Minimizing Normal Tissue Dose Spillage Via Broad-range Optimization of Hundreds of Intensity Modulated Beams for Treating Multiple Brain Targets

Overview

Journal J Radiosurg SBRT

Date 2018 Jan 4

PMID 29296435

Authors

Peng Dong

Sabbir Hossain

Vance Keeling

Salahuddin Ahmad

Lei Xing

Lijun Ma

Affiliations

Soon will be listed here.

Abstract

Variable normal tissue dose and inter-target dose interplay effects have been reported in volumetric modulated arc therapy (VMAT) of multiple brain metastases. In order to minimize such adverse effects, a Broad-Range Optimization of Modulated Beam Approach (BROOMBA) was developed whereby hundreds of intensity-modulated beams surrounding the central axis of the skull were progressively selected and optimized. To investigate technical feasibility and potential dosimetric benefits of BROOMBA, we first developed such an approach on a standalone workstation and then implemented it for a multi-center benchmark case involving 3 to 12 multiple brain metastases. The BROOMBA planning results was compared with VMAT treatment plans of the same case using coplanar and non-coplanar arc beams. We have found that BROOMBA consistently outperformed VMAT plans in terms of low-level normal brain sparing and reduction in the dose interplay effects among the targets. For example, when planning simultaneous treatment of 12 targets, BROOMBA lowered the normal brain dose by as much as 65% versus conventional VMAT treatment plans and the dose interplay effects across 8 Gy to 12 Gy levels was reduced to be negligible. In conclusion, we have demonstrated BROOMBA as a powerful tool for improving the planning quality of multiple brain metastases treatments via modern high-output linear accelerators.

References

Blonigen B, Steinmetz R, Levin L, Lamba M, Warnick R, Breneman J . Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2009; 77(4):996-1001. DOI: 10.1016/j.ijrobp.2009.06.006. View

Hossain S, Keeling V, Hildebrand K, Ahmad S, Larson D, Sahgal A . Normal Brain Sparing With Increasing Number of Beams and Isocenters in Volumetric-Modulated Arc Beam Radiosurgery of Multiple Brain Metastases. Technol Cancer Res Treat. 2015; 15(6):766-771. DOI: 10.1177/1533034615614208. View

Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J . Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol. 2014; 15(4):387-95. DOI: 10.1016/S1470-2045(14)70061-0. View

McDonald D, Schuler J, Takacs I, Peng J, Jenrette J, Vanek K . Comparison of radiation dose spillage from the Gamma Knife Perfexion with that from volumetric modulated arc radiosurgery during treatment of multiple brain metastases in a single fraction. J Neurosurg. 2014; 121 Suppl:51-9. DOI: 10.3171/2014.7.GKS141358. View

Chin L, Ma L, DiBiase S . Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up. J Neurosurg. 2001; 94(6):899-904. DOI: 10.3171/jns.2001.94.6.0899. View

Korytko T, Radivoyevitch T, Colussi V, Wessels B, Pillai K, Maciunas R . 12 Gy gamma knife radiosurgical volume is a predictor for radiation necrosis in non-AVM intracranial tumors. Int J Radiat Oncol Biol Phys. 2005; 64(2):419-24. DOI: 10.1016/j.ijrobp.2005.07.980. View

Ma L, Nichol A, Hossain S, Wang B, Petti P, Vellani R . Variable dose interplay effects across radiosurgical apparatus in treating multiple brain metastases. Int J Comput Assist Radiol Surg. 2014; 9(6):1079-86. PMC: 4215114. DOI: 10.1007/s11548-014-1001-4. View

Dong P, Lee P, Ruan D, Long T, Romeijn E, Low D . 4π noncoplanar stereotactic body radiation therapy for centrally located or larger lung tumors. Int J Radiat Oncol Biol Phys. 2013; 86(3):407-13. DOI: 10.1016/j.ijrobp.2013.02.002. View

Sneed P, Mendez J, Vemer-van den Hoek J, Seymour Z, Ma L, Molinaro A . Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg. 2015; 123(2):373-86. DOI: 10.3171/2014.10.JNS141610. View

10.

Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M . Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2015; 91(4):710-7. DOI: 10.1016/j.ijrobp.2014.10.024. View

11.

Ma L, Petti P, Wang B, Descovich M, Chuang C, Barani I . Apparatus dependence of normal brain tissue dose in stereotactic radiosurgery for multiple brain metastases. J Neurosurg. 2011; 114(6):1580-4. DOI: 10.3171/2011.1.JNS101056. View

12.

Sahgal A, Ma L, Chang E, Shiu A, Larson D, Laperriere N . Advances in technology for intracranial stereotactic radiosurgery. Technol Cancer Res Treat. 2009; 8(4):271-80. DOI: 10.1177/153303460900800404. View

13.

Lawrence Y, Li X, El Naqa I, Hahn C, Marks L, Merchant T . Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S20-7. PMC: 3554255. DOI: 10.1016/j.ijrobp.2009.02.091. View