Effects of Institutional Experience on Plan Quality in Stereotactic Radiotherapy Using HyperArc for Brain Metastases

Overview

Journal In Vivo

Specialty Oncology

Date 2024 Dec 31

PMID 39740907

Authors

Sayaka Kihara

Shingo Ohira

Naoyuki Kanayama

Toshiki Ikawa

Shoki Inui

Masaru Isono

Yuya Nitta

Yoshihiro Ueda

Teiji Nishio

Koji Konishi

Affiliations

Soon will be listed here.

Abstract

Background/aim: HyperArc (HA) is an automated planning technique enabling single-isocenter brain stereotactic radiotherapy (SRT); however, dosimetric outcomes may be influenced by the planner's expertise. This study aimed to assess the impact of institutional experience on the plan quality of HA-SRT for both single and multiple brain metastases.

Materials And Methods: Twenty patients who underwent HA-SRT for single metastasis between 2020 and 2021 comprised the earlier group, while those treated between 2022 and 2024 constituted the later group. For multiple metastases, 40 patients who received HA-SRT from 2020-2024 were divided into earlier and later treatment groups. Dosimetric parameters including gross tumor volume (GTV) doses (D and Dmean), volumes of the normal brain (Brain-GTV V and V), homogeneity index (HI), gradient index (GI), and total monitor unit (MU) were compared. A linear regression model was used to evaluate the effects of planning target volume (PTV) on volumes of normal brain via interaction between PTV volume and treatment era group (earlier vs. later).

Results: The later group exhibited significantly higher D and D values for both single and multiple metastases, while V and V and GI mean values were comparable. Consequently, mean HI and total MU values increased significantly. Both single and multiple metastases showed significant interaction between PTV volume and treatment era group.

Conclusion: Enhanced dosimetric outcomes in the later group suggested that accumulated experience contributed to improve GTV and brain dose in HA SRT. Institutional experience is important to improve the plan quality for SRT even with automatic planning such as HA.

References

Brown P, Jaeckle K, Ballman K, Farace E, Cerhan J, Anderson S . Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA. 2016; 316(4):401-409. PMC: 5313044. DOI: 10.1001/jama.2016.9839. View

Niemierko A . Reporting and analyzing dose distributions: a concept of equivalent uniform dose. Med Phys. 1997; 24(1):103-10. DOI: 10.1118/1.598063. View

Berry S, Boczkowski A, Ma R, Mechalakos J, Hunt M . Interobserver variability in radiation therapy plan output: Results of a single-institution study. Pract Radiat Oncol. 2016; 6(6):442-449. PMC: 5099085. DOI: 10.1016/j.prro.2016.04.005. View

Sagawa T, Ueda Y, Tsuru H, Kamima T, Ohira S, Tamura M . Dosimetric potential of knowledge-based planning model trained with HyperArc plans for brain metastases. J Appl Clin Med Phys. 2022; 24(2):e13836. PMC: 9924102. DOI: 10.1002/acm2.13836. View

Ohira S, Ueda Y, Kanayama N, Isono M, Inui S, Komiyama R . Impact of Multileaf Collimator Width on Dose Distribution in HyperArc Fractionated Stereotactic Irradiation for Multiple (-) Brain Metastases. Anticancer Res. 2021; 41(6):3153-3159. DOI: 10.21873/anticanres.15101. View

Kanayama N, Ikawa T, Ohira S, Hirata T, Morimoto M, Ogawa K . Volumetric reduction of brain metastases after stereotactic radiotherapy: Prognostic factors and effect on local control. Cancer Med. 2022; 11(24):4806-4815. PMC: 9761087. DOI: 10.1002/cam4.4809. View

Jung H, Yoon J, Dona Lemus O, Tanny S, Zhou Y, Milano M . Dosimetric evaluation of LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery with more than 20 targets: comparing MME, HyperArc, and RapidArc. Radiat Oncol. 2024; 19(1):19. PMC: 10848506. DOI: 10.1186/s13014-024-02416-7. View

Lee Y, Wieczorek D, Chaswal V, Kotecha R, Hall M, Tom M . A study on inter-planner plan quality variability using a manual planning- or Lightning dose optimizer-approach for single brain lesions treated with the Gamma Knife Icon™. J Appl Clin Med Phys. 2023; 24(11):e14088. PMC: 10647977. DOI: 10.1002/acm2.14088. View

Kennedy W, DeWees T, Acharya S, Mahmood M, Knutson N, Goddu S . Internal dose escalation associated with increased local control for melanoma brain metastases treated with stereotactic radiosurgery. J Neurosurg. 2020; 135(3):855-861. DOI: 10.3171/2020.7.JNS192210. View

10.

Liu H, Andrews D, Evans J, Werner-Wasik M, Yu Y, Dicker A . Plan Quality and Treatment Efficiency for Radiosurgery to Multiple Brain Metastases: Non-Coplanar RapidArc vs. Gamma Knife. Front Oncol. 2016; 6:26. PMC: 4749694. DOI: 10.3389/fonc.2016.00026. View

11.

Goldbaum D, Hurley J, Hamilton R . A simple knowledge-based tool for stereotactic radiosurgery pre-planning. J Appl Clin Med Phys. 2019; 20(12):97-108. PMC: 6909177. DOI: 10.1002/acm2.12770. View

12.

Clark G, Popple R, Young P, Fiveash J . Feasibility of single-isocenter volumetric modulated arc radiosurgery for treatment of multiple brain metastases. Int J Radiat Oncol Biol Phys. 2009; 76(1):296-302. DOI: 10.1016/j.ijrobp.2009.05.029. View

13.

Hofmaier J, Bodensohn R, Garny S, Hadi I, Fleischmann D, Eder M . Single isocenter stereotactic radiosurgery for patients with multiple brain metastases: dosimetric comparison of VMAT and a dedicated DCAT planning tool. Radiat Oncol. 2019; 14(1):103. PMC: 6560766. DOI: 10.1186/s13014-019-1315-z. View

14.

Ohira S, Ueda Y, Akino Y, Hashimoto M, Masaoka A, Hirata T . HyperArc VMAT planning for single and multiple brain metastases stereotactic radiosurgery: a new treatment planning approach. Radiat Oncol. 2018; 13(1):13. PMC: 5789615. DOI: 10.1186/s13014-017-0948-z. View

15.

Abraham C, Garsa A, Badiyan S, Drzymala R, Yang D, DeWees T . Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS). Adv Radiat Oncol. 2018; 3(2):146-153. PMC: 6000027. DOI: 10.1016/j.adro.2017.11.003. View

16.

Xu Y, Ma P, Xu Y, Dai J . Selection of prescription isodose line for brain metastases treated with volumetric modulated arc radiotherapy. J Appl Clin Med Phys. 2019; 20(12):63-69. PMC: 6909111. DOI: 10.1002/acm2.12761. View

17.

Andruska N, Kennedy W, Bonestroo L, Anderson R, Huang Y, Robinson C . Dosimetric predictors of symptomatic radiation necrosis after five-fraction radiosurgery for brain metastases. Radiother Oncol. 2020; 156:181-187. DOI: 10.1016/j.radonc.2020.12.011. View

18.

Inui S, Takahashi Y, Ueda Y, Ohira S, Washio H, Ono S . Dosimetric Comparison of Helical Tomotherapy and HyperArc Treatment Plans for Angiosarcoma of the Scalp. Anticancer Res. 2023; 43(7):3079-3087. DOI: 10.21873/anticanres.16479. View

19.

Milano M, Grimm J, Niemierko A, Soltys S, Moiseenko V, Redmond K . Single- and Multifraction Stereotactic Radiosurgery Dose/Volume Tolerances of the Brain. Int J Radiat Oncol Biol Phys. 2020; 110(1):68-86. PMC: 9387178. DOI: 10.1016/j.ijrobp.2020.08.013. View

20.

Raza G, Capone L, Tini P, Giraffa M, Gentile P, Minniti G . Single-isocenter multiple-target stereotactic radiosurgery for multiple brain metastases: dosimetric evaluation of two automated treatment planning systems. Radiat Oncol. 2022; 17(1):116. PMC: 9250172. DOI: 10.1186/s13014-022-02086-3. View