A multi-centre stereotactic radiosurgery planning study of multiple brain metastases using isocentric linear accelerators with 5 and 2.5 mm width multi-leaf collimators, CyberKnife and Gamma Knife.

BJR open Pub Date : 2024-01-30 eCollection Date: 2024-01-01 DOI:10.1093/bjro/tzae003
Scott Hanvey, Philippa Hackett, Lucy Winch, Elizabeth Lim, Robin Laney, Liam Welsh
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Abstract

Objectives: This study compared plans of high definition (HD), 2.5 mm width multi-leaf collimator (MLC), to standard, 5 mm width, isocentric linear accelerator (linacs), CyberKnife (CK), and Gamma Knife (GK) for stereotactic radiosurgery (SRS) techniques on multiple brain metastases.

Methods: Eleven patients undergoing SRS for multiple brain metastases were chosen. Targets and organs at risk (OARs) were delineated and optimized SRS plans were generated and compared.

Results: The linacs delivered similar conformity index (CI) values, but the gradient index (GI) for HD MLCs was significantly lower (P-value <.001). Half the OARs received significantly lower dose using HD MLCs. CK delivered a significantly lower CI than HD MLC linac (P-value <.001), but a significantly higher GI (P-value <.001). CI was significantly improved with the HD MLC linac compared to GK (P-value = 4.591 × 10-3), however, GK delivered a significantly lower GI (P-value <.001). OAR dose sparing was similar for the HD MLC TL, CK, and GK.

Conclusions: Comparing linacs for SRS, the preferred choice is HD MLCs. Similar results were achieved with the HD MLC linac, CK, or GK, with each delivering significant improvements in different aspects of plan quality.

Advances in knowledge: This article is the first to compare HD and standard width MLC linac plans using a combination of single isocentre volumetric modulated arc therapy and multi-isocentric dynamic conformal arc plans as required, which is a more clinically relevant assessment. Furthermore, it compares these plans with CK and GK, assessing the relative merits of each technique.

一项多中心立体定向放射外科规划研究,使用带有 5 毫米和 2.5 毫米宽多叶准直器的等中心直线加速器、CyberKnife 和伽玛刀对多发性脑转移瘤进行治疗。
研究目的:本研究比较了高清(HD)、2.5 毫米宽多叶准直器(MLC)与标准、5 毫米宽等中心直线加速器(linacs)、CyberKnife(CK)和伽玛刀(GK)用于多发性脑转移瘤立体定向放射外科(SRS)技术的方案:方法:选择了11名因多发性脑转移而接受SRS治疗的患者。方法:选择 11 名因多发性脑转移接受 SRS 治疗的患者,划定靶点和危险器官(OAR),并生成和比较优化的 SRS 计划:结果:直列加速器提供了相似的符合性指数(CI)值,但HD MLCs的梯度指数(GI)显著较低(P值 P值 P值 P值 P值 P值 = 4.591 × 10-3),然而GK提供的GI显著较低(P值 结论:在SRS治疗中比较直列加速器是非常重要的:比较用于 SRS 的线加速器,首选是高清 MLC。使用 HD MLC 直列加速器、CK 或 GK 都能获得类似的结果,每种方法都能显著改善计划质量的不同方面:这篇文章首次比较了高清和标准宽度MLC直列加速器计划,根据需要结合使用了单等中心容积调制弧治疗和多等中心动态适形弧计划,这是更贴近临床的评估。此外,它还将这些计划与 CK 和 GK 进行了比较,评估了每种技术的相对优点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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