Dosimetric comparison of volumetric modulated arc therapy with TrueBeam LINAC and hypofractionated radiosurgery with gamma knife ICON for large (>10 cm 3 ) skull base meningiomas

Abstract

BACKGROUND:

Multi Fractionated stereotactic radiosurgery (MF-SRS) of Linac has an essential role in the treatment of skull base meningiomas (sbMNG). However, Gamma Knife Icon (GK) allows MF-SRS using mask immobilization with onboard image guidance.

OBJECTIVE:

This dosimetric study aims to investigate whether equivalent plan quality can be achieved with Volumetric Modulated Arc Therapy (VMAT) in patients with large sbMNG (>10 cm³) previously treated with GK.

METHODS:

Twenty patients with the median target volume of 19.7cm³ are re-planned by using VMAT with 20 Gy in 5 fractions. Plan qualities are compared to tumor coverage, paddick conformity index (PCI), gradient index (GI), V₄ _Gy, V₁₀ _Gy, V₁₂ _Gy, optic chiasm V₂₀ _Gy, brainstem V₂₃ _Gy, optic nerve V₂₅ _Gy volumes, and maximum doses for all. Additionally, beam-on time and approximate planning time are also analyzed and compared.

RESULTS:

All plans provide adequate clinical requirements. First, the CI is comparable for the GK and VMAT (0.99±0.01 vs. 1.13±0.20; p = 0.18). Second, VMAT has a significantly higher GI than GK (3.81±0.35 vs. 2.63±0.09; p < 0.001). Third, the PCI is significantly higher in GK than VMAT (0.76±0.05 vs. 0.70±0.07; p < 0.001). The lower GI of the GK also results in significantly lower V₄ _Gy (156.1±43.8 vs. 207.5±40.1 cm³, p < 0.001) and V₁₀ _Gy (26.1±9.0 vs. 28.9±7.7 cm³, p ^< 0.001) compared to VMAT. Last, the VMAT reduces beam-on time (4.8±0.5 vs. 19±1.1 min.; p < 0.001).

CONCLUSION:

Although both systems have succeeded in creating effective plans in clinical practice, the GK reveals more effective lower normal brain tissue doses. However, the shorter treatment time with LINAC, excluding the total procedure time, can be considered advantageous over GK.

Keywords

Dosimetric study gamma knife LINAC meningioma

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