title: Dose conformation of intensity-modulated stereotactic photon beams, proton beams, and intensity-modulated proton beams for intracranial lesions.
abstract: OBJECTIVE
  This study evaluates photon beam intensity-modulated stereotactic radiotherapy (IMSRT) based on dynamic leaf motion of a micromultileaf collimator (mMLC), proton beams, and intensity-modulated proton therapy (IMPT) with respect to target coverage and organs at risk.
  
  
  METHODS
  Dose plans of 6 stereotactically treated patients were recalculated for IMSRT by use of the same field setup and an inverse planning algorithm. Proton and IMPT plans were calculated anew. Three different tumor shapes, multifocal, ovoid, and irregular, were analyzed, as well as dose to organs-at-risk (OAR) in the vicinity of the planning target volume (PTV). Dose distributions were calculated from beam-setup data for a manual mMLC for stereotactically guided conformal radiotherapy (SCRT), a dynamic mMLC for IMSRT, the spot-scanning technique for protons, and a modified spot-scanning technique for IMPT. SCRT was included for a part of the comparison. Criteria for assessment were PTV coverage, dose-volume histograms (DVH), volumes of specific isodoses, and the dose to OAR.
  
  
  RESULTS
  Dose conformation to the PTV is equally good for all three techniques and tumor shapes considered. The volumes of the 90% and 80% isodose were comparable for all techniques. For the 50% isodose volume, a divergence between the two modes was seen. In 3 cases, this volume is smaller for IMSRT, and in the 3 other cases, it is smaller for IMPT. This difference was even more pronounced for the volumes of the 30% isodose; IMPT shows further improvement over conventional protons. OAR in concavities (e.g., the brainstem) were similarly well spared by protons and IMSRT. IMPT spares critical organs best. Fewer proton beams are required to achieve similar results.
  
  
  CONCLUSIONS
  The addition of intensity modulation improves the conformality of mMLC-based SCRT. Conformation of dose to the PTV is comparable for IMSRT, protons, and IMPT. Concerning the sparing of OAR, IMSRT is equivalent to IMPT, and IMPT is superior to conventional protons. The advantage of protons lies in the lower integral dose.
authors.affiliation: Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland. brigitta.baumert@maastro.nl
authors.forename: Brigitta G
authors.initials: BG
authors.lastname: Baumert
authors.forename: Ian A
authors.initials: IA
authors.lastname: Norton
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Lomax
authors.forename: J Bernard
authors.initials: JB
authors.lastname: Davis
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy; D003397:Craniopharyngioma / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008577:Meningeal Neoplasms / Q000473:pathology / Q000532:radiotherapy; D008579:Meningioma / Q000473:pathology / Q000532:radiotherapy; D017785:Photons / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000532:radiotherapy; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods*; D013238:Stereotaxic Techniques; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000532:radiotherapy; D011522:Protons
chemical_list: D011522:Protons