PMID- 31231614 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2234-943X (Print) IS - 2234-943X (Electronic) IS - 2234-943X (Linking) VI - 9 DP - 2019 TI - Multi-Institutional Dosimetric Evaluation of Modern Day Stereotactic Radiosurgery (SRS) Treatment Options for Multiple Brain Metastases. PG - 483 LID - 10.3389/fonc.2019.00483 [doi] LID - 483 AB - Purpose/Objectives: There are several popular treatment options currently available for stereotactic radiosurgery (SRS) of multiple brain metastases: (60)Co sources and cone collimators around a spherical geometry (GammaKnife), multi-aperture dynamic conformal arcs on a linac (BrainLab Elements v1.5), and volumetric arc therapy on a linac (VMAT) calculated with either the conventional optimizer or with the Varian HyperArc solution. This study aimed to dosimetrically compare and evaluate the differences among these treatment options in terms of dose conformity to the tumor as well as dose sparing to the surrounding normal tissues. Methods and Materials: Sixteen patients and a total of 112 metastases were analyzed. Five plans were generated per patient: GammaKnife, Elements, HyperArc-VMAT, and two Manual-VMAT plans to evaluate different treatment planning styles. Manual-VMAT plans were generated by different institutions according to their own clinical planning standards. The following dosimetric parameters were extracted: RTOG and Paddick conformity indices, gradient index, total volume of brain receiving 12Gy, 6Gy, and 3Gy, and maximum doses to surrounding organs. The Wilcoxon signed rank test was applied to evaluate statistically significant differences (p < 0.05). Results: For targets /= 1 cm, HyperArc-VMAT and Manual-VMAT plans resulted in superior conformity vs. GammaKnife and Elements. All SRS plans achieved clinically acceptable organs-at-risk dose constraints. Beam-on times were significantly longer for GammaKnife. Manual-VMAT(A) and Elements resulted in shorter delivery times relative to Manual-VMAT(B) and HyperArc-VMAT. Conclusion: The study revealed that Manual-VMAT and HyperArc-VMAT are capable of achieving similar low dose brain spillage and conformity as GammaKnife, while significantly minimizing beam-on time. For targets smaller than 1 cm in diameter, GammaKnife still resulted in superior gradient indices. The quality of the two sets of Manual-VMAT plans varied greatly based on planner and optimization constraint settings, whereas HyperArc-VMAT performed dosimetrically superior to the two Manual-VMAT plans. FAU - Vergalasova, Irina AU - Vergalasova I AD - Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States. FAU - Liu, Haisong AU - Liu H AD - Department of Radiation Oncology, Thomas Jefferson University Kimmel Cancer Center, Philadelphia, PA, United States. FAU - Alonso-Basanta, Michelle AU - Alonso-Basanta M AD - Department of Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, United States. FAU - Dong, Lei AU - Dong L AD - Department of Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, United States. FAU - Li, Jun AU - Li J AD - Department of Radiation Oncology, Thomas Jefferson University Kimmel Cancer Center, Philadelphia, PA, United States. FAU - Nie, Ke AU - Nie K AD - Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States. FAU - Shi, Wenyin AU - Shi W AD - Department of Radiation Oncology, Thomas Jefferson University Kimmel Cancer Center, Philadelphia, PA, United States. FAU - Teo, Boon-Keng Kevin AU - Teo BK AD - Department of Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, United States. FAU - Yu, Yan AU - Yu Y AD - Department of Radiation Oncology, Thomas Jefferson University Kimmel Cancer Center, Philadelphia, PA, United States. FAU - Yue, Ning Jeff AU - Yue NJ AD - Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, United States. FAU - Zou, Wei AU - Zou W AD - Department of Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, United States. FAU - Li, Taoran AU - Li T AD - Department of Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, United States. LA - eng PT - Journal Article DEP - 20190607 PL - Switzerland TA - Front Oncol JT - Frontiers in oncology JID - 101568867 PMC - PMC6568036 OTO - NOTNLM OT - conformity index OT - dynamic conformal arcs OT - multiple brain metastases OT - stereotactic radiosurgery OT - volumetric arc therapy EDAT- 2019/06/25 06:00 MHDA- 2019/06/25 06:01 PMCR- 2019/01/01 CRDT- 2019/06/25 06:00 PHST- 2019/03/07 00:00 [received] PHST- 2019/05/21 00:00 [accepted] PHST- 2019/06/25 06:00 [entrez] PHST- 2019/06/25 06:00 [pubmed] PHST- 2019/06/25 06:01 [medline] PHST- 2019/01/01 00:00 [pmc-release] AID - 10.3389/fonc.2019.00483 [doi] PST - epublish SO - Front Oncol. 2019 Jun 7;9:483. doi: 10.3389/fonc.2019.00483. eCollection 2019.