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. 2022 Jul 1;17(1):116.
doi: 10.1186/s13014-022-02086-3.

Single-isocenter multiple-target stereotactic radiosurgery for multiple brain metastases: dosimetric evaluation of two automated treatment planning systems

Giorgio Hamid Raza  1 , Luca Capone  1 , Paolo Tini  2 , Martina Giraffa  1 , Piercarlo Gentile  1 , Giuseppe Minniti  3   4
Affiliations

Single-isocenter multiple-target stereotactic radiosurgery for multiple brain metastases: dosimetric evaluation of two automated treatment planning systems

Giorgio Hamid Raza et al. Radiat Oncol. .

Abstract

Purpose: Automated treatment planning systems are available for linear accelerator (linac)-based single-isocenter multi-target (SIMT) stereotactic radiosurgery (SRS) of brain metastases. In this study, we compared plan quality between Brainlab Elements Multiple Brain Metastases (Elements MBM) software which utilizes dynamic conformal arc therapy (DCAT) and Varian HyperArc (HA) software using a volumetric modulated arc therapy (VMAT) technique.

Patients and methods: Between July 2018 and April 2021, 36 consecutive patients ≥ 18 years old with 367 metastases who received SIMT SRS at UPMC Hillman Cancer San Pietro Hospital, Rome, were retrospectively evaluated. SRS plans were created using the commercial software Elements MBM SRS (Version 1.5 and 2.0). Median cumulative gross tumor volume (GTV) and planning tumor volume (PTV) were 1.33 cm3 and 3.42 cm3, respectively. All patients were replanned using HA automated software. Extracted dosimetric parameters included mean dose (Dmean) to the healthy brain, volumes of the healthy brain receiving more than 5, 8,10, and 12 Gy (V5Gy, V8Gy, V10Gy and V12Gy), and doses to hippocampi.

Results: Both techniques resulted in high-quality treatment plans, although Element MBM DCAT plans performed significantly better than HA VMAT plans, especially in cases of more than 10 lesions). Median V12Gy was 13.6 (range, 1.87-45.9) cm3 for DCAT plans and 18.5 (2.2-62,3) cm3 for VMAT plans (p < 0.0001), respectively. Similarly, V10Gy, V8Gy, V5Gy (p < 0.0001) and median dose to the normal brain (p = 0.0001) were favorable for DCAT plans.

Conclusions: Both Elements MBM and HA systems were able to generate high-quality plans in patients with up to 25 brain metastases. DCAT plans performed better in terms of normal brain sparing, especially in patients with more than ten lesions and limited total tumor volume.

Keywords: Brain metastases; DCAT; Single-isocenter multiple-targets radiosurgery; Stereotactic radiosurgery; VMAT.

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Conflict of interest statement

GM received speaker honoraria from Brainlab. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of 12 Gy, 10 Gy, 8 Gy, and 5 Gy isodose volume for 36 cases between Elements MBM DCAT (▲) and HA VMAT (•) plans
Fig. 2
Fig. 2
Axial (first row) and sagittal (second row) dose distributions, shown in color wash (12 to 24 Gy), from Elements MBM DCAT (panel A and C) and HA VMAT (panel B and D) plans in a patient (case 36) with 25 brain metastases (only some of them are visible in the selected slices). Total tumor volume was 2.43 cm3. A 1-mm GTV-to-PTV margin was used with 20 Gy prescribed to all targets in single fraction. The 12 Gy isodose-shell around the targets with the typical enlargement in case of adjacent lesions, which may bring to dose bridging, is shown for both plans. The volume of normal brain receiving 12 Gy (V12Gy) was 45.9 cm3 for DCAT plan and 56.3 cm3 for VMAT plan. The different management of the dose bridging between the different techniques is noticeable
Fig. 3
Fig. 3
Comparison of mean dose to left and right hippocampus for 36 cases between Elements MBM DCAT (▲) and HA VMAT (•) plans
See this image and copyright information in PMC

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