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A dosimetric comparison between CyberKnife and tomotherapy treatment plans for single brain metastasis

  • RADIOTHERAPY
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Abstract

Purpose

Radiosurgery (RS) is a well-established treatment in selected patients with brain metastasis. The aim of this study is to compare the differences between CyberKnife (CK) and TomoTherapy (HT) treatment plans of RS of single brain metastasis (BM) to define when HT should be used in cases beyond Cyberknife—when both systems are readily available for the radiation oncologist.

Methods and materials

Nineteen patients with single brain metastasis treated with CK were re-planned for radiosurgery using TomoTherapy Hi-ART system. Two planning approaches have been used for TomoTherapy plans: the classical one (HT) and the improved conformity (icHT) that produces dose distributions more similar to those of RS plans. PTV coverage, Conformity Index (CI), Paddick Conformity Index (nCI), Homogeneity Index (HI), Gradient Index (GI), and beam on time of CK, HT, and icHT plans were evaluated and compared.

Results

A good coverage was found for CK, HT, and icHT plans. A difference between mean HI of CK and icHT plans was observed (p = 0.007). Better dose gradients compared to both icHT and HT modalities were observed in CK plans. icHT modality showed improved mean CI respect to HT modality, similar to that obtained in CK plans.

Conclusions

CK plans show higher conformity and lower GI than icHT and HT plans. TomoTherapy demonstrates the advantage of being a device capable to reach different clinical objectives depending on the different planning modality employed. CyberKnife and TomoTherapy are both optimal RS devices, the choice to use one over another has to be clinically guided.

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References

  1. Eichler AF, Loeffler JS (2007) Multidisciplinary management of brain metastases. Oncologist 12(7):884–898

    Article  CAS  PubMed  Google Scholar 

  2. Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4259 patients. Int J Radiat Oncol Biol Phys 77:655–661

    Article  PubMed  Google Scholar 

  3. Aoyama H, Shirato H, Tago M et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491

    Article  CAS  PubMed  Google Scholar 

  4. Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141

    Article  PubMed  Google Scholar 

  5. Tsao MN, Rades D, Wirth A et al (2012) Radiotherapeutic and surgical management for newly diagnosed brain metastasis (es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol 2:210–225

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brown PD, Brown CA, Pollock BE et al (2002) Stereotactic radiosurgery for patients with “radioresistant”brain metastases. Neurosurgery 51:656–665

    PubMed  Google Scholar 

  7. Chang EL, Selek U, Hassenbusch SJIII et al (2005) Outcome variation among so called “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56:936–945

    Article  PubMed  Google Scholar 

  8. Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901):a multi institutional prospective observational study. Lancet Oncol 15(4):387–395

    Article  PubMed  Google Scholar 

  9. Soisson ET, Hoban PW, Kammeyer T et al (2011) A technique for stereotactic radiosurgery treatment planning with helical TomoTherapy. Med Dosim 36(1):46–56

    Article  PubMed  PubMed Central  Google Scholar 

  10. Baumert BG, Rutten I, Dehing-Oberije C et al (2006) A pathology-based substrate for target definition in radiosurgery of brain metastases. Int J Radiat Oncol Biol Phys 66(1):187–194

    Article  PubMed  Google Scholar 

  11. Hoogeman MS, Nuyttens JJ, Levenda G et al (2008) Time dependence of intrafraction patient motion assessed by repeat stereoscopic imaging. Int J Radiat Oncol Biol Phys 70:1313–1319

    Article  Google Scholar 

  12. Drabick DM, MacKenzie MA, Fallone GB (2007) Quantifying appropriate PTV setup margins: analysis of patient setup fidelity and intrafraction motion using post-treatment megavoltage computed tomography scans. Int J Radiat Oncol Biol Phys 68:1222–1228

    Article  Google Scholar 

  13. Shaw E, Scott C, Souhami L et al (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brainmetastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47(2):291–298

  14. Gladwish A, Oliver M, Craig J et al (2007) Segmentation ad leaf sequencing for intensity modulated arc therapy. Med Phys 34(5):1779–1788

    Article  PubMed  Google Scholar 

  15. Lomax NJ, Scheib SG (2003) Quantifying the degree of conformity in radiosurgery treatment panning. Int J Radiat Oncol Biol Phys 55(5):1409–1419

    Article  PubMed  Google Scholar 

  16. Kubo HD, Wilder RB, Pappas CTE (1999) Impact of collimator leaf width on stereotactic radiosurgery and 3D conformal radiotherapy treatment plans. Int J Radiat Oncol Biol Phys 44:937–945

    Article  CAS  PubMed  Google Scholar 

  17. Han C, Liu A, Schultheiss TE et al (2006) Dosimetric comparisons of Helical Tomotherapy treatment plans and step-and-shoot intensity modulated radiosurgery treatment plans in intracranial stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 65(2):608–616

  18. Bauman G, Yartsev S, Fisher B et al (2007) Simultaneous infield boost with helical TomoTherapy for patients with 1 to 3 brain metastases. Am J Clin Oncol 30(1):38–40

    Article  PubMed  Google Scholar 

  19. McGuinnes CM, Gottschalk AR, Lessard E et al (2015) Investigating the clinical advantages of a robotic linac equipped with a multileaf collimator in the treatment of brain and prostate cancer patients. J Appl Clin Med Phys 16(5):284–295

    Article  Google Scholar 

  20. Nakamura JL, Verhey LJ, Smith V et al (2001) Dose conformity of gamma knife radiosurgery and risk factors for complications. Int J Radiat Oncol Biol Phys 51(5):1313–1319

    Article  CAS  PubMed  Google Scholar 

  21. Leith JT, Cook S, Chougule P et al (1994) Intrinsic and extrinsic characteristics of human tumors relevant to radiosurgery: comparative cellular radiosensitivity and hypoxic percentages. Acta Neurochir Suppl 62:18–27

    Article  CAS  PubMed  Google Scholar 

  22. Tome W, Fowler J (2000) Selective boosting of tumor sub-volumes. Int J Radiat Oncol Biol Phys 48(2):593–599

    Article  CAS  PubMed  Google Scholar 

  23. Kohutek ZA, Yamada Y, Chan TA et al (2015) Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases. J Neurooncol 125(1):149–156

    Article  PubMed  PubMed Central  Google Scholar 

  24. Flickinger JC, Lunsford LD, Kondziolka D et al (1992) Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 23:19–26

    Article  CAS  PubMed  Google Scholar 

  25. Blonigen BJ, Steinmetz RD, Levin L et al (2010) Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 77:996–1001

    Article  PubMed  Google Scholar 

  26. Minniti G, Clarke E, Lanzetta G et al (2011) Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol 6:48

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The abstract was presented in the poster session of the ESTRO 33 Congress, 4–8 April 2014, Barcelona, Spain.

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Authors and Affiliations

  1. Radiotherapy Unit, Azienda Ospedaliero Universitaria Careggi, University of Florence, Largo Brambilla 3, 50141, Florence, Italy

    Daniela Greto, Silvia Scoccianti, Isacco Desideri & Lorenzo Livi

  2. Medical Physics Unit, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy

    Stefania Pallotta, Cinzia Talamonti & Livia Marrazzo

  3. Medical Physics Unit, I.F.C.A., Florence, Italy

    Laura Masi & Raffaella Doro

  4. Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), Florence, Italy

    Calogero Saieva

Authors
  1. Daniela Greto
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  2. Stefania Pallotta
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  3. Laura Masi
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  4. Cinzia Talamonti
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  5. Livia Marrazzo
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  6. Raffaella Doro
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  7. Calogero Saieva
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  8. Silvia Scoccianti
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  9. Isacco Desideri
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  10. Lorenzo Livi
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Corresponding author

Correspondence to Daniela Greto.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Greto, D., Pallotta, S., Masi, L. et al. A dosimetric comparison between CyberKnife and tomotherapy treatment plans for single brain metastasis. Radiol med 122, 392–397 (2017). https://doi.org/10.1007/s11547-017-0735-9

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  • DOI: https://doi.org/10.1007/s11547-017-0735-9

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