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首页> 外文期刊>Physics and Imaging in Radiation Oncology >Single isocenter treatment planning techniques for stereotactic radiosurgery of multiple cranial metastases
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Single isocenter treatment planning techniques for stereotactic radiosurgery of multiple cranial metastases

机译：多个颅转移术刻膜放射术治疗规划技术

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Background and purpose Whole brain radiation therapy use has decreased in favor of stereotactic radiosurgery (SRS) for the treatment of multiple brain metastases due to reduced neurotoxicity. Here we compare two single isocenter radiosurgery planning techniques, volumetric modulated arc therapy (VMAT) and dynamic conformal arcs (DCA) in terms of their dosimetric and delivery performance. Materials and methods Sixteen patients with 2– 18 brain metastases (total 103; median 4) previously treated with single fraction SRS were replanned for multiple lesion single isocenter treatments using VMAT and DCA using different treatment planning systems for each and three different plan geometries for DCA. Plans were evaluated using the Paddick conformity index, normal tissue V 12Gy , the probability for symptomatic brain necrosis (S-NEC), maximum organ-at-risk (OAR) point doses, and total number of monitor units (MU). Results Conformity was not significantly different between VMAT and DCA plans. VMAT plans showed a trend towards higher MU with a median difference between 18% and 24% (p?≤?0.09). Median V 12Gy differences were 7.0?cm 3 –8.6?cm 3 favoring DCA plans (p??0.01). VMAT plans had median excess absolute and relative S-NEC risks compared to DCA plans of 8%–10% and 25%–31%, respectively (p??0.01). Moreover for VMAT compared to DCA, maximum OAR doses were significantly higher for the brainstem (1.9?Gy; p??0.01), chiasm (0.5?Gy; p?≤?0.02), and optic nerves (0.5?Gy; p?≤?0.04). Conclusions In most cases DCA plans were found to be dosimetrically superior to VMAT plans with reduced V 12Gy and associated risk for S-NEC. Maximum doses to important OARs showed significant improvement, increasing the ability for subsequent salvage treatments involving radiation.
机译：背景和目的，全脑放射治疗用途减少了型刻膜放射饲养（SRS），用于治疗多种肿瘤性由于神经毒性降低。在这里，我们将两个单一的ISOcenter放射咨询机规划技术，体积调制的电弧治疗（VMAT）和动态保形弧（DCA）在其剂量测定性能方面进行了比较。材料和方法60例脑转移的患者（总量103;中值4），用于使用VMAT和DCA的多个病变单均匀的单位处理SRS对每个和三种不同的DCA不同计划几何形状的不同治疗计划系统。使用Paddick符合性指数，正常组织V 12Gy，症状脑坏死（S-NEC），最大器官风险（OAR）点剂量的概率以及监测单元（MU）的总数来评估计划。 VMAT和DCA计划之间的结果符合性并没有显着差异。 VMAT计划显示出高亩的趋势，中位数差异为18％至24％（P？≤≤0.09）。中位V 12Gy差异为7.0？cm 3 -8.6？cm 3，优先达到DCA计划（p？＆？0.01）。 VMAT计划的绝对和相对S-NEC风险分别具有8％-10％和25％-31％的DCA计划，分别为8％-10％和25％-31％（P？＆ 0.01）。此外，对于VMAT与DCA相比，脑干的最大OAR剂量显着高（1.9？GY;p≤0.01），Chiasm（0.5？gy;p≤≤02）和视神经（0.5？gy; p？≤≤0.04）。在大多数情况下，发现DCA计划被发现与VMAT计划有多近于VMAT计划，减少了S-NEC的v 12Gy和相关风险。重要剂量至重要的桨显示出显着改善，增加了涉及辐射的后续挽救治疗的能力。

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