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Comparison of dosimetric parameters and robustness for rotational errors in fractionated stereotactic irradiation using automated noncoplanar volumetric modulated arc therapy for patients with brain metastases: single- versus multi-isocentric technique

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Abstract

To compare the dosimetric parameters of automated noncoplanar volumetric modulated arc therapy plans using single-isocentric (SIC) and multi-isocentric (MIC) techniques for patients with two brain metastases (BMs) in stereotactic irradiation and to evaluate the robustness of rotational errors. The SIC and MIC plans were retrospectively generated (35 Gy/five fractions) for 58 patients. Subsequently, a receiver operating characteristic curve analysis between the tumor surface distance (TSD) and V25Gy was performed to determine the thresholds for the brain tissue. The SIC and MIC plans were recalculated based on the rotational images to evaluate the dosimetric impact of rotational error. The MIC plans showed better brain tissue sparing for TSD > 6.6 cm. The SIC plans provided a significantly better conformity index for TSD ≤ 6.6 cm, while significantly lower gradient index was obtained (3.22 ± 0.56vs. 3.30 ± 0.57, p < 0.05) in the MIC plans with TSD > 6.6 cm. For organs at risk (OARs) (brainstem, chiasm, lens, optic nerves, and retinas), D0.1 cc was significantly lower (p < 0.05) in the MIC plans than in the SIC plans. The prescription dose could be delivered (D99%) to the gross tumor volume (GTV) for patients with TSD ≤ 6.6 cm when the rotational error was < 1°, whereas 31% of the D99% of GTV fell below the prescription dose with TSD > 6.6 cm. MIC plans can be an optimal approach for reducing doses to OARs and providing robustness against rotational errors in BMs with TSD > 6.6 cm.

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Funding

This study was supported by JSPS KAKENHI Grant (Grant-in-Aid for Scientific Research (C) 21K07742).

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Author notes

  1. Yuki Yamamoto and Shingo Ohira have contributed equally.

Authors and Affiliations

  1. Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan

    Yuki Yamamoto, Teiji Nishio & Masahiko Koizumi

  2. Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, Osaka, 537-8567, Japan

    Shingo Ohira, Naoyuki Kanayama, Shoki Inui, Yoshihiro Ueda, Masayoshi Miyazaki & Koji Konishi

  3. Department of Radiology, Kansai Medical University, Osaka, Japan

    Yuhei Koike

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  1. Yuki Yamamoto
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All the authors participated in the writing this article and take responsibility for its content. The authors confirm that the content of the manuscript has not been published, or submitted for publication elsewhere.

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Correspondence to Shingo Ohira.

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Yamamoto, Y., Ohira, S., Kanayama, N. et al. Comparison of dosimetric parameters and robustness for rotational errors in fractionated stereotactic irradiation using automated noncoplanar volumetric modulated arc therapy for patients with brain metastases: single- versus multi-isocentric technique. Radiol Phys Technol 16, 310–318 (2023). https://doi.org/10.1007/s12194-023-00720-7

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  • DOI: https://doi.org/10.1007/s12194-023-00720-7

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