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• W2973168225 abstract "Stereotactic radiosurgery (SRS) for acoustic neuromas (ANs) yields control rates ≥ 90%. Among the available treatment planning systems, the commonly used algorithms for SRS include TMR10, which assumes tissue homogeneity equivalent to water, and collapsed-cone convolutional (CCC) algorithms, which corrects for tissue inhomogeneity. The dosimetric differences between these approaches for patients receiving SRS is not well understood. Given both bone/brain and air/brain interfaces exist adjacent to the internal auditory canal, ANs pose a clinical scenario in which dose inhomogeneity may be relevant. The aim of this study was to quantify the dosimetric differences between TMR10 and CCC planning algorithms for ANs treated with SRS. We performed a retrospective review of 50 AN treated with SRS at a large academic center from 2015-2018. All patients underwent MRI and CT imaging during their initial treatment and were treated using TMR10 generated plans. Electron density curves from CT images were then used to generate a second plan using the CCC planning algorithm. Shot locations and size were kept constant to allow for comparison of the two planning algorithms. Dosimetric outcomes of interest included differences in Dmax, D50%, Cochlea Dmax, and mean cochlea dose. In effort to identify characteristics associated with significant dosimetric differences, patient dosimetry was also analyzed based on laterality (>5mm from central axis) and size (PTV <1cc). 50 patients were treated from 2015-2018 with median planning target volume (PTV) of 1.5cc (0.3cc - 2.8cc) and median dose prescription of 12Gy prescribed to the 50% isodose line. Compared to CCC algorithms, the TMR10 algorithm overestimated the actual delivered dose. Dmax was overestimated by an average 6.2% (3.4%-10.1%, p<.001), Dmin was overestimated by an average 3.1% (1.1%-7.3%, p<.032). The average D50% difference between plans was 11.3% (4.7%-16.1%, p<0.001). The average max Cochlea dose difference between plans was 20.1% (12.9%-24.0%, p<0.001). Differences in Dmax and D50% were greatest in AN that were lateralized, >5mm from central axis (mean Dmax difference: 8.5% vs 1.5%, p<0.001, D50% mean difference: 13.2% vs 6.1%, p<0.001) and small in size, <1cc (mean Dmax difference: 8.9% vs 3.9%, p<0.003, D50% mean difference: 12.1% vs 7.2% p<0.001). We found statistically significant dosimetric differences among ANs planned using TMR10 and CCC algorithms. Plans generated using the TMR10 algorithm are likely overestimating delivered dose, particularly in small and lateralized ANs. For more accurate dosimetry in AN treatment, institutions should consider heterogeneity corrected algorithms. As the use of heterogeneity correction algorithms increases, clinicians should be cognizant of these dosimetric differences when comparing historical studies and outcomes." @default.
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• W2973168225 date "2019-09-01" @default.
• W2973168225 modified "2023-10-18" @default.
• W2973168225 title "Impact of Tissue Heterogeneity Correction on Stereotactic Radiosurgery of Acoustic Neuromas" @default.
• W2973168225 doi "https://doi.org/10.1016/j.ijrobp.2019.06.749" @default.
• W2973168225 hasPublicationYear "2019" @default.
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