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• W2065312900 abstract "Awareness of inter- and intra-fraction uncertainties is increasingly important in the era of stereotactic radiation therapy (SRT); their incorporation into the margin of the planning target volume (PTV) is essential to ensure delivery of the prescribed dose to the target. The purpose of this work is to develop a method to formulate PTV margins for gamma-knife intracranial SRT to manage uncertainties for the relocatable head frame (RHF). A Margin Calculator tool was developed for PTV margin derivation, and applied to gamma-knife intracranial stereotactic radiosurgery (SRS). Under ethics approval, 5 patient's targets (0 mm PTV margin originally) were re-planned in the treatment planning system with 3 PTV margins: isotropic 1 and 2 mm; and the clinical PTV margin used for the RHF, 1.5 mm anterior/posterior (AP) and left/right (LR), and 2 mm superior/inferior (SI). The dose distributions were imported into the Margin Calculator module for stochastic simulations using uncertainties measured on the RHF immobilization device. The RHF's localization (no image-guidance) and residual (image-guidance) systematic (∑) and random (σ) errors were determined with cone-beam CT imaging from patients treated with LINAC-based SRT. In the AP, RL, SI directions, no image-guidance ∑ and σ were [0.8, 0.8, 1.2] mm and [0.6, 0.6, 0.9] mm, respectively; image-guidance ∑ and σ were [0.6, 0.2, 0.8] mm and [0.4, 0.3, 0.6] mm, respectively. For each patient, 4 fractionation schedules were assessed: 1, 3, 5 and 10. Dose population histograms were used to evaluate the differential effects of various factors on the required PTV margin. Cumulative dose population histograms were used to assess a goal of 95% population receiving a minimum dose (Dmin) of 95%. Over 5 patients, 20 000 simulations were performed for 4 radiation therapy fractionation schedules using the RHF's ∑ and σ uncertainties with and without image-guidance. Without image-guidance and a PTV margin of 2 mm, the Dmin for 95% population was 69%, 85%, 90% and 94% for 1, 3, 5, and 10 fractions, respectively. With image-guidance and a PTV margin of 2 mm, the Dmin for 95% population was 82%, 95%, 95.25%, and 97.5% for 1, 3, 5, and 10 fractions, respectively. For a 10 fraction schedule, a Dmin of 95% for 95% of the population was achieved at a 1 mm PTV margin. Using a specified objective of 95% population receiving a minimum dose of 95%, in the absence of image guidance, a PTV margin of > 2 mm is required for 1, 3, 5 and 10 fraction intracranial SRT using the RHF. With image guidance, a 2 mm margin is sufficient for 3 and 5 fraction treatment, while dose coverage for a 10 fraction schedule is assured with a 1 mm margin. The Margin Calculator tool is useful in deriving population specific PTV margins." @default.
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• W2065312900 date "2013-10-01" @default.
• W2065312900 modified "2023-10-16" @default.
• W2065312900 title "Deriving Planning Target Volume Margins for Intracranial Stereotactic Radiation Therapy" @default.
• W2065312900 doi "https://doi.org/10.1016/j.ijrobp.2013.06.1941" @default.
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