, real-time interactive inverse planning approach, based on a fully convex framework, to be used for Gamma Knife radiosurgery.METHODSThe convex framework is based on the precomputation of a dictionary composed of the individual dose distributions of all possible shots, considering all their possible locations, sizes, and shapes inside the target volume. The convex problem is solved to determine the plan, i.e., which shots and with which weights, that will actually be used, considering a sparsity constraint on the shots to fulfill the constraints while minimizing the beam-on time. The system is called IntuitivePlan and allows data to be transferred from generated dose plans into the Gamma Knife treatment planning software for further dosimetry evaluation.RESULTSThe system has been very efficiently implemented, and an optimal plan is usually obtained in less than 1 to 2 minutes, depending on the complexity of the problem, on a desktop computer or in only a few minutes on a high-end laptop. Dosimetry data from 5 cases, 2 meningiomas and 3 vestibular schwannomas, were generated with IntuitivePlan. Results of evaluation of the dosimetry characteristics are very satisfactory and adequate in terms of conformity, selectivity, gradient, protection of organs at risk, and treatment time.CONCLUSIONSThe possibility of using optimal, interactive real-time inverse planning in conjunction with the Leksell Gamma Knife opens new perspectives in radiosurgery, especially considering the potential use of the full capabilities of the latest generations of the Leksell Gamma Knife. This approach gives new users the possibility of using the system for easier and quicker access to good-quality plans with a shorter technical training period and opens avenues for new planning strategies for expert users. The use of a convex optimization approach allows an optimal plan to be provided in a very short processing time. This way, innovative graphical user interfaces can be developed, allowing the user to interact directly with the planning system to graphically define the desired dose map and to modify on-the-fly the dose map by moving, in a very user-friendly manner, the isodose surfaces of an initial plan. Further independent quantitative prospective evaluation comparing inverse planned and forward planned cases is warranted to validate this novel and promising treatment planning approach.
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Affiliation(s)
- Marc Levivier
- 1Department of Neurosurgery and Gamma Knife Center, Lausanne University Hospital, Lausanne
| | - Rafael E Carrillo
- 2Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL).,3CSEM SA, Neuchâtel; and
| | - Rémi Charrier
- 4Intuitive Therapeutics SA, Saint-Sulpice, Switzerland
| | - André Martin
- 4Intuitive Therapeutics SA, Saint-Sulpice, Switzerland
| | - Jean-Philippe Thiran
- 2Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL)
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Pasquier D, Lacornerie T, Mirabel X, Brassart C, Vanquin L, Lartigau E. [Stereotactic body radiotherapy. How to better protect normal tissues?]. Cancer Radiother 2019; 23:630-635. [PMID: 31447339 DOI: 10.1016/j.canrad.2019.07.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022]
Abstract
The use of stereotactic body radiotherapy (SBRT) has increased rapidly over the past decade. Optimal preservation of normal tissues is a major issue because of their high sensitivity to high doses per session. Extreme hypofractionation can convert random errors into systematic errors. Optimal preservation of organs at risk requires first of all a rigorous implementation of this technique according to published guidelines. The robustness of the imaging modalities used for planning, and training medical and paramedical staff are an integral part of these guidelines too. The choice of SBRT indications, dose fractionation, dose heterogeneity, ballistics, are also means of optimizing the protection of normal tissues. Non-coplanarity and tracking of moving targets allow dosimetric improvement in some clinical settings. Automatic planning could also improve normal tissue protection. Adaptive SBRT, with new image guided radiotherapy modalities such as MRI, could further reduce the risk of toxicity.
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Affiliation(s)
- D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - C Brassart
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - L Vanquin
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - E Lartigau
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France
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Ueda Y, Ohira S, Yamazaki H, Mabuchi N, Higashinaka N, Miyazaki M, Teshima T. Dosimetric performance of two linear accelerator-based radiosurgery systems to treat single and multiplebrain metastases. Br J Radiol 2019; 92:20190004. [PMID: 31188018 DOI: 10.1259/bjr.20190004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate and compare the dosimetric plan quality for noncoplanar volumetric arc therapy of single and multiple brain metastases using the linear accelerator-based radiosurgery system HyperArc and a robotic radiosurgery system. METHODS 31 tumors from 24 patients were treated by stereotactic radiosurgery using the CyberKnife system. CT images, structure sets, and dose files were transferred to the Eclipse treatment planning system for the HyperArc system. Dosimetric parameters for both plans were compared. The beam-on time was calculated from the total monitor unit and dose rate. RESULTS For normal brain tissue, the received volume doses were significantly lower for HyperArc than for CyberKnife_G4 and strongly correlated with the planning target volume (PTV) for cases of single brain metastasis. In addition, the difference in volume dose between CyberKnife_G4 and HyperArc was proportional to the PTV. For multiple brain metastases, no significant difference was observed between the two stereotactic radiosurgery systems, except for high-dose region in the normal tissue. In low dose for brain minus PTV, when the maximum distance among each target was above 8.0 cm, HyperArc delivered higher dose than CyberKnife_G4. The mean ± SDs for the beam-on time were 15.8 ± 5.3 and 5.6 ± 0.8 min for CyberKnife_G4 and HyperArc, respectively (p < .01). CONCLUSION HyperArc is best suited for larger targets in single brain metastasis and for smaller inter tumor tumor distances in multiple brain metastases. ADVANCES IN KNOWLEDGE The performance of HyperArc in comparison with CyberKnife_G4 was depended on defined margin and tumor distances.
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Affiliation(s)
- Yoshihiro Ueda
- 1 Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Ohira
- 1 Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hideya Yamazaki
- 2 Department of Radiation Oncology, Soseikai General Hospital CyberKnife Center, Kyoto, Japan
| | - Nobuhisa Mabuchi
- 2 Department of Radiation Oncology, Soseikai General Hospital CyberKnife Center, Kyoto, Japan
| | - Naokazu Higashinaka
- 2 Department of Radiation Oncology, Soseikai General Hospital CyberKnife Center, Kyoto, Japan
| | - Masayoshi Miyazaki
- 1 Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Teruki Teshima
- 1 Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Rossi L, Méndez Romero A, Milder M, de Klerck E, Breedveld S, Heijmen B. Individualized automated planning for dose bath reduction in robotic radiosurgery for benign tumors. PLoS One 2019; 14:e0210279. [PMID: 30726214 PMCID: PMC6364873 DOI: 10.1371/journal.pone.0210279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/19/2018] [Indexed: 12/05/2022] Open
Abstract
Object To explore the use of automated planning in robotic radiosurgery of benign vestibular schwannoma (VS) tumors for dose reduction outside the planning target volume (PTV) to potentially reduce risk of secondary tumor induction. Methods A system for automated planning (AUTOplans) for VS patients was set up. The goal of AUTO- planning was to reduce the dose bath, including the occurrence of high dose spikes leaking from the PTV into normal tissues, without worsening PTV coverage, OAR doses, or treatment time. For 20 VS patients treated with 1x12 Gy, the AUTOplan was compared with the plan generated with conventional, manual trial-and-error planning (MANplan). Results With equal PTV coverage, AUTOplans showed clinically negligible differences with MANplans in OAR sparing (largest mean difference for all OARs: ΔD2% = 0.2 Gy). AUTOplan dose distributions were more compact: mean/maximum reductions of 23.6/53.8% and 9.6/28.5% in patient volumes receiving more than 1 or 6 Gy, respectively (p<0.001). AUTOplans also showed smaller dose spikes with mean/maximum reductions of 22.8/37.2% and 14.2/40.4% in D2% for shells at 1 and 7 cm distance from the PTV, respectively (p<0.001). Conclusion Automated planning for benign VS tumors highly outperformed manual planning with respect to the dose bath outside the PTV, without deteriorating PTV coverage or OAR sparing, or significantly increasing treatment time.
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Affiliation(s)
- Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- * E-mail:
| | | | - Maaike Milder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Erik de Klerck
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Yoon KJ, Cho B, Kwak JW, Lee D, Kwon DH, Ahn SD, Lee SW, Kim CJ, Roh SW, Cho YH. Cyberknife Dosimetric Planning Using a Dose-Limiting Shell Method for Brain Metastases. J Korean Neurosurg Soc 2018; 61:753-760. [PMID: 30396248 PMCID: PMC6280060 DOI: 10.3340/jkns.2018.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022] Open
Abstract
Objective We investigated the effect of optimization in dose-limiting shell method on the dosimetric quality of CyberKnife (CK) plans in treating brain metastases (BMs).
Methods We selected 19 BMs previously treated using CK between 2014 and 2015. The original CK plans (CKoriginal) had been produced using 1 to 3 dose-limiting shells : one at the prescription isodose level (PIDL) for dose conformity and the others at lowisodose levels (10–30% of prescription dose) for dose spillage. In each case, a modified CK plan (CKmodified) was generated using 5 dose-limiting shells : one at the PIDL, another at intermediate isodose level (50% of prescription dose) for steeper dose fall-off, and the others at low-isodose levels, with an optimized shell-dilation size based on our experience. A Gamma Knife (GK) plan was also produced using the original contour set. Thus, three data sets of dosimetric parameters were generated and compared.
Results There were no differences in the conformity indices among the CKoriginal, CKmodified, and GK plans (mean 1.22, 1.18, and 1.24, respectively; p=0.079) and tumor coverage (mean 99.5%, 99.5%, and 99.4%, respectively; p=0.177), whereas the CKmodified plans produced significantly smaller normal tissue volumes receiving 50% of prescription dose than those produced by the CKoriginal plans (p<0.001), with no statistical differences in those volumes compared with GK plans (p=0.345).
Conclusion These results indicate that significantly steeper dose fall-off is able to be achieved in the CK system by optimizing the shell function while maintaining high conformity of dose to tumor.
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Affiliation(s)
- Kyoung Jun Yoon
- Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Won Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Doheui Lee
- Radiosurgery Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kwon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Eaton DJ, Lee J, Patel R, Millin AE, Paddick I, Walker C. Stereotactic radiosurgery for benign brain tumors: Results of multicenter benchmark planning studies. Pract Radiat Oncol 2018; 8:e295-e304. [PMID: 29884596 DOI: 10.1016/j.prro.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/30/2018] [Accepted: 02/13/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) is strongly indicated for treatment of surgically inaccessible benign brain tumors. Various treatment platforms are available, but few comparisons have included multiple centers. As part of a national commissioning program, benchmark planning cases were completed by all clinical centers in the region. METHODS AND MATERIALS Four benign cases were provided, with images and structures predelineated, including intracanalicular vestibular schwannoma (VS), larger VS, skull base meningioma, and secreting pituitary adenoma. Centers were asked to follow their local practice, and plans were reviewed centrally using metrics for target coverage, selectivity, gradient falloff, and normal tissue sparing. RESULTS Sixty-eight plans were submitted using 18 different treatment platforms. Fourteen plans were subsequently revised following feedback, and review of 5 plans led to a restriction of service on 2 platforms (2 centers). Prescription doses were consistent for VS and meningioma submissions, but a wide range of doses were used for the pituitary case. All centers prioritized coverage, with the prescription isodose covering ≥95% of 78/82 target volumes. Lower values may be expected next to air cavities when using advanced algorithms, and in general may be acceptable for some benign lesions. Selectivity was much more variable, and in some cases this was combined with high gradient index and/or >1 mm margin, resulting in large volumes of normal tissue being irradiated. Normal tissue doses were more variable across linear accelerator (LINAC)-based plans than with Gamma Knife or CyberKnife, and dose spillage seemed independent of prescription isodose (inhomogeneity). This may reflect the variety of LINAC-based approaches represented or the necessary tradeoff between different objectives. CONCLUSIONS These benchmarking exercises have highlighted areas of different clinical practice and priorities and potential for improvement. The subsequent sharing of plan data and margin philosophies between the neurosurgery and oncology communities allowed for meaningful comparison between centers and their peers.
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Affiliation(s)
- David J Eaton
- National Radiotherapy Trials Quality Assurance group, Mount Vernon Hospital, Northwood, United Kingdom.
| | - Jonathan Lee
- National Radiotherapy Trials Quality Assurance group, Mount Vernon Hospital, Northwood, United Kingdom
| | - Rushil Patel
- National Radiotherapy Trials Quality Assurance group, Mount Vernon Hospital, Northwood, United Kingdom
| | | | - Ian Paddick
- Medical Physics Ltd, Reading, United Kingdom; Cromwell Hospital, London, United Kingdom
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Hsu SM, Lai YC, Jeng CC, Tseng CY. Dosimetric comparison of different treatment modalities for stereotactic radiotherapy. Radiat Oncol 2017; 12:155. [PMID: 28915893 PMCID: PMC5602945 DOI: 10.1186/s13014-017-0890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background The modalities for performing stereotactic radiotherapy (SRT) on the brain include the cone-based linear accelerator (linac), the flattening filter-free (FFF) volumetric modulated arc therapy (VMAT) linac, and tomotherapy. In this study, the cone-based linac, FFF-VMAT linac, and tomotherapy modalities were evaluated by measuring the differences in doses delivered during brain SRT and experimentally assessing the accuracy of the output radiation doses through clinical measurements. Methods We employed a homemade acrylic dosimetry phantom representing the head, within which a thermoluminescent dosimeter (TLD) and radiochromic EBT3 film were installed. Using the conformity/gradient index (CGI) and Paddick methods, the quality of the doses delivered by the various SRT modalities was evaluated. The quality indicators included the uniformity, conformity, and gradient indices. TLDs and EBT3 films were used to experimentally assess the accuracy of the SRT dose output. Results The dose homogeneity indices of all the treatment modalities were lower than 1.25. The cone-based linac had the best conformity for all tumors, regardless of the tumor location and size, followed by the FFF-VMAT linac; tomography was the worst-performing treatment modality in this regard. The cone-based linac had the best gradient, regardless of the tumor location and size, whereas the FFF-VMAT linac had a better gradient than tomotherapy for a large tumor diameter (28 mm). The TLD and EBT3 measurements of the dose at the center of tumors indicated that the average difference between the measurements and the calculated dose was generally less than 4%. When the 3% 3-mm gamma passing rate metric was used, the average passing rates of all three treatment modalities exceeded 98%. Conclusions Regarding the dose, the cone-based linac had the best conformity and steepest dose gradient for tumors of different sizes and distances from the brainstem. The results of this study suggest that SRT should be performed using the cone-based linac on tumors that require treatment plans with a steep dose gradient, even as the tumor is slightly irregular, we should also consider using a high dose gradient of the cone base to treat and protect the normal tissue. If normal tissues require special protection exist at positions that are superior or inferior to the tumor, we can consider using tomotherapy or Cone base with couch at 0° for treatment.
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Affiliation(s)
- Shih-Ming Hsu
- Medical Physics and Radiation Measurements Laboratory, National Yang-Ming University, Taipei, Taiwan, ROC. .,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Beitou District, Taipei, 112, Taiwan, ROC. .,Biophotonics and Molecular Imaging Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Yuan-Chun Lai
- Medical Physics and Radiation Measurements Laboratory, National Yang-Ming University, Taipei, Taiwan, ROC.,Department of Physics, National Chung Hsing University, Taichung, Taiwan, ROC.,Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Chien-Chung Jeng
- Department of Physics, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Chia-Ying Tseng
- Medical Physics and Radiation Measurements Laboratory, National Yang-Ming University, Taipei, Taiwan, ROC.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Beitou District, Taipei, 112, Taiwan, ROC
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Ding C, Hrycushko B, Whitworth L, Li X, Nedzi L, Weprin B, Abdulrahman R, Welch B, Jiang SB, Wardak Z, Timmerman RD. Multistage stereotactic radiosurgery for large cerebral arteriovenous malformations using the Gamma Knife platform. Med Phys 2017; 44:5010-5019. [PMID: 28681423 DOI: 10.1002/mp.12455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Radiosurgery is an established technique to treat cerebral arteriovenous malformations (AVMs). Obliteration of larger AVMs (> 10-15 cm3 or diameter > 3 cm) in a single session is challenging with current radiosurgery platforms due to toxicity. We present a novel technique of multistage stereotactic radiosurgery (SRS) for large intracranial arteriovenous malformations (AVM) using the Gamma Knife system. MATERIALS/METHODS Eighteen patients with large (> 10-15 cm3 or diameter > 3 cm) AVMs, which were previously treated using a staged SRS technique on the Cyberknife platform, were retrospectively selected for this study. The AVMs were contoured and divided into 3-8 subtargets to be treated sequentially in a staged approach at half to 4 week intervals. The prescription dose ranged from 15 Gy to 20 Gy, depending on the subtarget number, volume, and location. Gamma Knife plans using multiple collimator settings were generated and optimized. The coordinates of each shot from the initial plan covering the total AVM target were extracted based on their relative positions within the frame system. The shots were regrouped based on their location with respect to the subtarget contours to generate subplans for each stage. The delivery time of each shot for a subtarget was decay corrected with 60 Co for staging the treatment course to generate the same dose distribution as that planned for the total AVM target. Conformality indices and dose-volume analysis were performed to evaluate treatment plans. RESULTS With the shot redistribution technique, the composite dose for the multistaged treatment of multiple subtargets is equivalent to the initial plan for total AVM target. Gamma Knife plans resulted in an average PTV coverage of 96.3 ± 0.9% and a PITV of 1.23 ± 0.1. The resulting Conformality indices, V12Gy and R50 dose spillage values were 0.76 ± 0.05, 3.4 ± 1.8, and 3.1 ± 0.5 respectively. CONCLUSION The Gamma Knife system can deliver a multistaged conformal dose to treat large AVMs when correcting for translational setup errors of each shot at each staged treatment.
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Affiliation(s)
- Chuxiong Ding
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian Hrycushko
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Louis Whitworth
- Neurological Surgery Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiang Li
- Medical Physics Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucien Nedzi
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bradley Weprin
- Neurological Surgery Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ramzi Abdulrahman
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Babu Welch
- Neurological Surgery Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steve B Jiang
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zabi Wardak
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert D Timmerman
- Radiation Oncology Department, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Burger H, Mac Gregor H, Balchin R, Parkes JD. Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2017. [DOI: 10.4102/sajo.v1i0.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<strong>Purpose:</strong> Treatment options for acoustic neuromas (ANs) are limited in low- and middle-income countries. The aim of this study was to investigate whether hypofractionated image-guided radiotherapy (IGRT) is a clinically acceptable treatment option for departments where no other radiosurgery options are available.<br /><strong>Methods and materials:</strong> Fifteen dynamic conformal arc plans that had been clinically utilised were evaluated against the Radiation Therapy Oncology Group (RTOG) radiosurgery criteria and published indices. Analysis involved evaluating critical structure doses and the volume of normal tissue receiving 12 and 10 Gy single fraction equivalent dose (V12<sub><span style="font-size: small;">Eq</span></sub> and V10<sub><span style="font-size: small;">Eq</span></sub>).<br /><strong>Results:</strong> Overall, there was only one RTOG protocol deviation in the whole patient group, where quality of coverage was compromised in order to achieve brainstem tolerance. Conformity indices were within clinically acceptable limits (CI<sub><span style="font-size: small;">Paddick</span></sub> ≥ 0.6) despite being inferior to the published Universitair Ziekenhuis Brussel (UZB) Gamma Knife and CyberKnife results (<em>p</em> < 0.0001). Homogeneity was superior to the Gamma Knife (<em>p</em> < 0.0001) and Novalis dynamic conformal arc (<em>p</em> = 0.0002) results. Gradient index results were inferior to all published techniques, but doses to the normal structures were well controlled with the exception of the cochlea. The V10<sub><span style="font-size: small;">Eq</span></sub> data showed increased sensitivity when compared with V12<sub><span style="font-size: small;">Eq</span></sub>.<br /><strong>Conclusion:</strong> Dynamic arc IGRT allows for good coverage of AN lesions, but the dose fall-off is not as steep as that obtained with mainstream radiosurgery systems. Contouring and planning should include detailed critical structures analysis. For normal brain parenchyma analysis, V10<sub><span style="font-size: small;">Eq</span></sub> is a superior risk indicator when compared to V12<sub><span style="font-size: small;">Eq</span></sub> for this technique. Dynamic arc IGRT offers a dosimetrically acceptable treatment alternative for patients without serviceable hearing, in departments where there are no mainstream radiosurgery treatment options available.
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Kuo CY, Tsai YC, Shiau AC, Cheng HW, Yu HW, Su YK, Tsai JT. Evaluation of Clinical Application and Dosimetric Comparison of Treatment Plans of Gamma Knife and CyberKnife in Treating Arteriovenous Malformations. Stereotact Funct Neurosurg 2017; 95:142-148. [PMID: 28486221 DOI: 10.1159/000460259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To analyze and compare the characteristics of dose distributions for Leksell Gamma Knife Perfexion (LGK-PFX) and CyberKnife (CK) in treating arteriovenous malformations (AVMs). SUBJECTS AND METHODS Twenty-four patients with AVMs who received CK radiosurgery at a prescribed dose (PD) of 16-25 Gy in a single fraction were selected. A LGK-PFX treatment plan with the same PD was designed for each patient. Dosimetric values for both systems were compared with respect to the conformity index (CI); selectivity index (SI); gradient index (GI) of 75, 50, and 25% of the PD; heterogeneity index; volume of the brain tissue covered by doses of 10 and 12 Gy; maximum dose delivered to the brainstem; and beam-on time. RESULTS The CIs of LGK-PFX and CK were 0.744 ± 0.075 and 0.759 ± 0.071 (p = 0.385), respectively. The SIs of LGK-PFX and CK were 0.764 ± 0.081 and 0.780 ± 0.076 (p = 0.424), respectively. The GI75%, GI50%, and GI25% values of LGK-PFX and CK were 1.028 ± 0.123 and 2.439 ± 0.338 (p < 0.001), 3.169 ± 0.265 and 4.972 ± 0.852 (p < 0.001), and 8.650 ± 0.914 and 14.261 ± 2.476 (p < 0.001), respectively. Volumes of the brain tissue covered by 10 Gy and 12 Gy for LGK-PFX and CK (p < 0.001) exhibited a significant difference. CONCLUSIONS LGK-PFX and CK exhibited similar dose conformity. LGK-PFX showed superior normal tissue sparing.
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Affiliation(s)
- Chun-Yuan Kuo
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC
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Mahboubi H, Sahyouni R, Moshtaghi O, Tadokoro K, Ghavami Y, Ziai K, Lin HW, Djalilian HR. CyberKnife for Treatment of Vestibular Schwannoma: A Meta-analysis. Otolaryngol Head Neck Surg 2017; 157:7-15. [PMID: 28441508 DOI: 10.1177/0194599817695805] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives (1) Perform a meta-analysis of the available data on the outcomes of CyberKnife radiosurgery for treatment of vestibular schwannomas (VSs) in the published English-language literature and (2) evaluate the collective outcomes of CyberKnife treatment with respect to tumor control and hearing preservation. Data Sources A thorough literature search of published English-language articles was performed in the PubMed, Ovid, and Cochrane databases. Review Methods A database search was conducted with the keywords "CyberKnife" and "vestibular schwannoma" or "acoustic neuroma." A total of 25 papers were found and reviewed. Data were extracted for patient demographics, number of patients with neurofibromatosis type 2, pretreatment hearing status, tumor size, margin dose, and follow-up duration. The primary outcome variables evaluated were tumor control and hearing preservation. Results After careful review of the published articles, 11 papers reported data on outcomes of CyberKnife treatment for VS and were included in the analysis, comprising 800 patients studied during 1998 to 2012. The reported mean tumor volume ranged from 0.02 to 19.8 cm3, and the follow-up duration ranged from 6 to 120 months. Margin dose varied from 14 to 25 Gy. The collective mean tumor control rate was 96.3% (95% CI: 94.0%-98.5%). The collective hearing preservation rate was 79.1% (95% CI: 71.0%-87.3%) in 427 patients with measurable hearing. Conclusion Clinical data on outcomes of CyberKnife radiosurgery for treatment of VSs are sparse and primarily limited to single-institution analyses, with considerable variation in tumor volume and follow-up time. This meta-analysis not only provides an in-depth analysis of available data in the literature but also reviews reported outcomes and complications.
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Affiliation(s)
- Hossein Mahboubi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Ronald Sahyouni
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Omid Moshtaghi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Kent Tadokoro
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Yaser Ghavami
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Kasra Ziai
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Harrison W Lin
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Hamid R Djalilian
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, California, USA
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Clement-Colmou K, Roualdes V, Martin SA, Josset S, Desal H, Campion L, Thillays F. Dynamic conformal arc radiosurgery for arteriovenous malformations: Outcome and influence of clinical and dosimetrical data. Radiother Oncol 2017; 123:251-256. [PMID: 28351522 DOI: 10.1016/j.radonc.2017.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess efficacy, toxicity, and their predictive factors for dynamic conformal arc arteriovenous malformations (AVM) stereotactic radiosurgery. METHOD Data concerning 90 consecutive patients were retrospectively studied. Clinical, radiological, dosimetrical data and quality indexes were computed. RESULTS AVM median volume was 1.06cc. Median prescribed dose was 22Gy. Total occlusion was obtained for 69% of patients. Post-radiosurgery annual hemorrhage rate was 2.2%. Predictive factor for total occlusion was delivered dose. Undesirable events occurred for 28% of patients. Predictive factors for adverse events were AVM revealing mode with seizure or headache, age≤28, AVM diameter≥3cm Spetzler-Martin score≥4, V12Gy≥2cc, large target volume and low homogeneity index (p<0.05). Brain parenchymal radiological reactions concerned 23% of patients, and their predictive factors were AVM revelation by seizure, deep localization, AVM diameter≥3cm, Spetzler-Martin score≥4, previous radiosurgery, numerous embolization, target volume, V12Gy and low homogeneity index (p<0.05). CONCLUSION Occlusion rate and toxicities are comparable to other series. Specific attention must be paid on pre-treatment clinical data, and target volume should be as small as possible, without reducing the delivered dose.
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Affiliation(s)
| | | | | | - Stephanie Josset
- Medical Physics, Integrated Center of Oncology, Saint-Herblain, France.
| | - Hubert Desal
- Neuroradiology, Centre Hospitalier Universitaire, Nantes, France.
| | - Loïc Campion
- Statistics, Integrated Center of Oncology, Saint-Herblain, France.
| | - François Thillays
- Radiation Oncology, Integrated Center of Oncology, Saint-Herblain, France.
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Schmidt MA, Wells EJ, Davison K, Riddell AM, Welsh L, Saran F. Stereotactic radiosurgery planning of vestibular schwannomas: Is MRI at 3 Tesla geometrically accurate? Med Phys 2017; 44:375-381. [PMID: 28019663 PMCID: PMC5965671 DOI: 10.1002/mp.12068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose MRI is a mandatory requirement to accurately plan Stereotactic Radiosurgery (SRS) for Vestibular Schwannomas. However, MRI may be distorted due not only to inhomogeneity of the static magnetic field and gradients but also due to susceptibility‐induced effects, which are more prominent at higher magnetic fields. We assess geometrical distortions around air spaces and consider MRI protocol requirements for SRS planning at 3 T. Methods Hardware‐related distortion and the effect of incorrect shimming were investigated with structured test objects. The magnetic field was mapped over the head on five volunteers to assess susceptibility‐related distortion in the naso‐oro‐pharyngeal cavities (NOPC) and around the internal ear canal (IAC). Results Hardware‐related geometric displacements were found to be less than 0.45 mm within the head volume, after distortion correction. Shimming errors can lead to displacements of up to 4 mm, but errors of this magnitude are unlikely to arise in practice. Susceptibility‐related field inhomogeneity was under 3.4 ppm, 2.8 ppm, and 2.7 ppm for the head, NOPC region and IAC region, respectively. For the SRS planning protocol (890 Hz/pixel, approximately 1 mm3 isotropic), susceptibility‐related displacements were less than 0.5 mm (head), and 0.4 mm (IAC and NOPC). Large displacements are possible in MRI examinations undertaken with lower receiver bandwidth values, commonly used in clinical MRI. Higher receiver bandwidth makes the protocol less vulnerable to sub‐optimal shimming. The shimming volume and the CT‐MR co‐registration must be considered jointly. Conclusion Geometric displacements can be kept under 1 mm in the vicinity of air spaces within the head at 3 T with appropriate setting of the receiver bandwidth, correct shimming and employing distortion correction.
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Affiliation(s)
- M A Schmidt
- The Institute of Cancer Research, CR-UK & EPSRC Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E J Wells
- Medical Physics, Royal Marsden NHS Foundation Trust, London, UK
| | - K Davison
- Radiology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - A M Riddell
- Radiology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - L Welsh
- Neuro-Oncology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - F Saran
- Neuro-Oncology Unit, Royal Marsden NHS Foundation Trust, London, UK
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Alongi F, Fiorentino A, Mancosu P, Navarria P, Giaj Levra N, Mazzola R, Scorsetti M. Stereotactic radiosurgery for intracranial metastases: linac-based and gamma-dedicated unit approach. Expert Rev Anticancer Ther 2016; 16:731-40. [DOI: 10.1080/14737140.2016.1190648] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Filippo Alongi
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Pietro Mancosu
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
| | - Pierina Navarria
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
| | | | - Rosario Mazzola
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Marta Scorsetti
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
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Gevaert T, Steenbeke F, Pellegri L, Engels B, Christian N, Hoornaert MT, Verellen D, Mitine C, De Ridder M. Evaluation of a dedicated brain metastases treatment planning optimization for radiosurgery: a new treatment paradigm? Radiat Oncol 2016; 11:13. [PMID: 26831367 PMCID: PMC4736109 DOI: 10.1186/s13014-016-0593-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/20/2016] [Indexed: 01/06/2023] Open
Abstract
Purpose To 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 Methods Ten 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). Results The 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. Conclusions The 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.
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Affiliation(s)
- Thierry Gevaert
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Femke Steenbeke
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Luca Pellegri
- Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium.
| | - Benedikt Engels
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Nicolas Christian
- Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium.
| | | | - Dirk Verellen
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Carine Mitine
- Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium.
| | - Mark De Ridder
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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Yang J, Ma L, Wang XS, Xu WX, Cong XH, Xu SP, Ju ZJ, Du L, Cai BN, Yang J. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases. Med Dosim 2016; 41:105-12. [PMID: 26831753 DOI: 10.1016/j.meddos.2015.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/28/2015] [Accepted: 10/14/2015] [Indexed: 12/25/2022]
Abstract
To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33Gy in 3 fractions (3F) or 40Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the preferential choice for the body + pedicle-type lesions. This study suggests further clinical investigations with longer follow-up for these studied cases.
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Affiliation(s)
- Jun Yang
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China; Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui, Henan, 453100, China
| | - Lin Ma
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China; Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000, China
| | - Xiao-Shen Wang
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Wei Xu Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Hu Cong
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shou-Ping Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhong-Jian Ju
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lei Du
- Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000, China
| | - Bo-Ning Cai
- Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jack Yang
- Department of Radiation Oncology, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA
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Molinier J, Kerr C, Simeon S, Ailleres N, Charissoux M, Azria D, Fenoglietto P. Comparison of volumetric-modulated arc therapy and dynamic conformal arc treatment planning for cranial stereotactic radiosurgery. J Appl Clin Med Phys 2016; 17:92-101. [PMID: 26894335 PMCID: PMC5690199 DOI: 10.1120/jacmp.v17i1.5677] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/14/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022] Open
Abstract
The aim was to analyze arc therapy techniques according to the number and position of the brain lesions reported by comparing dynamic noncoplanar conformal arcs (DCA), two coplanar full arcs (RAC) with volumetric-modulated arc therapy (VMAT), multiple noncoplanar partial arcs with VMAT (RANC), and two full arcs with VMAT and 10° table rotation (RAT). Patients with a single lesion (n= 10), multiple lesions (n = 10) or a single lesion close to organs at risk (n = 5) and previously treated with DCA were selected. For each patient, the DCA treatment was replanned with all VMAT techniques. All DCA plans were compared with VMAT plans and evaluated in regard to the different quality indices and dosimetric parameters. For single lesion, homogeneity index (HI) better results were found for the RANC technique (0.17 ± 0.05) compared with DCA procedure (0.27± 0.05). Concerning conformity index (CI), the RAT technique gave higher and better values (0.85 ± 0.04) compared with those obtained with the DCA technique (0.77 ± 0.05). DCA improved healthy brain protection (8.35 ± 5.61 cc vs. 10.52 ± 6.40 cc for RANC) and reduced monitor unit numbers (3046 ± 374 MU vs. 4651 ± 736 for RANC), even if global room occupation was higher. For multiple lesions, VMAT techniques provided better HI (0.16) than DCA (0.24 ± 0.07). The CI was improved with RAT (0.8 ± 0.08 for RAT vs. 0.71 ± 0.08 for DCA). The V10Gy healthy brain was better protected with DCA (9.27 ± 4.57 cc). Regarding the MU numbers: RANC < RAT< RAC < DCA. For a single lesion close to OAR, RAT achieved high degrees of homogeneity (0.27 ± 0.03 vs. 0.53 ± 0.2 for DCA) and conformity (0.72± 0.06vs. 0.56 ± 0.13 for DCA) while sparing organs at risk (Dmax = 12.36 ± 1.05Gyvs. 14.12 ± 0.59 Gy for DCA, and Dmean = 3.96 ± 3.57Gyvs. 4.72 ± 3.28Gy for DCA). On the other hand, MU numbers were lower with DCA (2254 ± 190 MUvs. 3438 ± 457 MU for RANC) even if overall time was inferior with RAC. For a single lesion, DCA provide better plan considering low doses to healthy brain even if quality indexes are better for the others techniques. For multiple lesions, RANC seems to be the best compromise, due to the ability to deliver a good conformity and homogeneity plan while sparing healthy brain tissue. For a single lesion close to organs at risk, RAT is the most appropriate technique.
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Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases. Acta Neurochir (Wien) 2015; 157:2003-9; discussion 2009. [PMID: 26381540 DOI: 10.1007/s00701-015-2585-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In this study, we compared the dosimetric properties between Gamma Knife (GK) and Cyberknife (CK), and investigated the clinical implications in treating brain metastases (BMs). METHODS Between 2011 and 2013, 77 patients treated with either single-fraction GK for small BMs (n = 40) or fractionated CK for large BMs >3 cm (n = 37) were analyzed. Among a total of 160 lesions, 81 were treated with GK (median, 22 Gy) and 38 (large lesions) with three- or five-fraction CK (median, 35 Gy). The median tumor volume was 1.0 cc (IQR, 0.12-4.4 cc) for GK and 17.6 cc (IQR, 12.8-23.7 cc) for fractionated CK. A lesion-to-lesion dosimetric comparison was performed using the identical contour set in both systems. RESULTS The mean dose to tumor was significantly higher in GK by 1.25-fold (P < 0.001), whereas normal tissue volume receiving 90-10 % of prescription dose was significantly larger in CK by 1.26-fold (P < 0.001). Nevertheless, no differences were observed in local tumor control (rates at 1 year, 89.7 % vs 87.0 %; P = 0.594) and overall survival (median, 14 vs 16 months; P = 0.493) between GK and fractionated CK groups. The incidences of radiation necrosis were also not different (12.3 % vs 15.8 %; P = 0.443). CONCLUSIONS Despite slightly inferior dosimetric properties of CK, fractionated CK for large BMs appears to be as effective and safe as single-fraction GK for small BMs, representing fractionation as an effective strategy for enhancing efficacy and moderating toxicity in stereotactic radiosurgery for BMs.
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Treuer H, Hoevels M, Luyken K, Visser-Vandewalle V, Wirths J, Kocher M, Ruge M. Authors' reply to "Dosimetric of intracranial stereotactic radiosurgery: only 'an exercise of style'". Strahlenther Onkol 2015; 191:812-3. [PMID: 26253789 DOI: 10.1007/s00066-015-0881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Harald Treuer
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Moritz Hoevels
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Klaus Luyken
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jochen Wirths
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Radiotherapy, University Hospital Cologne, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Kaul D, Badakhshi H, Gevaert T, Pasemann D, Budach V, Tuleasca C, Gruen A, Prasad V, Levivier M, Kufeld M. Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma. Acta Neurochir (Wien) 2015; 157:559-63; discussion 563-4. [PMID: 25413163 DOI: 10.1007/s00701-014-2272-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/31/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to compare the three most prominent systems for stereotactic radiosurgery in terms of dosimetric characteristics: the Cyberknife system, the Gamma Knife Perfexion and the Novalis system. METHODS Ten patients treated for recurrent grade I meningioma after surgery using the Cyberknife system were identified; the Cyberknife contours were exported and comparative treatment plans were generated for the Novalis system and Gamma Knife Perfexion. Dosimetric values were compared with respect to coverage, conformity index (CI), gradient index (GI) and beam-on time (BOT). RESULTS All three systems showed comparable results in terms of coverage. The Gamma Knife and the Cyberknife system showed significantly higher levels of conformity than the Novalis system (Cyberknife vs Novalis, p = 0.002; Gamma Knife vs Novalis, p = 0.002). The Gamma Knife showed significantly steeper gradients compared with the Novalis and the Cyberknife system (Gamma Knife vs Novalis, p = 0.014; Gamma Knife vs Cyberknife, p = 0.002) and significantly longer beam-on times than the other two systems (BOT = 66 ± 21.3 min, Gamma Knife vs Novalis, p = 0.002; Gamma Knife vs Cyberknife, p = 0.002). CONCLUSIONS The multiple focal entry systems (Gamma Knife and Cyberknife) achieve higher conformity than the Novalis system. The Gamma Knife delivers the steepest dose gradient of all examined systems. However, the Gamma Knife is known to require long beam-on times, and despite worse dose gradients, LINAC-based systems (Novalis and Cyberknife) offer image verification at the time of treatment delivery.
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Affiliation(s)
- David Kaul
- Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Casentini L, Fornezza U, Perini Z, Perissinotto E, Colombo F. Multisession stereotactic radiosurgery for large vestibular schwannomas. J Neurosurg 2015; 122:818-24. [DOI: 10.3171/2014.11.jns131552] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Microsurgery is not the only option for larger vestibular schwannomas (VSs); recent reviews have confirmed the feasibility and efficacy of radiosurgery for larger VSs. This study illustrates the outcomes of a series of large VSs after multisession stereotactic radiosurgery (SRS).
METHODS
A series of 33 VSs larger than 8 cm3 (range 8–24 cm3, mean 11 cm3, median 9.4 cm3) were treated using the CyberKnife from 2003 to 2011 with the multisession SRS technique in 2–5 fractions (14–19.5 Gy). Five patients had undergone surgical removal and 5 had ventriculoperitoneal shunts. Nine patients were eligible for but refused surgery. Twelve patients were older than 70 years and 5 were younger than 40 years. Two female patients had neurofibromatosis.
RESULTS
The follow-up period ranged from 12 to 111 months (median 48 months); radiological growth control was achieved in 94% of cases: 19 tumors (58%) displayed no size variation or reduction in tumor diameter; 12 (36%), after a transient enlargement, presented with arrested growth or shrinkage. Seven patients had a volume reduction of more than 50%. Two patients (6%) needed debulking and 2 were treated with ventriculoperitoneal shunts. Actuarial progressionfree survival rates at 1 year and 5 years were 97% and 83%, respectively. Hearing was retained in 7 of the 8 patients with serviceable baseline hearing. Adverse events were limited to 1 case each of vertigo, tongue paresthesia, and trigeminal neuralgia.
CONCLUSIONS
The good control rate obtained with multisession SRS deepens the controversy of the radiobiology of VSs and may extend the indication of radiation therapy (fractionated or SRS) for large VSs to include patients without symptoms of mass effect. The limited number of cases and short follow-up period do not provide sufficient support for widespread application of multisession SRS in young patients. Further studies with multisession SRS are warranted.
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Affiliation(s)
- Leopoldo Casentini
- 1Center of Stereotactic Radiosurgery, S. Bortolo City Hospital, Vicenza; and
| | - Umberto Fornezza
- 1Center of Stereotactic Radiosurgery, S. Bortolo City Hospital, Vicenza; and
| | - Zeno Perini
- 1Center of Stereotactic Radiosurgery, S. Bortolo City Hospital, Vicenza; and
| | - Egle Perissinotto
- 2Department of Cardiac, Thoracic, and Vascular Sciences, Padua University, Padova, Italy
| | - Federico Colombo
- 1Center of Stereotactic Radiosurgery, S. Bortolo City Hospital, Vicenza; and
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Mindermann T. Gamma Knife, CyberKnife or micro-multileaf collimator LINAC for intracranial radiosurgery? Acta Neurochir (Wien) 2015; 157:557-8. [PMID: 25413164 DOI: 10.1007/s00701-014-2275-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
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Safain MG, Rahal JP, Raval A, Rivard MJ, Mignano JE, Wu JK, Malek AM. Use of cone-beam computed tomography angiography in planning for gamma knife radiosurgery for arteriovenous malformations: a case series and early report. Neurosurgery 2015; 74:682-95; discussion 695-6. [PMID: 24584136 DOI: 10.1227/neu.0000000000000331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effectiveness of Gamma Knife radiosurgery (GKR) for cerebral arteriovenous malformations (AVMs) is predicated on inclusion of the entire nidus while excluding normal tissue. As such, GKR may be limited by the resolution and accuracy of the imaging modality used in targeting. OBJECTIVE We present the first case series to demonstrate the feasibility of using ultrahigh-resolution C-arm cone-beam computed tomography angiography (CBCT-A) in AVM targeting. METHODS From June 2009 to June 2013, CBCT-A was used for targeting of all patients with AVMs treated with GKR at our institution. Patients underwent Leksell stereotactic head frame placement followed by catheter-based biplane 2-dimensional digital subtraction angiography, 3-dimensional rotational angiography, as well as CBCT-A. The CBCT-A dataset was used for stereotactic planning for GKR. Patients were followed at 1, 3, 6, and 12 months and then annually thereafter. RESULTS CBCT-A-based targeting was used in 22 consecutive patients. CBCT-A provided detailed spatial resolution and sensitivity of nidal angioarchitecture enabling treatment. The average radiation dose to the margin of the AVM nidus corresponding to the 50% isodose line was 15.6 Gy. No patient had treatment-associated hemorrhage. At early follow-up (mean, 16 months), 84% of patients had a decreasing or obliterated AVM nidus. CONCLUSION CBCT-A-guided radiosurgery is feasible and useful because it provides sufficient detailed resolution and sensitivity for imaging brain AVMs.
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Affiliation(s)
- Mina G Safain
- *Cerebrovascular and Endovascular Division, Department of Neurosurgery, ‡Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts; §Boston Gamma Knife Center, Boston, Massachusetts
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Correction of measured Gamma-Knife output factors for angular dependence of diode detectors and PinPoint ionization chamber. Phys Med 2014; 30:914-9. [DOI: 10.1016/j.ejmp.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 11/18/2022] Open
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Torrens M, Chung C, Chung HT, Hanssens P, Jaffray D, Kemeny A, Larson D, Levivier M, Lindquist C, Lippitz B, Novotny J, Paddick I, Prasad D, Yu CP. Standardization of terminology in stereotactic radiosurgery: Report from the Standardization Committee of the International Leksell Gamma Knife Society. J Neurosurg 2014; 121 Suppl:2-15. [DOI: 10.3171/2014.7.gks141199] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectThis report has been prepared to ensure more uniform reporting of Gamma Knife radiosurgery treatment parameters by identifying areas of controversy, confusion, or imprecision in terminology and recommending standards.MethodsSeveral working group discussions supplemented by clarification via email allowed the elaboration of a series of provisional recommendations. These were also discussed in open session at the 16th International Leksell Gamma Knife Society Meeting in Sydney, Australia, in March 2012 and approved subject to certain revisions and the performance of an Internet vote for approval from the whole Society. This ballot was undertaken in September 2012.ResultsThe recommendations in relation to volumes are that Gross Target Volume (GTV) should replace Target Volume (TV); Prescription Isodose Volume (PIV) should generally be used; the term Treated Target Volume (TTV) should replace TVPIV, GTV in PIV, and so forth; and the Volume of Accepted Tolerance Dose (VATD) should be used in place of irradiated volume. For dose prescription and measurement, the prescription dose should be supplemented by the Absorbed Dose, or DV% (for example, D95%), the maximum and minimum dose should be related to a specific tissue volume (for example, D2% or preferably D1 mm3), and the median dose (D50%) should be recorded routinely. The Integral Dose becomes the Total Absorbed Energy (TAE). In the assessment of planning quality, the use of the Target Coverage Ratio (TTV/ GTV), Paddick Conformity Index (PCI = TTV2/[GTV · PIV]), New Conformity Index (NCI = [GTV · PIV]/TTV2), Selectivity Index (TTV/PIV), Homogeneity Index (HI = [D2% –D98%]/D50%), and Gradient Index (GI = PIV0.5/PIV) are reemphasized. In relation to the dose to Organs at Risk (OARs), the emphasis is on dose volume recording of the VATD or the dose/volume limit (for example, V10) in most cases, with the additional use of a Maximum Dose to a small volume (such as 1 mm3) and/or a Point Dose and Mean Point Dose in certain circumstances, particularly when referring to serial organs. The recommendations were accepted by the International Leksell Gamma Knife Society by a vote of 92% to 8%.ConclusionsAn agreed-upon and uniform terminology and subsequent standardization of certain methods and procedures will advance the clinical science of stereotactic radiosurgery.
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Affiliation(s)
- Michael Torrens
- 1Department of Neurosurgery, Hygeia Hospital, Athens, Greece
| | - Caroline Chung
- 2Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Hyun-Tai Chung
- 3Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Patrick Hanssens
- 4Gamma Knife Centre, St. Elizabeth Hospital, Tilburg, The Netherlands
| | - David Jaffray
- 2Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Andras Kemeny
- 5National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - David Larson
- 6Department of Radiation Oncology, University of California, San Francisco, California
| | - Marc Levivier
- 7Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Bodo Lippitz
- 8Gamma Knife Department, Cromwell Hospital, London, United Kingdom
| | - Josef Novotny
- 9Department of Medical Physics, Na Homolce Hospital, Prague, Czech Republic
| | - Ian Paddick
- 8Gamma Knife Department, Cromwell Hospital, London, United Kingdom
| | - Dheerendra Prasad
- 10Departments of Radiation Medicine and Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York; and
| | - Chung Ping Yu
- 11Gamma Knife, Canossa Hospital, Hong Kong, People's Republic of China
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Treuer H, Hoevels M, Luyken K, Visser-Vandewalle V, Wirths J, Kocher M, Ruge M. Intracranial stereotactic radiosurgery with an adapted linear accelerator vs. robotic radiosurgery. Strahlenther Onkol 2014; 191:470-6. [DOI: 10.1007/s00066-014-0786-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
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