title: Beam shaping for conformal fractionated stereotactic radiotherapy: a modeling study.
abstract: OBJECTIVE
  The patient population treated with fractionated stereotactic radiotherapy (SRT) is significantly different than that treated with stereotactic radiosurgery (SRS). Generally, lesions treated with SRT are larger, less spherical, and located within critical regions of the central nervous system; hence, they offer new challenges to the treatment planner. Here a simple, cost effective, beam shaping system has been evaluated relative to both circular collimators and an ideal dynamically conforming system for effectiveness in providing conformal therapy for these lesions.
  
  
  METHODS
  We have modeled a simple system for conformal arc therapy using four independent jaws. The jaw positions and collimator angle are changed between arcs but held fixed for the duration of each arc. Eleven previously treated SRT cases have been replanned using this system. The rectangular jaw plans were then compared to the original treatment plans which used circular collimators. The plans were evaluated with respect to tissue sparing at 100%, 80%, 50%, and 20% of the prescription dose. A plan was also done for each tumor in which the beam aperture was continuously conformed to the beams eye view projection of the tumor. This was used as an ideal standard for conformal therapy in the absence of fluence modulation.
  
  
  RESULTS
  For tumors with a maximum extent of over 3.5 cm the rectangular jaw plans reduced the mean volume of healthy tissue involved at the prescription dose by 57% relative to the circular collimator plans. The ideal conformal plans offered no significant further improvement at the prescription dose. The relative advantage of the rectangular jaw plans decreased at lower isodoses so that at 20% of the prescription dose tissue involvement for the rectangular jaw plans was equivalent to that for the circular collimator plans. At these isodoses the ideal conformal plans gave substantially better tissue sparing.
  
  
  CONCLUSIONS
  A simple and economical field shaping device has been shown to provide all of the beam shaping advantage of a hypothetical ideal dynamically conforming system at the prescription level. This system may be immediately implemented in the clinic. It offers a substantial advantage over the currently used circular collimators in the high dose region with equivalent performance in the low dose region.
authors.affiliation: Joint Center for Radiation Therapy, Department of Radiation Oncology, Harvard Medical School, Boston, MA 02215, USA. hacker@gog.jcrt.harvard.edu
authors.forename: F L
authors.initials: FL
authors.lastname: Hacker
authors.forename: H M
authors.initials: HM
authors.lastname: Kooy
authors.forename: M R
authors.initials: MR
authors.lastname: Bellerive
authors.forename: J H
authors.initials: JH
authors.lastname: Killoran
authors.forename: Z H
authors.initials: ZH
authors.lastname: Leber
authors.forename: D C
authors.initials: DC
authors.lastname: Shrieve
authors.forename: N J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: J S
authors.initials: JS
authors.lastname: Loeffler
mesh_terms: D006801:Humans; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation / Q000379:methods*