Dosimetric Comparison of Dynamic Conformal Arc Therapy and Volumetric Modulated Arc Therapy using Stereotactic Radiotherapy for Carcinoma Brain

Document Type : Original Paper

Authors

1 Department of Radiation Oncology, Medical Radiation Physics Program, Manipal, Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.

2 Department of Radiation Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India-576104.

10.22038/ijmp.2025.78775.2393

Abstract

Introduction: Stereotactic radiosurgery (SRS) conventionally relies upon dynamic conformal arc therapy (DCAT), yet the untapped potential of volumetric modulated arc therapy (VMAT) has not undergone comprehensive scrutiny. This investigation seeks to bridge this research lacuna by comparing DCAT and VMAT in the context of four-fraction SRS for single brain carcinoma treatment.
Material and Methods: A retrospective cohort of twenty patients with solitary brain tumors was meticulously chosen, and treatment plans using both VMAT and DCAT were devised for each case utilizing congruent CT images. The comparative study analysed factors such as target conformity, monitor units and doses to organs at risk.
Results: VMAT plans notably exhibited enhanced conformity indices with mean and standard deviation values for the Paddick Conformity Index being 0.650 ± 0.18 for DCAT and 0.751 ± 0.08 for VMAT. Also, VMAT reduced radiation doses to pivotal anatomical structures, in contrast to the DCAT plans. However, the VMAT approach necessitated a greater number of Mus than DCAT with the mean and standard deviation being 986.95 ± 146.3 and 571.36 ± 59.6, respectively.
Conclusion: In the realm of SRS for isolated brain carcinoma, VMAT decidedly surpassed DCAT in target conformity as well as in mitigating the risk of brain radiation necrosis. Nonetheless, DCAT find relevance in patients with compromised performance status to prolonged radiotherapy sessions due to its abbreviated duration in the treatment. This research highlights the nuanced considerations inherent in treatment selection and also sheds insightful light on the optimal therapeutic approach.

Keywords

Main Subjects


  1. Baskar R, Lee KA,Yeo R,Yeoh KW “Cancer and radiation therapy: Current advances and future directions,” J. Med. Sci.,2012;9(3):193-9
  2. Munshi A, “Central nervous system tumors: Spotlight on India,” South Asian J. Cancer,2016;5(3):146-7
  3. Torizuka D, Uto M,Takehana K, Mizowaki T. Dosimetric comparison among dynamic conformal arc therapy, coplanar and non-coplanar volumetric modulated arc therapy for single brain metastasis. J. Radiat. Res.,2021;62(6):1114-9
  4. Park H, Cho J, Kim S. Dosimetric Effects of Rotational Setup Error in Volumetric Modulated Arc Radiotherapy on Brain Tumor Patients.
  5. Suresh T and Madeswaran S. Impact of 6 MV & 10 MV Flattened and Flattening Filter Free Beams in Whole Brain Radiotherapy : A Treatment Planning Study, no. Mlc.
  6. Nabavi M, Nedaie HA, Salehi N, Naderi M. Stereotactic Radiosurgery / Radiotherapy : A Historical Review. 2014;10(4):156-67
  7. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J. Clin. Oncol., 2004;22(14):2865-72
  8. Hiyama H, Arai K, Izawa M,Takakura K. Stereotactic radiosurgery for the treatment of brain metastases. Brain and Nerve. 1996;48(2):113-9
  9. Yamamoto M, Kawabe T, Sato Y, Higuchi Y, Nariai T, Watanabe S, et al., Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2-9 versus 10 or more tumors. J. Neurosurg. 2014;121(Suppl_2):16-25.
  10. Mhatre VR, Chadha P, Chauhan R, Talapatra K, Kumar AP.“Dosimetric Comparison of Two Linear Accelerator-Based Radiosurgery Systems for Intracranial Tumours with Rapidarc and Dynamic Conformal Arc Therapy. Iranian Journal of Medical Physics. 2021;18(5).
  11. Saroj DK, Yadav S, Ghosh G, Shukla S, Gupta G, Choudhary S. Dosimetric Comparison between 6MV Flattened Filter and Flattening Filter Free Photon Beams in the Treatment of Glioblastoma with IMRT Technique : A Treatment Planning Study. Iranian Journal of Medical Physics. 2020;17(3):188-96.
  12. Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G. Phase II trial of hypofractionated stereotactic radiotherapy for brain metastases: Results and toxicity. Radiother. Oncol.2006;81(1):18-24
  13. Moon YM, Jeon W,Yu T, Bae SI, Kim JY, Kang JK, et al. Which Is Better for Liver SBRT : Dosimetric Comparison Between DCAT and VMAT for Liver Tumors. 2020;10:1-7
  14. Clements M, Schupp N, Tattersall M, Brown A, Larson R. Medical Dosimetry Monaco treatment planning system tools and optimization processes. Med. Dosim.2018;43(2):106-17
  15. Blonigen BJ, Steinmetz RD, Levin L, Lamba MA, Warnick RE, Breneman JC.Irradiated Volume as a Predictor of Brain Radionecrosis After Linear Accelerator Stereotactic Radiosurgery. Int. J. Radiat. Oncol. Biol. Phys. 2010;77(4):996-1001
  16. Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, et al. Stereotactic radiosurgery for brain metastases: Analysis of outcome and risk of brain radionecrosis, Radiat. Oncol. 2011;6(1):1-9
  17. Putz F, Weissmann T, Oft D, Schmidt MA, Roesch J, Siavooshhaghighi H, et al. FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study. Front. Oncol. 2020;10:1-12
  18. Remick JS, Kowalski E, Khairnar R, Sun K, Morse E, Cherng HR, et al. A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis. Radiat. Oncol. 2020;15(1);1-11
  19. Kirkpatrick JP, Soltys SG, Lo SS, Beal K, Shrieve DC, Brown PD. The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro. Oncol. 2017;19:II38–49
  20. Türkkan G, Bilici N, Sertel H, Tavli B, Özkirim M, Fayda M. Dosimetric Comparison of Volumetric-Modulated Arc Therapy and Dynamic Conformal Arc Therapy in Threefraction Single-isocenter Stereotactic Radiosurgery for Multiple Brain Metastases. Turk Onkol. Derg. 2022;37(1):67-73
  21. Hofmaier J, Bodensohn R, Garny S, Hadi I, Fleischmann DF, Eder M, et al. 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):4-11
  22. Uto M, Mizowaki T, Ogura K, Mukumoto N, Katagiri T, Takehana K, et al. Dosimetric comparison between dual-isocentric dynamic conformal arc therapy and mono-isocentric volumetric-modulated arc therapy for two large brain metastases. J. Radiat. Res. 2018;59(6):774-81.
  23. Yuan J, Lee R, Dusenbery KE, Lee CK, Mathew DC, Sperduto PW, et al. Cumulative doses to brain and other critical structures after multisession Gamma Knife stereotactic radiosurgery for treatment of multiple metastatic tumors. Front. Oncol. 2018;8:1-8
  24. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: Final report of RTOG Protocol 90-05. International Journal of Radiation Oncology*Biology*Physics, 2000; 47(2), 291–
  25. Kirkpatrick JP, Wang Z, Sampson JH, McSherry F, Herndon II JE, Allen KJ, et al. Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: Results of a randomized trial. Int. J. Radiat. Oncol. Biol. Phys.2015;91(1):100-8
  26. Fatima N, Meola A, Pollom E, Chang SD, Soltys S. Stereotactic Radiosurgery for Large Benign Intracranial Tumors. World Neurosurg. 2020;134:e172–80,
  27. Dupic G, Brun L, Molnar I, Leyrat B, Chassin V, Moreau J, et al. Significant correlation between gross tumor volume (GTV) D98% and local control in multifraction stereotactic radiotherapy (MF-SRT) for unresected brain metastases. Radiother. Oncol. 2021;154:260-8
  28. Paddick I and Lippitz B, A simple dose gradient measurement tool to complement the conformity index. J. Neurosurg. 2006;105:194-201.
  29. Marks JE, Bagĺan RJ, Prassad SC, Blank WF. Cerebral radionecrosis: Incidence and risk in relation to dose, time, fractionation, and volume. Int. J. Radiat. Oncol. Biol. Phys.,1981;7(2):243-52
  30. Vaios EJ, Winter SF, Shih HA, Dietrich J, Peters KB, Floyd SR, et al. Novel Mechanisms and Future Opportunities for the Management of Radiation Necrosis in Patients Treated for Brain Metastases in the Era of Immunotherapy. Cancers (Basel). 2023;15(9):1-28
  31. Nissen C, Ying J, Newkirk M, Narayanasamy G, Lewis G, Xia F. et al. “An Analysis of Risk Factors for Radiation Necrosis Following Cranial Radiation,” Cureus, 2022;14(9).
  32. Bohoudi O, Bruynzeel AM, Lagerwaard FJ, Cuijpers JP, Slotman BJ, Palacios MA. Isotoxic radiosurgery planning for brain metastases. Radiother. Oncol. 2016;120(2):253-7
  33. Monk JE, Perks JR,Doughty D, Plowman PN. Comparison of a micro-multileaf collimator with a 5-mm-leaf-width collimator for intracranial stereotactic radiotherapy. Int. J. Radiat. Oncol. Biol. Phys., 2003;57(5):1443-9.
  34. Jin JY, Yin FF, Ryu S, Ajlouni M, Jae HK. Dosimetric study using different leaf-width MLCs for treatment planning of dynamic conformal arcs and intensity-modulated radiosurgery. Med. Phys., 2005;32(2):405-11 .