Jeongho Kim PhD , Tae Gyu Kim MD , Byungdo Park PhD , Hyunjung Kim MD , Yun Gyu Song MD , Hyoun Wook Lee MD , Young Zoon Kim MD , Jun Ho Ji MD , Seok-Hyun Kim MD , Sung Min Kim MD , Jun Ho Lee MD , Haeyoung Kim MD
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This study aimed to compare dosimetric parameters of 2 commercially-available volumetric-modulated arc radiotherapy techniques, HyperArc and </span>RapidArc<span>, when using hippocampal-sparing WBRT with a SIB to treat brain metastases.</span></span></p><p><span>Treatment plans using HyperArc and RapidArc techniques were generated retrospectively for 19 previously treated patients (1 to 3 brain metastases). The planning target volumes for the whole brain (excluding the hippocampal avoidance region; PTV</span><sub>WB</sub><span>) and metastases (PTV</span><sub>met</sub>) were prescribed 25 and 45 Gy, respectively, in 10 fractions. Each plan included homogeneous and inhomogeneous delivery to the PTV<sub>met</sub>. Dosimetric parameters for the target (conformity index [CI], homogeneity index [HI], target coverage [D<sub>95%</sub>]), and nontarget organs at risk were compared for the HyperArc and RapidArc plans.</p><p>For homogeneous delivery, dosimetric parameters, including mean CI, HI, and target coverage in PTV<sub>WB</sub> and PTV<sub>met</sub>, were superior for HyperArc than RapidArc plans (all <em>p</em> < 0.01). The PTV<sub>WB</sub> and PTV<sub>met</sub> target coverage for HyperArc plans was significantly greater than for RapidArc plans (96.17% <em>vs</em> 93.38%, <em>p</em> < 0.01; 94.02% <em>vs</em> 92.21%, <em>p</em> < 0.01, respectively). HyperArc plans had significantly lower mean hippocampal D<sub>max</sub> and D<sub>min</sub> values than RapidArc plans (D<sub>max</sub>: 15.53 Gy <em>vs</em>, 16.71 Gy, <em>p</em> < 0.01; D<sub>min</sub>: 8.33 Gy <em>vs</em> 8.93 Gy, <em>p</em> < 0.01, respectively). Similarly, inhomogeneous delivery of hyperArc produced a superior target and lower hippocampal dosimetric parameters than RapidArc, except for the HI of PTV<sub>met</sub> (all <em>p</em> < 0.01).</p><p>HyperArc generated superior conformity and target coverage with lower hippocampal doses than RapidArc. 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However, there is no reported feasibility of using the HyperArc technique in hippocampal-sparing WBRT with a simultaneous integrated boost (SIB). This study aimed to compare dosimetric parameters of 2 commercially-available volumetric-modulated arc radiotherapy techniques, HyperArc and </span>RapidArc<span>, when using hippocampal-sparing WBRT with a SIB to treat brain metastases.</span></span></p><p><span>Treatment plans using HyperArc and RapidArc techniques were generated retrospectively for 19 previously treated patients (1 to 3 brain metastases). The planning target volumes for the whole brain (excluding the hippocampal avoidance region; PTV</span><sub>WB</sub><span>) and metastases (PTV</span><sub>met</sub>) were prescribed 25 and 45 Gy, respectively, in 10 fractions. Each plan included homogeneous and inhomogeneous delivery to the PTV<sub>met</sub>. Dosimetric parameters for the target (conformity index [CI], homogeneity index [HI], target coverage [D<sub>95%</sub>]), and nontarget organs at risk were compared for the HyperArc and RapidArc plans.</p><p>For homogeneous delivery, dosimetric parameters, including mean CI, HI, and target coverage in PTV<sub>WB</sub> and PTV<sub>met</sub>, were superior for HyperArc than RapidArc plans (all <em>p</em> < 0.01). The PTV<sub>WB</sub> and PTV<sub>met</sub> target coverage for HyperArc plans was significantly greater than for RapidArc plans (96.17% <em>vs</em> 93.38%, <em>p</em> < 0.01; 94.02% <em>vs</em> 92.21%, <em>p</em> < 0.01, respectively). HyperArc plans had significantly lower mean hippocampal D<sub>max</sub> and D<sub>min</sub> values than RapidArc plans (D<sub>max</sub>: 15.53 Gy <em>vs</em>, 16.71 Gy, <em>p</em> < 0.01; D<sub>min</sub>: 8.33 Gy <em>vs</em> 8.93 Gy, <em>p</em> < 0.01, respectively). 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引用次数: 0
摘要
众所周知，HyperArc 技术可为颅内病变或海马区全脑放射治疗（WBRT）生成高质量的放射外科治疗计划。然而，目前还没有关于将 HyperArc 技术用于海马区全脑放射治疗（WBRT）中同步综合增强（SIB）的可行性报告。本研究旨在比较HyperArc和RapidArc这两种市售容积调制弧形放射治疗技术在使用海马区保全WBRT与SIB治疗脑转移瘤时的剂量学参数。全脑（不包括海马回避区；PTVWB）和转移灶（PTVmet）的计划目标体积分别为 25 Gy 和 45 Gy，分 10 次进行。每个计划都包括对 PTVmet 的均质和非均质给药。对HyperArc和RapidArc计划的靶点（符合指数[CI]、均匀指数[HI]、靶点覆盖率[D95%]）和非危险靶器官的剂量参数进行了比较。对于均匀给药，HyperArc计划的剂量参数，包括PTVWB和PTVmet的平均CI、HI和靶点覆盖率，均优于RapidArc计划（所有P均为0.01）。HyperArc 计划的 PTVWB 和 PTVmet 目标覆盖率明显高于 RapidArc 计划（分别为 96.17% vs 93.38%，p < 0.01；94.02% vs 92.21%，p < 0.01）。超弧形计划的海马平均 Dmax 和 Dmin 值明显低于快速弧形计划（Dmax：15.53 Gy vs, 16.71 Gy, p < 0.01；Dmin：8.33 Gy vs 8.93 Gy, p < 0.01）。同样，与 RapidArc 相比，HyperArc 的非均匀给药产生了更好的靶点和更低的海马剂量参数，但 PTVmet 的 HI 除外（均 p < 0.01）。与 RapidArc 相比，HyperArc 能产生更好的符合性和目标覆盖率，同时海马剂量更低。HyperArc 可能是一种有吸引力的采用 SIB 的海马保留 WBRT 技术。
Dosimetric comparison between RapidArc and HyperArc in hippocampal-sparing whole-brain radiotherapy with a simultaneous integrated boost
The HyperArc technique is known for generating high-quality radiosurgical treatment plans for intracranial lesions or hippocampal-sparing whole-brain radiotherapy (WBRT). However, there is no reported feasibility of using the HyperArc technique in hippocampal-sparing WBRT with a simultaneous integrated boost (SIB). This study aimed to compare dosimetric parameters of 2 commercially-available volumetric-modulated arc radiotherapy techniques, HyperArc and RapidArc, when using hippocampal-sparing WBRT with a SIB to treat brain metastases.
Treatment plans using HyperArc and RapidArc techniques were generated retrospectively for 19 previously treated patients (1 to 3 brain metastases). The planning target volumes for the whole brain (excluding the hippocampal avoidance region; PTVWB) and metastases (PTVmet) were prescribed 25 and 45 Gy, respectively, in 10 fractions. Each plan included homogeneous and inhomogeneous delivery to the PTVmet. Dosimetric parameters for the target (conformity index [CI], homogeneity index [HI], target coverage [D95%]), and nontarget organs at risk were compared for the HyperArc and RapidArc plans.
For homogeneous delivery, dosimetric parameters, including mean CI, HI, and target coverage in PTVWB and PTVmet, were superior for HyperArc than RapidArc plans (all p < 0.01). The PTVWB and PTVmet target coverage for HyperArc plans was significantly greater than for RapidArc plans (96.17% vs 93.38%, p < 0.01; 94.02% vs 92.21%, p < 0.01, respectively). HyperArc plans had significantly lower mean hippocampal Dmax and Dmin values than RapidArc plans (Dmax: 15.53 Gy vs, 16.71 Gy, p < 0.01; Dmin: 8.33 Gy vs 8.93 Gy, p < 0.01, respectively). Similarly, inhomogeneous delivery of hyperArc produced a superior target and lower hippocampal dosimetric parameters than RapidArc, except for the HI of PTVmet (all p < 0.01).
HyperArc generated superior conformity and target coverage with lower hippocampal doses than RapidArc. HyperArc could be an attractive technique for hippocampal-sparing WBRT with an SIB.
期刊介绍：
Medical Dosimetry, the official journal of the American Association of Medical Dosimetrists, is the key source of information on new developments for the medical dosimetrist. Practical and comprehensive in coverage, the journal features original contributions and review articles by medical dosimetrists, oncologists, physicists, and radiation therapy technologists on clinical applications and techniques of external beam, interstitial, intracavitary and intraluminal irradiation in cancer management. Articles dealing primarily with physics will be reviewed by a specially appointed team of experts in the field.
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