Dosimetric comparison of helical tomotherapy and Gamma Knife stereotactic radiosurgery for single brain metastasis.
BACKGROUND
Helical Tomotherapy (HT) integrates linear accelerator and computerized tomography (CT) technology to deliver IMRT. Targets are localized (i.e. outlined as gross tumor volume [GTV] and planning target volume [PTV]) on the planning kVCT study while daily MVCT is used for correction of patient's set-up and assessment of inter-fraction anatomy changes. Based on dosimetric comparisons, this study aims to find dosimetric equivalency between single fraction HT and Gamma Knife stereotactic radiosurgery (GKSRS) for the treatment of single brain metastasis.


METHODS
The targeting MRI data set from the GKSRS were used for tomotherapy planning. Five patients with single brain metastasis treated with GKSRS were re-planned in the HT planning station using the same prescribed doses. There was no expansion of the GTV to create the PTV. Sub-volumes were created within the PTV and prescribed to the maximum dose seen in the GKSRS plans to imitate the hot spot normally seen in GKSRS. The PTV objective was set as a region at risk in HT planning using the same prescribed dose to the PTV periphery as seen in the corresponding GKSRS plan. The tumor volumes ranged from 437-1840 mm(3).


RESULTS
Conformality indices are inconsistent between HT and GKSRS. HT generally shows larger lower isodose line volumes, has longer treatment time than GKSRS and can treat a much larger lesion than GKSRS. Both HT and GKSRS single fraction dose-volume toxicity may be prohibitive in treating single or multiple lesions depending on the number and the sizes of the lesions.


CONCLUSIONS
Based on the trend for larger lower dose volumes and more constricted higher dose volumes in HT as compared to GKSRS, dosimetric equivalency was not reached between HT and GKSRS.
Peñagarícano
José A
JA
University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. PenagaricanoJoseA@uams.edu
Yan
Yulong
Y
Shi
Chengyu
C
Linskey
Mark E
ME
Ratanatharathorn
Vaneerat
V
D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009362:Neoplasm Metastasis; D011874:Radiometry / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D013997:Time Factors; D036542:Tomography, Spiral Computed / Q000379:methods*