Recent studies have reported about the application of volumetric-modulated arc radiotherapy in the treatment of multiple brain metastases. One of the key concerns for these radiosurgical treatments lies in the integral dose within the normal brain tissue, as it has been shown to increase with increasing number of brain tumors treated. In this study, we investigate the potential to improve normal brain tissue sparing specific to volumetric-modulated arc radiotherapy by increasing the number of isocenters and arc beams. Adopting a multi-institutional benchmark study protocol of planning multiple brain metastases via a radiosurgical apparatus, a flattening filter-free TrueBeam RapidArc delivery system (Varian Oncology, Palo Alto, California) was used for a volumetric-modulated arc radiotherapy treatment planning study, where treatment plans for target combinations of N ¼ 1, 3, 6, 9, and 12 targets were developed with increasing numbers of isocenters and arc beams. The treatment plans for each target combination were compared dosimetrically among each other and against the reference Gamma Knife treatment plan from the original benchmark study. We observed that as the number of isocenters or arc beams increased, the normal brain isodose volumes such as 12-to 4-Gy on average decreased by up to 15% for all the studied cases. However, when the best volumetric-modulated arc radiotherapy normal brain isodose volumes were compared against the corresponding reference Gamma Knife values, volumetric-modulated arc radiotherapy remained 100% to 200% higher than those of Gamma Knife for all target combinations. The study results, particularly for the solitary (N ¼ 1) metastases case, directly challenged the general notion of dose equivalence among current radiosurgical modalities. In conclusion, multiple isocenter and multiple arc beam delivery solutions are capable of decreasing normal brain irradiation exposure for volumetric-modulated arc radiotherapy. However, there is further technological development in need for volumetric-modulated arc radiotherapy before similar dosimetric treatment plans could be achievable when compared to Gamma Knife radiosurgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.