A Comprehensive Evaluation of Single Isocenter Multiple Target SRS Plans and the Analytical Relationship between Plan Quality Indices with the Number and Volume of Targets

V, Hemalatha Priyadarsini; Murali, Reshma; Raj, N. Arunai Nambi; Saravanan, S. A.

doi:10.31557/apjcp.2022.23.9.3103

Asian Pac J Cancer Prev

2022

DOI: 10.31557/apjcp.2022.23.9.3103

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A Comprehensive Evaluation of Single Isocenter Multiple Target SRS Plans and the Analytical Relationship between Plan Quality Indices with the Number and Volume of Targets

Hemalatha Priyadarsini V

Reshma Murali

N. Arunai Nambi Raj

et al.

Abstract: WBRT alone, thus improving the quality of life of the patients (Chang et al., 2009).SRS is a non-invasive procedure that uses ionizing radiation to treat intracranial and extracranial lesions with a high dose of radiation delivered in a single fraction of treatment. The rapid dose fall-off of SRS spares the healthy brain tissues and becomes the treatment of choice for 1 to 3 BM of less than 3 cm diameter (Linskey et al., 2010). Patients with 5 to 10 BM also have a comparable survival

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2024

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Cited by 2 publications

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Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review

Mukwada,

Chamunyonga,

Rowshanfarzad

et al. 2024

PLoS ONE

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Background GammaKnife (GK) and CyberKnife (CK) have been the mainstay stereotactic radiosurgery (SRS) solution for multiple brain metastases (MBM) for several years. Recent technological advancement has seen an increase in single-isocentre C-arm linac-based SRS. This systematic review focuses on dosimetric and geometric insights into contemporary MBM SRS and thereby establish if linac-based SRS has matured to match the mainstay SRS delivery systems. Methods The PubMed, Web of Science and Scopus databases were interrogated which yielded 891 relevant articles that narrowed to 20 articles after removing duplicates and applying the inclusion and exclusion criteria. Primary studies which reported the use of SRS for treatment of MBM SRS and reported the technical aspects including dosimetry were included. The review was limited to English language publications from January 2015 to August 2023. Only full-length papers were included in the final analysis. Opinion papers, commentary pieces, letters to the editor, abstracts, conference proceedings and editorials were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The reporting of conformity indices (CI) and gradient indices, V12Gy, monitor units and the impact of translational and rotational shifts were extracted and analysed. Results The single-isocentre technique for MBM dominated recent SRS studies and the most studied delivery platforms were Varian. The C-arm linac-based SRS plan quality and normal brain tissue sparing was comparable to GK and CK and in some cases better. The most used nominal beam energy was 6FFF, and optimised couch and collimator angles could reduce mean normal brain dose by 11.3%. Reduction in volume of the healthy brain receiving a certain dose was dependent on the number and size of the metastases and the relative geometric location. GK and CK required 4.5–8.4 times treatment time compared with linac-based SRS. Rotational shifts caused larger changes in CI in C-arm linac-based single-isocentre SRS. Conclusion C-arm linac-based SRS produced comparable MBM plan quality and the delivery is notably shorter compared to GK and CK SRS.

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Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review

Mukwada,

Chamunyonga,

Rowshanfarzad

et al. 2024

PLoS ONE

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Approaches for Stereotactic Radiosurgery (SRS)/Stereotactic Radiotherapy (SRT) in brain metastases using different radiotherapy modalities (Feasibility study)

Tawfik,

Farid,

El Shahat

et al. 2024

Journal of X-Ray Science and Technology: Clinical Applications

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BACKGROUND: SRS and SRT are precise treatments for brain metastases, delivering high doses while minimizing doses to nearby organs. Modern linear accelerators enable the precise delivery of SRS/SRT using different modalities like three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and Rapid Arc (RA). OBJECTIVE: This study aims to compare dosimetric differences and evaluate the effectiveness of 3DCRT, IMRT, and Rapid Arc techniques in SRS/SRT for brain metastases. METHODS: 10 patients with brain metastases, 3 patients assigned for SRT, and 7 patients for SRS. For each patient, 3 treatment plans were generated using the Eclipse treatment planning system using different treatment modalities. RESULTS: No statistically significant differences were observed among the three techniques in the homogeneity index (HI), maximum D2%, and minimum D98% doses for the target, with a p > 0.05. The RA demonstrated a better conformity index of 1.14±0.25 than both IMRT 1.21±0.26 and 3DCRT 1.37±0.31. 3DCRT and IMRT had lower Gradient Index values compared to RA, suggesting that they achieved a better dose gradient than RA. The mean treatment time decreased by 26.2% and 10.3% for 3DCRT and RA, respectively, compared to IMRT. In organs at risk, 3DCRT had lower maximum doses than IMRT and RA, but some differences were not statistically significant. However, in the brain stem and brain tissues, RA exhibited lower maximum doses compared to IMRT and 3DCRT. Additionally, RA and IMRT had lower V15Gy, V12Gy, and V9Gy values compared to 3DCRT. CONCLUSION: While 3D-CRT delivered lower doses to organs at risk, RA and IMRT provided better conformity and target coverage. RA effectively controlled the maximum dose and irradiated volume of normal brain tissue. Overall, these findings indicate that 3DCRT, RA, and IMRT are suitable for treating brain metastases in SRS/SRT due to their improved dose conformity and target coverage while minimizing dose to healthy tissues.

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A Comprehensive Evaluation of Single Isocenter Multiple Target SRS Plans and the Analytical Relationship between Plan Quality Indices with the Number and Volume of Targets

Cited by 2 publications

References 22 publications

Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review

Insights into the dosimetric and geometric characteristics of stereotactic radiosurgery for multiple brain metastases: A systematic review

Approaches for Stereotactic Radiosurgery (SRS)/Stereotactic Radiotherapy (SRT) in brain metastases using different radiotherapy modalities (Feasibility study)

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