Dose homogeneity analysis of adjuvant radiation treatment in surgically resected brain metastases : Comparison of IORT, SRS, and IMRT indices
Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved..
PURPOSE: Although surgery remains a treatment option for symptomatic brain metastases, the need for adjuvant radiation after surgery is widely accepted as standard. Despite a multitude of randomized trials aimed at identifying the ideal radiation treatment plan for surgically resected metastases, the development of new delivery regiments necessitates a periodic re-evaluation of dosimetric performance/outcome. Here, we compare the homogeneity index (HI) across three platforms: single-session stereotactic radiosurgery (SRS), multisession stereotactic radiotherapy, and intraoperative radiotherapy (IORT).
METHODS AND MATERIALS: Patients treated with IORT after surgical resection of brain metastases were identified and dosimetric parameters collected from the dose-volume histograms based on the development of conformal plans for adjuvant radiation using Gamma Knife-SRS (GK-SRS), linear accelerator based intensity-modulated radiation therapy, and IORT. HIs were calculated using four established methods and compared across platforms within the patient cohort. Statistical analyses were performed using analysis of variance.
RESULTS: The mean maximal doses for the GK-SRS and IMRT plans were 30 Gy and 29 Gy with margin prescription doses of 16 Gy and 24 Gy, respectively. The IORT dose was 30 Gy to the applicator surface. HIs varied based on calculation methods, but maintained consistency when comparing across platforms with IORT having the lower mean HI value (0.56; 95% confidence interval (CI) 0.55-0.60) in single-fraction treatment, compared with GK-SRS (0.77; 95% CI 0.76-0.80). The mean multisession IMRT HI was lower than both single-fraction treatment modalities at 0.41 (95% CI 0.40-0.42).
CONCLUSIONS: When using the HI as the primary dosimetric parameter for adjuvant radiation plans after surgical resection of brain metastases IORT offers improved dose homogeneity compared with GK-SRS in single-fraction treatment, whereas fractionated LINAC-based IMRT was superior with respect to the HI in comparison among all three methods.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
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| Enthalten in: |
Brachytherapy - 20(2021), 2 vom: 13. März, Seite 426-432 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dahshan, Basem A [VerfasserIn] |
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| Links: |
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| Themen: |
Brain metastases |
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| Anmerkungen: |
Date Completed 19.08.2021 Date Revised 02.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.brachy.2020.11.004 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM320168859 |
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| 100 | 1 | |a Dahshan, Basem A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Dose homogeneity analysis of adjuvant radiation treatment in surgically resected brain metastases |b Comparison of IORT, SRS, and IMRT indices |
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| 500 | |a Date Completed 19.08.2021 | ||
| 500 | |a Date Revised 02.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: Although surgery remains a treatment option for symptomatic brain metastases, the need for adjuvant radiation after surgery is widely accepted as standard. Despite a multitude of randomized trials aimed at identifying the ideal radiation treatment plan for surgically resected metastases, the development of new delivery regiments necessitates a periodic re-evaluation of dosimetric performance/outcome. Here, we compare the homogeneity index (HI) across three platforms: single-session stereotactic radiosurgery (SRS), multisession stereotactic radiotherapy, and intraoperative radiotherapy (IORT) | ||
| 520 | |a METHODS AND MATERIALS: Patients treated with IORT after surgical resection of brain metastases were identified and dosimetric parameters collected from the dose-volume histograms based on the development of conformal plans for adjuvant radiation using Gamma Knife-SRS (GK-SRS), linear accelerator based intensity-modulated radiation therapy, and IORT. HIs were calculated using four established methods and compared across platforms within the patient cohort. Statistical analyses were performed using analysis of variance | ||
| 520 | |a RESULTS: The mean maximal doses for the GK-SRS and IMRT plans were 30 Gy and 29 Gy with margin prescription doses of 16 Gy and 24 Gy, respectively. The IORT dose was 30 Gy to the applicator surface. HIs varied based on calculation methods, but maintained consistency when comparing across platforms with IORT having the lower mean HI value (0.56; 95% confidence interval (CI) 0.55-0.60) in single-fraction treatment, compared with GK-SRS (0.77; 95% CI 0.76-0.80). The mean multisession IMRT HI was lower than both single-fraction treatment modalities at 0.41 (95% CI 0.40-0.42) | ||
| 520 | |a CONCLUSIONS: When using the HI as the primary dosimetric parameter for adjuvant radiation plans after surgical resection of brain metastases IORT offers improved dose homogeneity compared with GK-SRS in single-fraction treatment, whereas fractionated LINAC-based IMRT was superior with respect to the HI in comparison among all three methods | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Brain metastases | |
| 650 | 4 | |a Gamma Knife | |
| 650 | 4 | |a Homogeneity index | |
| 650 | 4 | |a IMRT | |
| 650 | 4 | |a IORT | |
| 650 | 4 | |a Radiation | |
| 700 | 1 | |a Weir, Joshua S |e verfasserin |4 aut | |
| 700 | 1 | |a Bice, Robert P |e verfasserin |4 aut | |
| 700 | 1 | |a Renz, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Cifarelli, Daniel T |e verfasserin |4 aut | |
| 700 | 1 | |a Poplawski, Linda |e verfasserin |4 aut | |
| 700 | 1 | |a Hack, Joshua |e verfasserin |4 aut | |
| 700 | 1 | |a Vargo, John A |e verfasserin |4 aut | |
| 700 | 1 | |a Cifarelli, Christopher P |e verfasserin |4 aut | |
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