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01-05-2022 | Metastasis | Original Article

Single-isocenter stereotactic non-coplanar arc treatment of 200 patients with brain metastases: multileaf collimator size and setup uncertainties

Authors: Lucie Calmels, Susan Blak Nyrup Biancardo, Patrik Sibolt, Susanne Nørring Bekke, Ulf Bjelkengren, Eva Wilken, Poul Geertsen, David Sjöström, Claus F. Behrens

Published in: Strahlentherapie und Onkologie | Issue 5/2022

Abstract

Purpose

The purpose of this study was to evaluate our 2 years’ experience with single-isocenter, non-coplanar, volumetric modulated arc therapy (VMAT) for brain metastasis (BM) stereotactic radiosurgery (SRS).

Methods

A total of 202 patients treated with the VMAT SRS solution were analyzed retrospectively. Plan quality was assessed for 5 mm (120) and 2.5 mm (high-definition, HD) central leaf width multileaf collimators (MLCs). For BMs at varying distances from the plan isocenter, the geometric offset from the ideal position for two image-guided radiotherapy workflows was calculated. In the workflow with ExacTrac (BrainLAB, München, Germany; W‑ET), patient positioning errors were corrected at each couch rotation. In the workflow without ExacTrac (W-noET), only the initial patient setup correction was considered. The dose variation due to rotational errors was simulated for multiple-BM plans with the HD-MLC.

Results

Plan conformity and quality assurance were equivalent for plans delivered with the two MLCs while the HD-MLC plans provided better healthy brain tissue (BmP) sparing. 95% of the BMs had residual intrafractional setup errors ≤ 2 mm for W‑ET and 68% for W‑noET. For small BM (≤1 cc) situated >3 cm from the plan isocenter, the dose received by 95% of the BM decreased in median (interquartile range) by 6.3% (2.8–8.8%) for a 1-degree rotational error.

Conclusion

This study indicates that the HD-MLC is advantageous compared to the 120-MLC for sparing healthy brain tissue. When a 2-mm margin is applied, W‑noET is sufficient to ensure coverage of BM situated ≤ 3 cm of the plan isocenter, while for BM further away, W‑ET is recommended.

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Title: Single-isocenter stereotactic non-coplanar arc treatment of 200 patients with brain metastases: multileaf collimator size and setup uncertainties
Authors: Lucie Calmels
Susan Blak Nyrup Biancardo
Patrik Sibolt
Susanne Nørring Bekke
Ulf Bjelkengren
Eva Wilken
Poul Geertsen
David Sjöström
Claus F. Behrens
Publication date: 01-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 5/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-021-01846-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-isocenter stereotactic non-coplanar arc treatment of 200 patients with brain metastases: multileaf collimator size and setup uncertainties

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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