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Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma

  • Experimental Research - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

An Erratum to this article was published on 23 December 2014

Abstract

Background

The objective of this study was to compare the three most prominent systems for stereotactic radiosurgery in terms of dosimetric characteristics: the Cyberknife system, the Gamma Knife Perfexion and the Novalis system.

Methods

Ten patients treated for recurrent grade I meningioma after surgery using the Cyberknife system were identified; the Cyberknife contours were exported and comparative treatment plans were generated for the Novalis system and Gamma Knife Perfexion. Dosimetric values were compared with respect to coverage, conformity index (CI), gradient index (GI) and beam-on time (BOT).

Results

All three systems showed comparable results in terms of coverage. The Gamma Knife and the Cyberknife system showed significantly higher levels of conformity than the Novalis system (Cyberknife vs Novalis, p = 0.002; Gamma Knife vs Novalis, p = 0.002). The Gamma Knife showed significantly steeper gradients compared with the Novalis and the Cyberknife system (Gamma Knife vs Novalis, p = 0.014; Gamma Knife vs Cyberknife, p = 0.002) and significantly longer beam-on times than the other two systems (BOT = 66 ± 21.3 min, Gamma Knife vs Novalis, p = 0.002; Gamma Knife vs Cyberknife, p = 0.002).

Conclusions

The multiple focal entry systems (Gamma Knife and Cyberknife) achieve higher conformity than the Novalis system. The Gamma Knife delivers the steepest dose gradient of all examined systems. However, the Gamma Knife is known to require long beam-on times, and despite worse dose gradients, LINAC-based systems (Novalis and Cyberknife) offer image verification at the time of treatment delivery.

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Conflicts of interest

V. Budach and M. Kufeld received travel and speech grants from Accuray Inc.

The other authors confirm that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    David Kaul, Harun Badakhshi, Diana Pasemann, Volker Budach & Arne Gruen

  2. Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium

    Thierry Gevaert & Marc Levivier

  3. Department of Neurosurgery and Gamma Knife Centre, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Constantin Tulaesca

  4. Charité CyberKnife Center, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Markus Kufeld

  5. Department of Nuclear Medicine, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Vikas Prasad

Authors
  1. David Kaul
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  2. Harun Badakhshi
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  3. Thierry Gevaert
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  4. Diana Pasemann
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  5. Volker Budach
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  6. Constantin Tulaesca
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  7. Arne Gruen
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  8. Vikas Prasad
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  9. Marc Levivier
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  10. Markus Kufeld
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Corresponding author

Correspondence to David Kaul.

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Comment

This article is the latest in a series of papers comparing different devices for stereotactic radiosurgery. The obvious aim of such papers is to see which one is “best”, perhaps with the aim of making purchase of these machines more attractive, or indeed for patients or referring doctors to choose one or other department for treatment.

Most of these papers suffer from the weakness that there is no simple answer to this question: the different comparison parameters favour one or another technology. This leaves the reader somewhat uncertain how to interpret the findings.

It is a strength of this paper that they calculated the necessary beam-on-time, which is not often shown in previous papers. This is a relevant feature for the delivery of the treatment on the day. Of course it is only part of the whole process, as the planning time is also vastly different (according to the information available to me it is the fastest using GammaPlan, the software utilised for Gamma Knife treatments. There is recent evidence to show that the biological equivalent dose (BED) depends on the length of time the radiation treatment is delivered, because of the fast component of cell repair that is in operation even during the treatment. As this factor is so dramatically different in the three technologies, experience with one machine (most clinical data are published with the Gamma Knife), cannot be automatically utilised for the faster LINAC based machines.

Andras Kemeny

Sheffield, UK

Hopewell JW, Millar WT, Lindquist C (2012) Radiobiological principles: their application to γ knife therapy. Prog Neurol Surg 25:39-54

David Kaul and Harun Badakhshi contributed equally to this study.

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Kaul, D., Badakhshi, H., Gevaert, T. et al. Dosimetric comparison of different treatment modalities for stereotactic radiosurgery of meningioma. Acta Neurochir 157, 559–564 (2015). https://doi.org/10.1007/s00701-014-2272-9

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  • DOI: https://doi.org/10.1007/s00701-014-2272-9

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