Dosimetry study comparing single-isocenter high-definition dynamic radiosurgery with multiple-isocenter cone-based stereotactic radiosurgery in treating multiple brain metastases
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Purpose: We sought to compare two radiotherapeutic strategies for treating multiple brain metastases (MBM), assessing delivery efficiency, plan quality, and dosimetry of planning target volume (PTV) and normal tissue. Methods: Our study population included 21 patients treated for MBM, each reliant on high-definition dynamic radiosurgery (Monaco-HDRS) or cone-based stereotactic radiosurgery (SRS) treatment plans. Monaco-HDRS plans called for one isocenter for all targets. In cone-based plans, each target corresponded with one isocenter. To compare these modalities, we assessed: monitor units (MU); new conformity index (nCI); dose gradient index (GI); homogeneity index (HI); PTV minimum/maximum (Dmax/Dmin) and mean (Dmean) doses; maximum doses to lenses, optic nerves, and brainstem; and brain dose volumes at 3, 6, 10, 12, and 22 Gy (V3Gy- V22Gy). Results: The Monaco-HDRS treatment plan proved more efficient, displaying lower MU, HI, and nCI values and better dosimetry (Dmax/Dmin and Dmean) for PTV. The cone-based plan yielded a lower GI value and dose volumes at 3 Gy and 22 Gy (V3Gy, V22Gy) for brain. There were no significant differences among other parameters. Conclusions: The Monaco-HDRS plan improved treatment efficiency, conformity, and homogeneity, although dose fall-off was worse. The cone-based plan reduced normal brain dose volumes at 3 Gy and 22 Gy.
Abstract
Purpose: We sought to compare two radiotherapeutic strategies for treating multiple brain metastases (MBM), assessing delivery efficiency, plan quality, and dosimetry of planning target volume (PTV) and normal tissue. Methods: Our study population included 21 patients treated for MBM, each reliant on high-definition dynamic radiosurgery (Monaco-HDRS) or cone-based stereotactic radiosurgery (SRS) treatment plans. Monaco-HDRS plans called for one isocenter for all targets. In cone-based plans, each target corresponded with one isocenter. To compare these modalities, we assessed: monitor units (MU); new conformity index (nCI); dose gradient index (GI); homogeneity index (HI); PTV minimum/maximum (Dmax/Dmin) and mean (Dmean) doses; maximum doses to lenses, optic nerves, and brainstem; and brain dose volumes at 3, 6, 10, 12, and 22 Gy (V3Gy- V22Gy). Results: The Monaco-HDRS treatment plan proved more efficient, displaying lower MU, HI, and nCI values and better dosimetry (Dmax/Dmin and Dmean) for PTV. The cone-based plan yielded a lower GI value and dose volumes at 3 Gy and 22 Gy (V3Gy, V22Gy) for brain. There were no significant differences among other parameters. Conclusions: The Monaco-HDRS plan improved treatment efficiency, conformity, and homogeneity, although dose fall-off was worse. The cone-based plan reduced normal brain dose volumes at 3 Gy and 22 Gy.