Quality of Radiosurgical Plans by Leksell Gamma Knife Perfexion in the Treatment of Meningioma: Comparison between two isodose lines (50% and 75%)

Document Type : Original Paper

Authors

1 Gamma knife unit ,Neurosurgery department,faculty of Medicine AL-Azhar university,Damietta,Egypt.

2 Gamma knife Damietta Center, Department of Neurosurgery, faculty of medicine, Damietta Azhar university Hospital. Cairo, Egypt.

3 Biophysics Branch, Physics Department, Faculty of Science, Cairo Azhar University. Cairo, Egypt.

4 M.D of Neurosurgery ,Stereotaxy and Functional Neurosurgery Unit, Neurological Surgery Department, Tanta University, Egypt. Marseille, Aix Marseille, 264 Rue Saint Pierre, Marseille-13006, Marseille-France

5 Biophysics Branch, Physics Department, Faculty of Science, Cairo Azhar University. Cairo, Egypt

6 Department of Radiotherapy and Nuclear Medicine, National Cancer Institute, Cairo;University, Cairo, Egypt

Abstract

Introduction: Radiosurgery is a well-established available technique for treating many diseases and indications. Planning quality assessment is a crucial step in the procedure itself and outcome probabilities; either control or complication probability. Several physical indices and methodology have been developed to describe any plan. Accordingly, plan quality and outcome could be compared with other plans. In current study, the aim was to compare two plans with different isodose line using radiobiological model, tumor control probability (TCP), normal tissue complication probability (NTCP) and plan’s physical indices.   
Material and Methods: The cross-sectional study included 20 patients (5 male and 15 female) with median age of 44 years (21-66) and presented with radiologically diagnosed meningioma. Two radiosurgical forward plans were applied with same marginal dose of 12Gy at two different isodose lines of 50% and 75% isodose alternatively using Leksell Gamma Plan of single session GKS. Dose-Volume Histogram (DVH) was imported to MATLAB to compute TCP, NTCP values at 5 years for each plan, and physical indices such as coverage, selectivity, conformity, heterogeneity, and gradient indices.
Results: Median target irradiated volume was 7.5 cm3 (0.588 -23.72). TCP was significantly higher in the plan using 50% isodose line for the marginal dose than that using 75% isodose line (95.05%, 49.44%, p<0.05, Independent Samples t-Test). Brainstem and optic apparatus NTCPs were very low 0.01% (0-0.045%) in the former plan and zero in the later one (p =0.001, Mann-Whitney test).
Conclusion: Radiobiological models and physical indices could be used for the optimum plan selection of GKS

Keywords

Main Subjects


  1. Pignol JP, Keller BM. Electron and photon spread contributions to the radiological penumbra for small monoenergetic x-ray beam (≤ 2 MeV). Journal of Applied Physics. 2009 May 15;105(10):102011.
  2. Ferris MC, Shepard DM. Optimization of gamma knife radiosurgery. Discrete Mathematical Problems with Medical Applications. 2000;55:27-44.
  3. Liščák R. Gamma Knife Radiosurgery (Surgery-procedures, Complications, and Results). Nova Science Publishers Incorporated; 2013.
  4. Johnson PB, Monterroso MI, Yang F, Mellon E. Optimization of the prescription isodose line for Gamma Knife radiosurgery using the shot within shot technique. Radiation Oncology. 2017 Dec;12(1):1-9.
  5. AB EI. LGP 10 Leksell Gamma Plan®. Online Reference Manual. 2011.
  6. Oldham M, Khoo VS, Rowbottom CG, Bedford JL, Webb S. A case study comparing the relative benefit of optimizing beam weights, wedge angles, beam orientations and tomotherapy in stereotactic radiotherapy of the brain. Physics in Medicine & Biology. 1998 Aug 1;43(8):2123.
  7. Niemierko A. A unified model of tissue response to radiation. InProceedings of the 41th AAPM annual meeting 1999 (Vol. 1100). Nashville: Wikipedia.
  8. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Physica Medica. 2007 Dec 1;23(3-4):115-25.
  9. Willner J, Baier K, Caragiani E, Tschammler A, Flentje M. Dose, volume, and tumor control prediction in primary radiotherapy of non-small-cell lung cancer. International Journal of Radiation Oncology* Biology* Physics. 2002 Feb 1;52(2):382-9.
  10. Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. International Journal of Radiation Oncology* Biology* Physics. 1991 May 15;21(1):109-22.
  11. Mansour Z, Attalla EM, Sarhan A, Awad IA, Hamid MA. Study the Influence of the number of beams on radiotherapy plans for the hyopfractionated treatment of breast cancer using biological model. 2019.
  12. Stavrev P, Stavreva N, Niemierko A, Goitein M. Generalization of a model of tissue response to radiation based on the idea of functional subunits and binomial statistics. Physics in Medicine & Biology. 2001 May 1;46(5):1501.
  13. Paddick I, Lippitz B. A simple dose gradient measurement tool to complement the conformity index. Journal of neurosurgery. 2006 Dec 1;105(Supplement):194-201.
  14. Balagamwala EH, Suh JH, Barnett GH, Khan MK, Neyman G, Cai RS, et al. The importance of the conformality, heterogeneity, and gradient indices in evaluating Gamma Knife radiosurgery treatment plans for intracranial meningiomas. International Journal of Radiation Oncology* Biology* Physics. 2012 Aug 1;83(5):1406-13.
  15. Langer M, Morrill SS, Lane R. A test of the claim that plan rankings are determined by relative complication and tumor-control probabilities. International Journal of Radiation Oncology* Biology* Physics. 1998 May 1;41(2):451-7.
  16. Moiseenko V, Battista J, Van Dyk J. Normal tissue complication probabilities: dependence on choice of biological model and dose-volume histogram reduction scheme. International Journal of Radiation Oncology* Biology* Physics. 2000 Mar 1;46(4):983-93.
  17. Shanei A, Abedi I, Saadatmand P, Amouheidari AR, Akbari-Zadeh H. Comparison of 3D conformal and intensity modulated radiotherapy in early stage oral tongue cancer: Dosimetric and radiobiological evaluation. International Journal of Radiation Research. 2020;18(1):33-42.
  18. Santacroce A, Walier M, Régis J, Liščák R, Motti E, Lindquist C, et al. Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery. 2012 Jan 1;70(1):32-9.
  19. Rana S, Cheng CY. Radiobiological impact of planning techniques for prostate cancer in terms of tumor control probability and normal tissue complication probability. Annals of Medical and Health Sciences Research. 2014;4(2):167-72.

 

 

 

 

 

Volume 20, Issue 1
January and February 2023
Pages 19-30
  • Receive Date: 06 December 2021
  • Revise Date: 05 February 2022
  • Accept Date: 16 February 2022