title: Total target volume is a better predictor of whole brain dose from gamma stereotactic radiosurgery than the number, shape, or location of the lesions.
abstract: OBJECTIVE
  To assess the hypothesis that the volume of whole brain that receives a certain dose level is primarily dependent on the treated volume rather than on the number, shape, or location of the lesions. This would help a physician validate the suitability of GammaKnife(®) based stereotactic radiosurgery (GKSR) prior to treatment.
  
  
  METHODS
  Simulation studies were performed to establish the hypothesis for both oblong and spherical shaped lesions of various numbers and sizes. Forty patients who underwent GKSR [mean age of 54 years (range 7-80), mean number of lesions of 2.5 (range 1-6), and mean lesion volume of 4.4 cm(3) (range 0.02-22.2 cm(3))] were also studied retrospectively. Following recommendations of QUANTEC, the volume of brain irradiated by the 12 Gy (VB12) isodose line was measured and a power-law based relation is proposed here for estimating VB12 from the known tumor volume and the prescription dose.
  
  
  RESULTS
  In the simulation study on oblong, spherical, and multiple lesions, the volume of brain irradiated by 50%, 10%, and 1% of maximum dose was found to have linear, linear, and exponentially increasing dependence on the volume of the treated region, respectively. In the retrospective study on 40 GKSR patients, a similar relationship was found to predict the brain dose with a Spearman correlation coefficient >0.9. In both the studies, the volume of brain irradiated by a certain dose level does not have a statistically significant relationship (p ≥ 0.05) with the number, shape, or position of the lesions. The measured VB12 agrees with calculation to within 1.7%.
  
  
  CONCLUSIONS
  The results from the simulation and the retrospective clinical studies indicate that the volume of whole brain that receives a certain percentage of the maximum dose is primarily dependent on the treated volume and less on the number, shape, and location of the lesions.
authors.affiliation: Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Narayanasamy
authors.forename: Adam
authors.initials: A
authors.lastname: Smith
authors.forename: Emily
authors.initials: E
authors.lastname: Van Meter
authors.forename: Ronald
authors.initials: R
authors.lastname: McGarry
authors.forename: Janelle A
authors.initials: JA
authors.lastname: Molloy
mesh_terms: D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005720:Gamma Rays / Q000627:therapeutic use*; D006801:Humans; D011829:Radiation Dosage; D016634:Radiosurgery / Q000379:methods*; D047368:Tumor Burden