open access

Vol 26, No 1 (2021)
Research paper
Published online: 2021-01-22
Submitted: 2021-01-14
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Feasibility and potential advantages using VMAT in SRS metastasis treatments

Maria Jose Perez-Calatayud, Antonio Vicente Menendez Lopez, Francisco Javier Celada-Alvarez, Antonio Jose Conde-Moreno, Mariola Bernisz, Françoise Lliso, Vicente Carmona, Jose Gimeno-Olmos, Carlos Botella-Asuncion, Jose Perez-Calatayud
DOI: 10.5603/RPOR.a2021.0019
·
Rep Pract Oncol Radiother 2021;26(1):119-127.

open access

Vol 26, No 1 (2021)
Original research articles
Published online: 2021-01-22
Submitted: 2021-01-14

Abstract

Background: Utilization of stereotactic radiosurgery (SRS) for brain metastases (BM) has become the technique of choice as opposed to whole brain radiation therapy (WBRT). The aim of this work is to evaluate the feasibility and potential benefits in terms of normal tissue (NT) and dose escalation of volumetric modulated arc therapy (VMAT) in SRS metastasis treatment. A VMAT optimization procedure has therefore been developed for internal dose scaling which minimizes planner dependence.

Materials and methods: Five patient-plans incorporating treatment with frame-based SRS with dynamic conformal arc technique (DA) were re-planned for VMAT. The lesions selected were between 4–6 cm3. The same geometry used in the DA plans was maintained for the VMAT cases. A VMAT planning procedure was performed attempting to scale the dose in inner auxiliary volumes, and to explore the potential for dose scaling with this technique. Comparison of dose-volume histogram (DVH) parameters were obtained.

Results: VMAT allows a superior NT sparing plus conformity and dose scaling using the auxiliary volumes. The VMAT results were significantly superior in NT sparing, improving both the V10 and V12 values in all cases, with a 2–3 cm3 saving. In addition, VMAT improves the dose coverage D95 by about 0.5 Gy. The objective of dose escalation was achieved with VMAT with an increment of the Dmean and the Dmedian of about 2 Gy.

Conclusions: This work shows a benefit of VMAT in SRS treatment with significant NT sparing. A VMAT optimization procedure, based on auxiliary inner volumes, has been developed, enabling internal dose escalation.

Abstract

Background: Utilization of stereotactic radiosurgery (SRS) for brain metastases (BM) has become the technique of choice as opposed to whole brain radiation therapy (WBRT). The aim of this work is to evaluate the feasibility and potential benefits in terms of normal tissue (NT) and dose escalation of volumetric modulated arc therapy (VMAT) in SRS metastasis treatment. A VMAT optimization procedure has therefore been developed for internal dose scaling which minimizes planner dependence.

Materials and methods: Five patient-plans incorporating treatment with frame-based SRS with dynamic conformal arc technique (DA) were re-planned for VMAT. The lesions selected were between 4–6 cm3. The same geometry used in the DA plans was maintained for the VMAT cases. A VMAT planning procedure was performed attempting to scale the dose in inner auxiliary volumes, and to explore the potential for dose scaling with this technique. Comparison of dose-volume histogram (DVH) parameters were obtained.

Results: VMAT allows a superior NT sparing plus conformity and dose scaling using the auxiliary volumes. The VMAT results were significantly superior in NT sparing, improving both the V10 and V12 values in all cases, with a 2–3 cm3 saving. In addition, VMAT improves the dose coverage D95 by about 0.5 Gy. The objective of dose escalation was achieved with VMAT with an increment of the Dmean and the Dmedian of about 2 Gy.

Conclusions: This work shows a benefit of VMAT in SRS treatment with significant NT sparing. A VMAT optimization procedure, based on auxiliary inner volumes, has been developed, enabling internal dose escalation.

Get Citation

Keywords

SRS; VMAT; metastasis; clinical dosimetry; radiotherapy

About this article
Title

Feasibility and potential advantages using VMAT in SRS metastasis treatments

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 26, No 1 (2021)

Article type

Research paper

Pages

119-127

Published online

2021-01-22

DOI

10.5603/RPOR.a2021.0019

Bibliographic record

Rep Pract Oncol Radiother 2021;26(1):119-127.

Keywords

SRS
VMAT
metastasis
clinical dosimetry
radiotherapy

Authors

Maria Jose Perez-Calatayud
Antonio Vicente Menendez Lopez
Francisco Javier Celada-Alvarez
Antonio Jose Conde-Moreno
Mariola Bernisz
Françoise Lliso
Vicente Carmona
Jose Gimeno-Olmos
Carlos Botella-Asuncion
Jose Perez-Calatayud

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