Is a single isocenter sufficient for volumetric modulated arc therapy radiosurgery when multiple intracranial metastases are spatially dispersed?
Previous work demonstrated improved dosimetry of single isocenter volumetric modulated arc therapy (VMAT) of multiple intracranial targets when they are located ≤ 4 cm from isocenter because of narrower multileaf collimators (MLCs). In follow-up, we sought to determine if decreasing isocenter-target distance (d{sub iso}) by using 2 to 3 isocenters would improve dosimetry for spatially dispersed targets. We also investigated the effect of a maximum dose constraint during VMAT optimization, and the dosimetric effect of the number of VMAT arcs used for a larger number of targets (i.e., 7 to 9). We identified radiosurgery cases that had multiple intracranial targets with d{sub iso} of at least 1 target > 5 cm. A single isocenter VMAT plan was created using a standardized 4-arc technique with 18 Gy per target. Each case was then replanned (1) using 2 to 3 isocenters, (2) including a maximum dose constraint per target, and in the case of 7 to 9 targets, (3) using 3 to 6 arcs. Dose evaluation included brain V{sub 6} {sub Gy} and V{sub 12} {sub Gy}, and conformity index (CI), gradient index (GI), and heterogeneity index (HI) per target. Two isocenters were sufficient to limit d{sub iso} to ≤ 4 cm and ≤ 5 cm for 11/15 and 13/15 cases, respectively; after replanning with 2 to 3 isocenters, d{sub iso} decreased from 5.8 ± 2.8 cm (2.3 14.9) to 2.5 ± 1.4 cm (0 5.2). All dose statistics improved on average, albeit modestly: V{sub 6} {sub Gy} = 6.9 ± 7.1%, V{sub 12} {sub Gy} = 0.9% ± 4.4%, CI = 2.6% ± 4.6%, GI = 0.9% ± 12.7%, and HI = 2.6% ± 5.2%; however, the number of arcs doubled and monitor units increase by nearly 2-fold. A maximum dose constraint had a negative effect on all dose indices, increasing V{sub 12} {sub Gy} by 9.7 ± 6.9%. For ≥ 7 targets, increasing number of arcs to > 3 improved CI, V{sub 12} {sub Gy}, and V{sub 6} {sub Gy}. A single isocenter is likely sufficient for VMAT radiosurgery of multiple intracranial metastases. Optimal treatment plan quality is achieved when no constraint is placed on the maximum target dose; for cases with many targets at least 4 arcs are needed for optimal plan quality.
- OSTI ID:
- 22685161
- Journal Information:
- Medical Dosimetry, Journal Name: Medical Dosimetry Journal Issue: 4 Vol. 41; ISSN 0958-3947
- Country of Publication:
- United States
- Language:
- English
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