Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

Zhang, Isabella; Antone, Jeff; Li, Jenny; Saha, Shyamali; Riegel, Adam C.; Vijeh, L.; Lauritano, J.; Marrero, M.; Salas, Sussan J.; Schulder, Michael; Zinkin, H.D.; Goenka, Anuj; Knisely, Jonathan

doi:10.1016/j.prro.2017.01.012

Cited by 35 publications

(28 citation statements)

References 15 publications

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“…Our results are consistent with the data presented by Zhang et al . but contradictory to the data presented by Liu et al .…”

Section: Discussionsupporting

confidence: 83%

“…However, their study examined cases with only 2–5 brain metastases and did not use either the 6‐MV FFF or 10‐MV FFF beam models. A recent study by Zhang et al . looking specifically at hippocampal‐sparing for cases with 3–10 brain metastases (median of six metastases per plan), concluded that GK Perfexion plans demonstrated significantly lower V12 Gy, V8 Gy, and V4 Gy irradiated brain volume compared to single‐isocenter VMAT.…”

Section: Introductionmentioning

confidence: 99%

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GammaKnife versus VMAT radiosurgery plan quality for many brain metastases

Potrebko

Keller

All

et al. 2018

J Applied Clin Med Phys

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The purpose of this work was to compare dose distributions between two radiosurgery modalities, single‐isocenter volumetric modulated arc therapy (VMAT), and GammaKnife Perfexion (GK), in the treatment of a large number (≥7) of brain metastases. Twelve patients with 103 brain metastases were analyzed. The median number of targets per patient was 8 (range: 7–14). GK plans were compared to noncoplanar VMAT plans using both 6‐MV flattening filter‐free (FFF) and 10‐MV FFF modes. Parameters analyzed included radiation therapy oncology group conformity index (CI), 12, 6, and 3 Gy isodose volumes (V12 Gy, V6 Gy, V3 Gy), mean and maximum hippocampal dose, and maximum skin dose. There were statistically significant differences in CI (2.5 ± 1.6 vs 1.6 ± 0.8 and 1.7 ± 0.9, P < 0.001, P < 0.001), V12 Gy (2.8 ± 6.1 cc vs 3.0 ± 5.2 cc and 3.1 ± 5.4 cc, P = 0.003, P < 0.001), and V3 Gy (323.0 ± 294.8 cc vs, 880.1 ± 369.1 cc and 937.9 ± vs 361.9 cc, P = 0.005, P = 0.001) between GK versus both 6‐MV FFF and 10‐MV FFF. No significant differences existed for maximum hippocampal or skin doses. In conclusion, highly optimized VMAT produced improved conformity at the expense of a higher V12 Gy and V3 Gy volume when compared with highly optimized GK.

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“…Our results are consistent with the data presented by Zhang et al . but contradictory to the data presented by Liu et al .…”

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

GammaKnife versus VMAT radiosurgery plan quality for many brain metastases

Potrebko

Keller

All

et al. 2018

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…The American National Comprehensive Cancer Network (NCCN) recommends SRS for patients with brain metastases that meet the following criteria: 1) tumour diameter <5 cm, 2) no more than 4 tumours, 3) co-application of surgery or WBRT, and 4) recurrence after SRS (6 months) [7]. Common SRS treatment equipment includes Gammaknife, Cyberknife (CK) and various kinds of linear accelerators [8,9]. CK can be used to treat encephalic lesions by adapting orthogonal X-ray tubes to image the patient's head in real time and performing radiotherapy of the lesions by positioning the CK after registering the patient's skull images.…”

Section: Introductionmentioning

confidence: 99%

Benefit of dosimetry distribution for patients with multiple brain metastases from non-small cell lung cancer by a Cyberknife stereotactic radiosurgery (SRS) system

YU¹,

Wang

Yuan³

et al. 2020

Preprint

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Background: To achieve high precision in treating tumors and a steep dose fall-off in healthy tissues for brain metastasis stereotactic radiosurgery (SRS), this study investigated SRS planning optimization by comparing one multiple-lesions plan (MLP) with multiple single-lesion plans (SLPs) for patients with multiple brain metastases using the Cyberknife (CK) system.Methods: Fifty non-small cell lung cancer (NSCLC) patients (28 males and 22 females) with 2-4 brain metastases, inter-tumour distances less than 3 cm, were retrospectively replanned with the original prescription dose (12-32 Gy) in the original fractions (1-3). Two different clinical CK SRS plans (SLPs and MLP) were generated for the same patients with the same collimator and prescription isodose line (62-68%) by the CK Multiplan System. Both SLPs and MLP were able to achieve >95% PTV volume covered prescription dose and met the Timmerman 2011 organs at risk (brainstem, optic nerve and pituitary) constraints.Results: Compared with those in the SLPs, the maximum dose (Dmax) and mean dose (Dmean) of brainstem in the MLP were reduced 0.22-3.13% (2.62%) and 2.71-12.56% (5.57%), respectively, all P<0.05. Meanwhile, the volumes of the whole brain minus the tumors that received a single dose equivalent of 8-16 Gy (V8Gy-V16Gy) were effectively reduced in the MLP. The treatment time parameters, the total number of beams and monitor units, of the MLP were reduced by 3.31% and 1.47% (P<0.05), respectively. Although there were a few differences in the conformity index (CI) and homogeneity index (HI) between the two treatment plans, the differences were not statistically significant (P = 2.94 and 1.08>0.05).Conclusion: One multiple-lesions plan for brain metastases could achieve higher precision in the target and lower doses in healthy tissue while shortening the treatment time and improving the treatment efficiency over multiple single-lesion plans.

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“…There are a lot of dosimetry comparison studies, such as GK vs CK, GK vs coplanar VMAT, GK vs non‐coplanar VMAT, coplanar IMRT vs coplanar VMAT, non‐coplanar IMRT vs coplanar VMAT, coplanar VMAT vs non‐coplanar VMAT . However, no direct comparison between CK and C‐arm linac based plans (including IMRT, coplanar VMAT and non‐coplanar VMAT) has been published.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

Zhang

Yang

Wang

2019

J Applied Clin Med Phys

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The incidence of brain metastases is increasing and various treatment modalities exist for brain metastases. The aim of this study was to investigate the dosimetric quality and delivery efficiency of robotic radiosurgery (CyberKnife) for multiple brain metastases compared with C-arm linear accelerator (linac) based plans. C-arm linac based plans included intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and non-coplanar VMAT with 1, 3 and 5 non-coplanar arcs, respectively (NC1, NC3 and NC5). For 20 patients, six plans with a prescription dose of 30 Gy in three fractions were generated. The gradient index (GI), conformity index (CI), maximum dose (D max ) of organs at risk (OARs), normal brain tissue volume (V 3 Gy -V 24 Gy ), monitor units (MUs) and beam on time (BT) were evaluated. The GI of CyberKnife plans (3.60 ± 0.70) was lower than IMRT (6.21 ± 2.26, P < 0.05), VMAT (6.04 ± 1.93, P < 0.05), NC1 (5.16 ± 1.71, P < 0.05), NC3 (5.02 ± 1.59, P < 0.05) and NC5 (5.03 ± 1.72, P < 0.05). The CI of the VMAT plans (both coplanar and non-coplanar) was larger than IMRT and CK plans. The D max for most OARs of the CyberKnife plan was lower than the C-arm linac based plans, although some differences were not statistically significant. The normal brain tissue volume of CyberKnife plan was lower than the C-arm linac based plans, and the normal brain tissue volume of non-coplanar VMAT plans was lower than IMRT and VMAT plans at high-moderate dose level. However, the MUs and BT of CyberKnife plans was more than C-arm linac based plans. CyberKnife plan was better than C-arm linac based plans in protecting normal brain tissue and OARs for patients with multiple brain metastases. C-arm linac based plan with non-coplanar arc provided better protection of normal brain tissue than coplanar plan. However, the BT of CyberKnife plan was longer than C-arm linac based plans. K E Y W O R D SCyberKnife, dosimetry, IMRT, multiple brain metastases,

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Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

Cited by 35 publications

References 15 publications

GammaKnife versus VMAT radiosurgery plan quality for many brain metastases

GammaKnife versus VMAT radiosurgery plan quality for many brain metastases

Benefit of dosimetry distribution for patients with multiple brain metastases from non-small cell lung cancer by a Cyberknife stereotactic radiosurgery (SRS) system

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

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