title: Evaluation of a dedicated brain metastases treatment planning optimization for radiosurgery: a new treatment paradigm?
abstract: OBJECTIVE
  To investigate the feasibility of a novel dedicated treatment planning solution, to automatically target multiple brain metastases with a single isocenter and multiple inversely-optimized dynamic conformal arcs (DCA), and to benchmark it against the well-established multiple isocenter DCA (MIDCA) and volumetric modulated arc therapy (VMAT) approaches.
  
  
  METHODS
  Ten previously treated patients were randomly selected, each representing a variable number of lesions ranging between 1 to 8. The original MIDCA treatments were replanned with both VMAT and the novel brain metastases tool. The plans were compared by means of Paddick conformity (CI) and gradient index (GI), and the volumes receiving 10 Gy (V10) and 12 Gy (V12).
  
  
  RESULTS
  The brain metastases software tool generated plans with similar CI (0.65 ± 0.08) as both established treatment techniques while improving the gradient (mean GI = 3.9 ± 1.4). The normal tissue exposure in terms of V10 (48.5 ± 35.9 cc) and V12 (36.3 ± 27.1 cc) compared similarly to the MIDCA technique and surpassed VMAT plans.
  
  
  CONCLUSIONS
  The automated brain metastases planning algorithm software is an optimization of DCA radiosurgery by increasing delivery efficiency to the level of VMAT approaches. Improving dose gradients and normal tissue sparing over VMAT, revives DCA as the paradigm for linac-based stereotactic radiosurgery of multiple brain metastases.
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. thierry.gevaert@uzbrussel.be.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gevaert
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Femke.steenbeke@uzbrussel.be.
authors.forename: Femke
authors.initials: F
authors.lastname: Steenbeke
authors.affiliation: Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium. luca.pellegri@jolimont.be.
authors.forename: Luca
authors.initials: L
authors.lastname: Pellegri
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. benedikt.engels@uzbrussel.be.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Engels
authors.affiliation: Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium. Nicolas.christian@jolimont.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Christian
authors.affiliation: Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium. mhoornaert@jolimont.be.
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Hoornaert
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. dirk.verellen@uzbrussel.be.
authors.forename: Dirk
authors.initials: D
authors.lastname: Verellen
authors.affiliation: Department of Radiotherapy, Centre Hospitalier Jolimont, Jolimont, Belgium. carine.mitine@jolimont.be.
authors.forename: Carine
authors.initials: C
authors.lastname: Mitine
authors.affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. mark.deridder@uzbrussel.be.
authors.forename: Mark
authors.initials: M
authors.lastname: De Ridder
mesh_terms: D000465:Algorithms; D001331:Automation; D019985:Benchmarking; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009362:Neoplasm Metastasis; D010363:Pattern Recognition, Automated; D011829:Radiation Dosage; D011874:Radiometry / Q000379:methods; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D011897:Random Allocation; D012984:Software
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