title: Radiosurgery of small skull-base lesions. No advantage for intensity-modulated stereotactic radiosurgery versus conformal arc technique.
abstract: OBJECTIVE
  Intensity-modulated stereotactic radiotherapy (IMSRT) has shown the ability to conform the dose to concavities and to better avoid critical organs for large tumors. Given the availability of an electronically driven micro-multileaf collimator, both intensity-modulated stereotactic radiosurgery (IMSRS) and dynamic conformal arc (DCA) technique (DCA) can be performed at the Novalis Shaped Beam Surgery Center, University of Erlangen-Nuremberg, Germany, since 12/2002. This study evaluates both techniques in small skull-base tumors treated with radiosurgery.
  
  
  METHODS
  Between 12/2002 and 04/2004, a total of 109 radiosurgical procedures were performed in 77 patients, equally distributed between patients with acoustic neuroma (AN), pituitary adenoma (PA) and meningeoma (M). Six index patients (n = 2 AN, n = 1 PA, n = 3 M) routinely planned for dynamic arc stereotactic radiosurgery were replanned using the IMSRS approach (BrainScan, BrainLAB, Heimstetten, Germany). The RTOG radiosurgery quality assurance guidelines, isodose volumes, doses to organs at risk (OAR), and dose delivery criteria were compared.
  
  
  RESULTS
  DCA was superior to IMSRS for homogeneity and coverage. IMSRS could keep the high-dose-irradiated volumes (90% isodose volume) lower than DCA in the PA and AN with very small volumes, but all other lower dose volumes were larger for IMSRS. Dose maxima to OAR were higher for IMSRS. Treatment delivery time for IMSRS would clearly exceed treatment time for DCA by a factor of 2-3. The integral absorbed dose to the brain was much higher in the IMSRS than in the DCA approach (factor 2-3).
  
  
  CONCLUSIONS
  RTOG radiosurgery guidelines were best met by the DCA rather than IMSRS approach for the treatment of small skull-base lesions. The IMSRS approach will increase the time for planning, dose delivery and integral dose to the brain. Thus, IMSRT techniques are recommended for fractionated stereotactic radiotherapy to larger volumes rather than for radiosurgery in small skull-base lesions.
authors.affiliation: Department of Radiation Therapy and Novalis Shaped Beam Surgery Center, University of Erlangen-Nuremberg, Erlangen, Germany. antje.ernst-stecken@strahlen.imed.uni-erlangen.de
authors.forename: Antje
authors.initials: A
authors.lastname: Ernst-Stecken
authors.forename: Ulrike
authors.initials: U
authors.lastname: Lambrecht
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.forename: Reinhold
authors.initials: R
authors.lastname: Mueller
authors.forename: Rudolf
authors.initials: R
authors.lastname: Fahlbusch
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Grabenbauer
mesh_terms: D000236:Adenoma / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008579:Meningioma / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000532:radiotherapy / Q000601:surgery; D010911:Pituitary Neoplasms / Q000532:radiotherapy / Q000601:surgery; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000532:radiotherapy* / Q000601:surgery*