title: Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for 1-3 brain metastases: a feasibility study using volumetric modulated arc therapy.
abstract: OBJECTIVE
  To evaluate the feasibility of using volumetric modulated arc therapy (VMAT) to deliver whole brain radiotherapy (WBRT) with hippocampal avoidance and a simultaneous integrated boost (SIB) for one to three brain metastases.
  
  
  METHODS
  Ten patients previously treated with stereotactic radiosurgery for one to three brain metastases underwent repeat planning using VMAT. The whole brain prescription dose was 32.25 Gy in 15 fractions, and SIB doses to brain metastases were 63 Gy to lesions >or=2.0 cm and 70.8 Gy to lesions <2.0 cm in diameter. The mean dose to the hippocampus was kept at <6 Gy(2). Plans were optimized for conformity and target coverage while minimizing hippocampal and ocular doses. Plans were evaluated on target coverage, prescription isodose to target volume ratio, conformity number, homogeneity index, and maximum dose to prescription dose ratio.
  
  
  RESULTS
  Ten patients had 18 metastases. Mean values for the brain metastases were as follows: conformity number = 0.73 +/- 0.10, target coverage = 0.98 +/- 0.01, prescription isodose to target volume = 1.34 +/- 0.19, maximum dose to prescription dose ratio = 1.09 +/- 0.02, and homogeneity index = 0.07 +/- 0.02. For the whole brain, the mean target coverage and homogeneity index were 0.960 +/- 0.002 and 0.39 +/- 0.06, respectively. The mean hippocampal dose was 5.23 +/- 0.39 Gy(2). The mean treatment delivery time was 3.6 min (range, 3.3-4.1 min).
  
  
  CONCLUSIONS
  VMAT was able to achieve adequate whole brain coverage with conformal hippocampal avoidance and radiosurgical quality dose distributions for one to three brain metastases. The mean delivery time was under 4 min.
authors.affiliation: Vancouver Centre, Department of Radiation Oncology, BC Cancer Agency, British Columbia, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Hsu
authors.forename: Hannah
authors.initials: H
authors.lastname: Carolan
authors.forename: Alan
authors.initials: A
authors.lastname: Nichol
authors.forename: Fred
authors.initials: F
authors.lastname: Cao
authors.forename: Nimet
authors.initials: N
authors.lastname: Nuraney
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Ermias
authors.initials: E
authors.lastname: Gete
authors.forename: Frances
authors.initials: F
authors.lastname: Wong
authors.forename: Moira
authors.initials: M
authors.lastname: Schmuland
authors.forename: Manraj
authors.initials: M
authors.lastname: Heran
authors.forename: Karl
authors.initials: K
authors.lastname: Otto
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation / Q000379:methods*; D005123:Eye / Q000528:radiation effects*; D005240:Feasibility Studies; D006624:Hippocampus / Q000528:radiation effects*; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*