Volumetric Modulated Arc–Based Hypofractionated Stereotactic Radiotherapy for the Treatment of Selected Intracranial Arteriovenous Malformations: Dosimetric Report and Early Clinical Experience

Subramanian, S.; Chilukuri, Srinivas; Ramalingam, K.; Babaiah, M.; Swamy, Shivakumar; Garg, Arun; Kathirvel, M; Ashok, Subha; Clivio, Alessandro; Fogliata, Antonella; Nicolini, G.; Rao, K. Srinivasa; Reddy, T. Pratap; Amit, J.; Vanetti, Eugenio; Cozzi, Luca

doi:10.1016/j.ijrobp.2011.02.005

Cited by 20 publications

(15 citation statements)

References 36 publications

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“…Lagerwaard [19] approached the usage of RA for VS demonstrating increased conformality and advanced dose shaping potential compared to conformal arcs. Subramanian [20] investigated the role of RA on (large) AVMs and reported well-tolerated treatments with minimal toxicity. More in general, Mayo [21], Clark [22] and Wolff [23] analysed the general role of RA for SRS and demonstrated relevant improvements in plan quality and also in delivery efficiency when compared to alternative techniques (e.g.…”

Section: Introductionmentioning

confidence: 99%

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Abacıoğlu¹,

Özen²,

Yılmaz

et al. 2014

Radiat Oncol

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BackgroundTo evaluate the role of RapidArc (RA) for stereotactic radiosurgery (SRS) of benign brain lesions in comparison to GammaKnife (GK) based technique.MethodsTwelve patients with vestibular schwannoma (VS, n = 6) or cavernous sinus meningioma (CSM, n = 6) were planned for both SRS using volumetric modulated arc therapy (VMAT) by RA. 104 MV flattening filter free photon beams with a maximum dose rate of 2400 MU/min were selected. Data were compared against plans optimised for GK. A single dose of 12.5 Gy was prescribed. The primary objective was to assess treatment plan quality. Secondary aim was to appraise treatment efficiency.ResultsFor VS, comparing best GK vs. RA plans, homogeneity was 51.7 ± 3.5 vs. 6.4 ± 1.5%; Paddick conformity Index (PCI) resulted 0.81 ± 0.03 vs. 0.84 ± 0.04. Gradient index (PGI) was 2.7 ± 0.2 vs. 3.8 ± 0.6. Mean target dose was 17.1 ± 0.9 vs. 12.9 ± 0.1 Gy. For the brain stem, D1cm3 was 5.1 ± 2.0 Gy vs 4.8 ± 1.6 Gy. For the ipsilateral cochlea, D0.1cm3 was 1.7 ± 1.0 Gy vs. 1.8 ± 0.5 Gy. For CSM, homogeneity was 52.3 ± 2.4 vs. 12.4 ± 0.6; PCI: 0.86 ± 0.05 vs. 0.88 ± 0.05; PGI: 2.6 ± 0.1 vs. 3.8 ± 0.5; D1cm3 to brain stem was 5.4 ± 2.8 Gy vs. 5.2 ± 2.8 Gy; D0.1cm3 to ipsi-lateral optic nerve was 4.2 ± 2.1 vs. 2.1 ± 1.5 Gy; D0.1cm3 to optic chiasm was 5.9 ± 3.1 vs. 4.5 ± 2.1 Gy. Treatment time was 53.7 ± 5.8 (64.9 ± 24.3) minutes for GK and 4.8 ± 1.3 (5.0 ± 0.7) minutes for RA for schwannomas (meningiomas).ConclusionsSRS with RA and FFF beams revealed to be adequate and comparable to GK in terms of target coverage, homogeneity, organs at risk sparing with some gain in terms of treatment efficiency.

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Section: Introductionmentioning

confidence: 99%

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Abacıoğlu¹,

Özen²,

Yılmaz

et al. 2014

Radiat Oncol

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“…Volumetric Modulated Arc Therapy (VMAT-RapidArc) produces highly conformal dose distribution by simultaneously changing multi-leaf collimator (MLC) position, dose rate and gantry speed during patient treatment. [1][2][3] Complex treatment deliveries demand a comprehensive quality assurance (QA) procedure. American Association of Physicists in Medicine Task Group (AAPM TG)-82 4 recommends verification of intensity modulated treatment plans with an independent QA method before treatment delivery.…”

Section: Introductionmentioning

confidence: 99%

Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system

Swamy

Chandrasekaran

Kathirvel

et al. 2014

Int J Cancer Ther Oncol

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Purpose: Aim of this study is to clinically implement the COMPASS 3D dosimetry system for pretreatment quality assurance of volumetric modulated arc therapy (VMAT-RapidArc) treatment plans. Methods: For this study, 10 head and neck (H&N) and pelvis VMAT plans dose response from Linac was measured using COMPASS system along with MatriXX Evolution and 3D dose reconstructed in the patient computed tomography (CT) scan. Dose volume histograms and 3D gamma were used to evaluate difference between the measured and calculated values. In order to validate the COMPASS system, dose response for open fields were acquired for both homogeneous and inhomogeneous phantoms. Results: The average dose difference between Eclipse treatment planning system (TPS) calculated and COMPASS measured (homogenous medium) in normalization region, inner region, penumbra region and buildup region was less than ±2%. In inhomogeneous phantom, there was a maximum difference -3.17% in lung, whereas the difference other densities was within ±2%. The systematic increase in the average 3D gamma between the TPS calculated and COMPASS measured for VMAT plans with known dose errors and multi-leaf collimator (MLC) offset errors shows that COMPASS system was sensitive enough to find clinical significant errors. The 3D dose parameters (D95, D1, and average dose) of all H&N and pelvis patients were well within the clinically acceptable tolerance level of ±5%. The average 3D gammas for planning target volumes (PTV) and organ at risks (OAR) of the patients were less than 0.6. Conclusion:The results from this study show that COMPASS along with MatriXX Evolution can be effectively used for pretreatment verification of VMAT plans in the patient anatomy.

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“…Some of these also documented improved conformity compared with threedimensional techniques [32e34] and similar conformity [38] or higher conformity compared with standard IMRT techniques [33,34]. Clinical studies were less numerous and involved lung [40e42], arteriovenous malformations [43] and abdominal targets [44]. These preliminary studies mainly documented the technical feasibility of stereotactic VMAT; moreover, all authors used the technique in fractionated treatments.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery (SRS) with Volumetric Modulated Arc Therapy (VMAT): Interim Results of a Multi-arm Phase I Trial (DESTROY-2)

et al. 2014

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Volumetric Modulated Arc–Based Hypofractionated Stereotactic Radiotherapy for the Treatment of Selected Intracranial Arteriovenous Malformations: Dosimetric Report and Early Clinical Experience

Cited by 20 publications

References 36 publications

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Pretreatment quality assurance of volumetric modulated arc therapy on patient CT scan using indirect 3D dosimetry system

Stereotactic Radiosurgery (SRS) with Volumetric Modulated Arc Therapy (VMAT): Interim Results of a Multi-arm Phase I Trial (DESTROY-2)

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