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• W1997138833 abstract "Purpose/Objective: To compare circular arcs, conformal arcs, conformal beams, and intensity-modulated radiotherapy (IMRT) using a micro-multileaf collimator (M3) in FSR of brain metastases. Particularly, to introduce a single isocenter for multiple targets (SIMT) FSR of brain metastases. Materials/Methods: A total of 32 patients with solitary (9) and multiple (23) brain metastases received FSR in the last year in our institution. Patients received 6 fractions of 5-Gy each for tumors < 3-cm in diameter or 10 fractions of 3-Gy for tumors > 3.0 cm in diameter. The prescription isodose was 80% for all patients. Treatment planning utilized the iohexol contrast-enhanced, transverse CT imaging and the stereotactic localization via the thermoplastic facemask. The planning-target-volumes (PTV) and organ-at-risk were delineated on either the transverse CT images or the fused MRI images. The isocenter was placed within the central of the multiple metastases. All unique tumor volumes were included within the single PTV. The plan optimization included arrangement of 6-15 non-coplanar beams or 3-8 non-coplanar arcs, reshaping each field according to the need of blocking the hotspot or irradiating the cold spot, and comparison of dose distribution and DVHs. The hot spots in normal tissue or cold spots in tumors were defined as unique volumes. The specific relationship of these cold or hot volumes to the leaves was displayed via the beam’s eye view (BEV). Iterative, manual assignment of leaf positions achieved high conformality of 80% isodose to GTV and minimized the dose within normal brain. Results: 8 of 9 solitary brain metastases having round tumors were treated with conformal arcs or circular arcs. One patient with irregular tumor was treated with 11 static beams. For multiple brain metastases, 13 patients with 2-8 lesions were treated with SIMT, 10 patients with 2-6 lesions were treated with arcs as one-isocenter per tumor technique due to a large separation (>10 cm) between lesions that would not allow treatment via the single isocenter for the M3. There is no significant difference between the DVHs for conformal arcs and conformal beams. In comparison between SIMT and IMRT, IMRT plans have decreased the standard deviation of dose in PTV from 8% to <4% but largely increased the dose to surrounding brain tissue. Conclusions: Arc modules are still useful for solitary and rounded brain metastases. IMRT can improve dose distribution for large and irregular targets. SIMT technique using 10 to 15 static beams appears to be the most efficient technique to achieve the desired dose distribution for multiple brain metastases. Under these conditions IMRT has not shown improvement for dose distribution. For multiple tumors, the SIMT technique offers rapid setup and delivery of superior dose distributions." @default.
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• W1997138833 date "2002-10-01" @default.
• W1997138833 modified "2023-09-27" @default.
• W1997138833 title "Optimal fractionated stereotactic radiotherapy (FSR) of brain metastases" @default.
• W1997138833 doi "https://doi.org/10.1016/s0360-3016(02)03638-6" @default.
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