Çoklu beyin metastazlarının stereotaktik radyoterapisi için tek izomerkezli dinamik konformal ark tedavi (DCAT) ve volumetrik ayarlı ark tedavi (VMAT) planlama tekniklerinin dozimetrik karşılaştırılması

Nezahat Olacak; Sinan Hoca; Mert Delikaya; Yusuf Ziya Hazeral; Deniz Yalman

doi:10.19161/etd.1615140

EN TR

Dosimetric comparison of single isocenter dynamic conformal arc therapy (DCAT) and volumetric modulated arc therapy (VMAT) planning techniques for stereotactic radiotherapy of multiple brain metastases

Abstract

ABSTRACT Aim: To compare dynamic conformal arc therapy (DCAT) and volumetric modulated arc therapy (VMAT) planning techniques for stereotactic radiotherapy (SRT) in multiple brain metastases. Materials and Methods: The total number of metastases in 10 patients with 2-5 metastases was 33. BrainLab Elements treatment planning system (TPS) for DCAT plans and Eclipse TPS was used for VMAT. A dose of 25-30 Gy in 3-5 fractions was administered to the planning target volumes. In addition to the mean and maximum doses for organs at risk (OAR), doses received by 0.5 and 0.2 cm3 volumes for some organs (D0.5 and D0.2), VxGy volumes of the normal brain (V5Gy V8Gy V10Gy V12Gy V18Gy and V24Gy cm3) and monitor unit (MU) were compared. Results: For plan quality, DCAT was significantly superior to VMAT in conformity index values (p= 0.005), while the difference in gradient index values was not significant (p= 0.359). In OAR, the difference was significant in favor of DCAT only for brainstem Dmed (p= 0.009) and D0.5 (p= 0.047), while similar results were obtained in the others. VMAT plans provided significant advantages over DCAT in terms of normal brain V10Gy V12Gy V18Gy and MU (p= 0.028, p= 0.028, p= 0.047 and p= 0.005, respectively). Conclusion:Clinically acceptable plans were obtained with DCAT and VMAT for patients with up to five brain metastases. The DCAT plan is significantly superior in terms of plan quality and brainstem doses, while the VMAT plan provided significant advantages in terms of better normal brain protection and a shorter irradiation time.

Keywords

Çoklu beyin metastazlarının stereotaktik radyoterapisi için tek izomerkezli dinamik konformal ark tedavi (DCAT) ve volumetrik ayarlı ark tedavi (VMAT) planlama tekniklerinin dozimetrik karşılaştırılması

Öz

Amaç: Çoklu beyin metastazlarında stereotaktik radyoterapi (SRT) için dinamik konformal ark tedavi (DCAT) ile volumetrik (hacimsel) ayarlı ark tedavi (VMAT) planlama tekniklerinin karşılaştırılmasıdır. Gereç ve Yöntem: 2-5 metastazı olan 10 hastanın toplam metastaz sayısı 33 idi. DCAT planlarında BrainLab Elements, VMAT’da Eclipse tedavi planlama sistemleri kullanıldı. Planlanan hedef hacimlere 3-5 fraksiyonda 25-30 Gy doz verildi. Risk altındaki organlar için (OAR) ortalama ve maksimum dozlara ek olarak bazı organlar için de 0,5 ve 0,2 cm3 lük hacimlerin aldığı dozlar (D0,5 ve D0,2), normal beynin VxGy hacimleri (V5Gy V8Gy V10Gy V12Gy V18Gy ve V24Gy cm3) ve monitor unit (MU) karşılaştırıldı. Bulgular: Plan kalitesi için konformite indeks değerlerinde DCAT VMAT’ye göre (p= 0,005) üstünlük sağlarken, gradiyent indeks değerlerinde aradaki fark anlamsızdı (p= 0,359). OAR’de sadece beyin sapı Dort. (p=0,009) ve D0,5 (p=0,047) için fark DCAT lehine anlamlı iken, diğerlerinde benzer sonuçlar elde edildi. Normal beyin V10Gy V12Gy ve V18Gy açısından VMAT planları DCAT’a göre önemli avantaj sağladı (sırasıyla, p= 0,028, p= 0,028, p= 0,047). MU için planlar benzerdi (p=0,059). Sonuç: DCAT ve VMAT ile beşe kadar beyin metastazı olan hastalarda klinik olarak kabul edilebilir planlar elde edildi. DCAT planı plan kalitesi ve beyin sapı dozlarında, VMAT planı daha iyi normal beyin koruması ve daha düşük bir ışınlama süresi açısından önemli avantaj sağladı.

Anahtar Kelimeler

References

Ruggieri R, Naccarato S, Mazzola R, Ricchetti F, Corradini S, Fiorentino A, et al. Linac-based radiosurgery for multiple brain metastases: Comparison between two mono-isocenter techniques with multiple non-coplanar arcs. Radiat Oncol 2019;132:70-8.
Guinement L, Salleron J, Buchheit I, Gérard K, Faivre JC, Royer P, et al. Comparison between the HyperArcTM technique and the CyberKnife technique for stereotactic treatment of brain metastases. Cancer Radiother 2023;27(2):136-44.
Clark GM, Popple RA, Young PE, Fiveash JB. Feasibility of singleisocenter volumetric modulated arc radiosurgery for treatment of multiple brain metastases. Int J Radiat Oncol Biol Phys 2010;76(1):296-302.
Palmiero AN, Critchfield L, Clair W, Randall M, Pokhrel D. Single-isocenter volumetric modulated arc therapy (VMAT) radiosurgery for multiple brain metastases: Potential loss of target(s) coverage due to isocenter misalignment. Cureus 2020;12(10):e11267.
Raza GH, Capone L, Tini P, Giraffa M, Gentile P, Minniti G. Single-isocenter multiple-target stereotactic radiosurgery for multiple brain metastases: dosimetric evaluation of two automated treatment planning systems. Radiat Oncol 2022;17(1):116.
Pirzkall A, Debus J, Lohr F, Fuss M, Rhein B, Engenhart-Cabillic R et al. Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases. J Clin Oncol 1998;16(11):3563-69.
Kocher M, Wittig A, Piroth MD, Treuer H, Seegenschmiedt H, Ruge M, et al. Stereotactic radiosurgery for treatment of brain metastases: a report of the DEGRO working group on stereotactic radiotherapy. Strahlenther Onkol 2014;190(6):521-32.
Chang J, Wernicke AG, Pannullo SC. Restricted single isocenter for multiple targets dynamic conformal arc (RSIMT DCA) technique for brain stereotactic radiosurgery (SRS) planning. J Radiosurg SBRT 2018;5(2):145-56.

Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, kawagishi J, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014;15(4):387-95.
Yamamoto M, Higuchi Y, Sato Y, Aiyama H, Kasuya H, Barfod BE. Stereotactic radiosurgery for patients with 10 or more brain metastases. Prog Neurol Surg 2019;34:110-24.
Jeong WJ, Park JH, Lee EJ, Kim JH, Kim CJ, Cho YH. Efficacy and safety of fractionated stereotactic radiosurgery for large brain metastases. J Korean Neurosurg Soc 2015;58(3):217-24.
Minniti G, D’Angelillo RM, Scaringi C, Trodella LE, Clarke E, Matteucci P, et al. Fractionated stereotactic radiosurgery for patients with brain metastases. J Neuro-Oncol 2014;117(2):295-301.
Ogura K, Mizowaki T, Ogura M, Sakanaka K, Arakawa Y, Miyamoto S, et al. Outcomes of hypofractionated stereotactic radiotherapy for metastatic brain tumors with high risk factors. J Neuro-Oncol 2012;109(2):425-32.
Minniti G, Scaringi C, Paolini S, Lanzetta G, Romano A, Cicone F, et al. Single-fraction versus multifraction (3x9 Gy) stereotactic radiosurgery for large (>2cm) brain metastases: A comparative analysis of local control and risk of radiation-induced brain necrosis. Int J Radiat Oncol Biol Phys 2016;95(4):1142-48.
Putz F, Weissmann T, Oft D, Schmidt MA, Roesch J, Siavooshhaghighi H, et al. FSRT vs. SRS in brain metastases differences in local control and radiation necrosis a volumetric study. Front Oncol 2020;10:559193.
Milano MT, Grimm J, Niemierko A, Soltys SG, Moiseenko V, Redmond KJ, et al. Single-and multifraction stereotactic radiosurgery dose/volume tolerances of the brain. Int J Radiat Oncol Biol Phys 2021;110(1):68-86.
Molinier J, Kerr C, Simeon S, Ailleres N, Charissoux M, Azria D, et al. Comparison of volumetric‐modulated arc therapy and dynamic conformal arc treatment planning for cranial stereotactic radiosurgery. J Appl Clin Med Phys 2016;17(1):92-101.
Ruggieri R, Naccarato S, Mazzola R, Ricchetti F, Corradini S, Fiorentino A, et al. Linac-based VMAT radiosurgery for multiple brain lesions: comparison between a conventional multi-isocenter approach and a new dedicated mono-isocenter technique. Radiat Oncol 2018;13(1):38.
Gregucci F, Fiorentino A, Corradini S, Figlia V, Mazzola R, Ricchetti F, et al. Linac-based radiosurgery or fractionated stereotactic radiotherapy with flattening filter-free volumetric modulated arc therapy in elderly patients. Strahlenther Onkol 2018;195(3):218-25.
Hofmaier J, Bodensohn R, Garny S, Hadi I, Fleischmann DF, Eder M, et al. Single isocenter stereotactic radiosurgery for patients with multiple brain metastases: dosimetric comparison of VMAT and a dedicated DCAT planning tool. Radiat Oncol 2019;14(1):103.
Huang Y, Chin K, Robbins JR, Kim J, Li H, Amro H, et al. Radiosurgery of multiple brain metastases with single-isocenter dynamic conformal arcs (SIDCA). Radiother Oncol 2014;112(1):128-32.
Minniti G, Capone L, Alongi F, Figlia V, Nardiello B, El Gawhary R, Scaringi C, Bianciardi F, Tolu B, Gentile P, Paolini S. Initial experience with singleisocenter radiosurgery to target multiple brain metastases using an automated treatment planning software: clinical outcomes and optimal target volume margins strategy. Adv Radiat Oncol 2020;5(5):856-64.
Bodensohn R, Kaempfel AL, Fleischmann DF, Hadi I, Hofmaier J, Garny S, et al. Simultaneous stereotactic radiosurgery of multiple brain metastases using single-isocenter dynamic conformal arc therapy: a prospective monocentric registry trial. Strahlenther Onkol 2021;197(7):601-13.
Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, et al. Stereotactic body radiation therapy: The report of AAPM task group 101. Med Phys 2010;37(8):4078-101.
Milano MT, Grimm J, Niemierko A, Soltys S, Moiseenko V, Redmond KJ, et al. Single- and multifraction stereotactic radiosurgery dose/volume tolerances of the brain. Int J Radiat Oncol Biol Phys 2021;110(1):68-86.
Grimm J, Marks LB, Jackson A, Kavanagh BD, Xue J, Yorke E. High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic (HyTEC): An Overview. Int J Radiat Oncol Biol Phys 2021;110(1)1-10.
Hanna GG, Murray L, Patel R, Jain S, Aitken KL, Franks KN, et al. UK consensus on normal tissue dose constraints for stereotactic radiotherapy. Clin Oncol (R Coll Radiol) 2018;30(1):5-14.
Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, et al. Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993;27(5):1231-39.
Audet C, Poffenbarger BA, Chang P, Jackson PS, Lundahl RE, Ryu SI, et al. Evaluation of volumetric modulated arc therapy for cranial radiosurgery using multiple noncoplanar arcs. Med Phys 2011 38:5863-72.
Paddick I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 2000; 93(Suppl. 3):219-22.
Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. J Neurosurg (2006) 105:194-201.
Agazaryan N, Tenn S, Lee C, Steinberg M, Hegde J, Chin R, et al. Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience. Radiat Oncol 202;16(221).
Chang J. A statistical model for analyzing the rotational error of single isocenter for multiple targets technique. Med Phys 2017;44(6):2115-23.
Faught AM, Trager M, Yin FF, Kirkpatrick J, Adamson J. Re-examining TG-142 recommendations in light of modern techniques for linear accelerator based radiosurgery. Med Phys 2016;43(10):5437-41.
Narayanasamy G, Stathakis S, Gutierrez AN, Pappas E, Crownover R, Floyd JR, et al. A systematic analysis of 2 monoisocentric techniques for the treatment of multiple brain metastases. Technol Cancer Res Treat 2017;16(5):639-44.
Gevaert T, Steenbeke F, Pellegri L, Engels B, Christian N, Hoornaert MT, et al. Evaluation of a dedicated brain metastases treatment planning optimization for radiosurgery: a new treatment paradigm? Radiat Oncol 2016;11(1):13.
Ohira S, Ueda Y, Akino Y, Hashimoto M, Masaoka A, Hirata T, et al. HyperArc VMAT planning for single and multiple brain metastases stereotactic radiosurgery: a new treatment planning approach. Radiat Oncol 2018;13(1):13.
Ohira S, Sagawa T, Ueda Y, Inui S, Masaoka A, Akino Y, et al. Effect of collimator angle on HyperArc stereotactic radiosurgery planning for single and multiple brain metastases. Med Dosim 2020;45(1):85–91.
Pan M, Xu W, Sun L, Wang C, Dong S, Guan Y, et al. Dosimetric quality of HyperArc in boost radiotherapy for single glioblastoma: comparison with CyberKnife and manual VMAT. Radiat Oncol 2023;18(1):8.
El Shafie RA, Tonndorf-Martini E, Schmitt D, Celik A, Weber D, Lang K, et al. Single-isocenter volumetric modulated arc therapy vs. cyberknife M6 for the stereotactic radiosurgery of multiple brain metastases. Front Oncol 2020;10:568.
Alongi F, Fiorentino A, Ruggieri R, Ricchetti F, Kupelian P. Cost-effectiveness of Linac-based single-isocenter non-coplanar technique (HyperArcTM) for brain metastases radiosurgery. Clin Exp Metastat 2018;35(7):601-3.
Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, et al. Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol 2011;6(1):48.
Liu H, Thomas EM, Li J, Yu Y, Andrews D, Markert JM et al. Interinstitutional plan quality assessment of 2 linac-based, single-isocenter, multiple metastasis radiosurgery techniques. Adv Radiat Oncol 2020;5(5):1051-60.
Sprowls CJ, Shah AP, Kelly P, Burch DR, Mathews RS, Swanick CW, et al. Whole brain radiotherapy with hippocampal sparing using VarianHyperArc. Med Dosim 2021;46:264-68.

Details

Primary Language

Turkish

Subjects

Radiation Therapy

Journal Section

Research Article

Authors

Nezahat Olacak ^*
0000-0002-0700-0420
Türkiye

Sinan Hoca
0000-0002-4619-4184
Türkiye

Mert Delikaya
0000-0001-5494-8073
Türkiye

Yusuf Ziya Hazeral
0000-0003-0449-6472
Türkiye

Deniz Yalman
0000-0002-4010-8353
Türkiye

Publication Date

June 10, 2025

Submission Date

January 8, 2025

Acceptance Date

February 25, 2025

Published in Issue

Year 2025 Volume: 64 Number: 2

DOI

https://doi.org/10.19161/etd.1615140

IZ

https://izlik.org/JA83PU29RX

Cite

RIS / Bibtex

Vancouver

1.Nezahat Olacak, Sinan Hoca, Mert Delikaya, Yusuf Ziya Hazeral, Deniz Yalman. Çoklu beyin metastazlarının stereotaktik radyoterapisi için tek izomerkezli dinamik konformal ark tedavi (DCAT) ve volumetrik ayarlı ark tedavi (VMAT) planlama tekniklerinin dozimetrik karşılaştırılması. EJM. 2025 Jun. 1;64(2):300-9. doi:10.19161/etd.1615140