The Leksell gamma knife Model U versus Model C: a quantitative comparison of radiosurgical treatment parameters.
OBJECTIVE
We present a quantitative comparison of radiosurgery treatments for cavernous sinus tumors using the Leksell gamma knife Model U versus the Model C with automatic positioning system (APS) (Elekta Instruments, Norcross, GA).


METHODS
At our medical center from August 1994 through May 2000, the Model U was used to treat 96 patients (37 men [39%] and 59 women [61%]; median age, 54.5 yr) with benign cavernous sinus tumors: 43 meningiomas (45%), 48 pituitary tumors (50%), and 5 others (5%). From June 2000 through April 2002, the Model C with APS treated 45 patients (20 men [44%] and 25 women [56%]; median age, 51.4 yr) with 15 meningiomas (33%), 29 pituitary tumors (65%), and 1 schwannoma (2%). The two groups had similar treated tumor volumes (Model U mean, 4.3 cm(3); Model C mean, 4.2 cm(3)), equivalent tumor distances from critical structures (optic nerve, chiasm, and pons), comparable distributions in Sekhar tumor grades, and the same median prescribed dose of 15 Gy to the 50% isodose line at the tumor periphery. All planning and treatments were performed by the same radiosurgery team to minimize dosage to adjacent critical tissues and to optimize conformity index.


RESULTS
Analysis of multiple treatment parameters showed that the Model C plans were superior. Model C treatments had an improved conformity index (Model U mean, 1.7; Model C mean, 1.6; P < 0.02) and a lower underdosed tumor volume (Model U mean, 0.4 cm(3); Model C mean, 0.1 cm(3); P < 0.004). The total treated volume and the excess treated volume were similar. The Model C group had a reduction in optic chiasm dose (Model C mean dose, 3.8 Gy; Model U mean dose, 5.3 Gy; P < 0.0001). The average number of isocenters was slightly higher for the Model C group (6.7 versus 6 for the Model U), but with a lower mean number of collimator sizes (1 versus 2 for the Model U). Model C plans required a mean of 93 fewer plugs per treatment, thus contributing to an estimated 67.6 minutes saved per treatment session.


CONCLUSIONS
Comparison of radiosurgery treatments using the Leksell gamma knife Model U versus the Model C with APS was performed by quantitative analysis of treatment parameters on a cohort of benign cavernous sinus tumors. Treatment plans using the Model C resulted in better tumor coverage (improved conformity, less underdosed tumor volume) and decreased optic chiasm dose. An estimated average of 1 hour was saved per treatment when using the Model C with APS.
Kuo
John S
JS
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033-1029, USA. Kuo5577@hotmail.com
Yu
Cheng
C
Giannotta
Steven L
SL
Petrovich
Zbigniew
Z
Apuzzo
Michael L J
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies