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Dosimetric comparison of volumetric modulated arc therapy and dynamic conformal arc therapy techniques for radiosurgery of single brain metastasis

1 Department of Radiation Oncology, Yeni Yuzyil University Gaziosmanpasa Hospital; Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
2 Department of Radiation Oncology, Nisantasi University, Istanbul, Turkey
3 Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey
4 Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey

Correspondence Address:
Ismail Faruk Durmus,
Department of Radiation Oncology, Yeni Yuzyil University Gaziosmanpasa Hospital, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_738_20

Background: Volumetric modulated arc therapy (VMAT) and/or dynamic conformal arc therapy (DCAT) techniques are commonly used for the radiosurgical management of the intracranial primary or metastatic tumors. Because the literature on the dosimetric comparison is scarce, we intended to dosimetrically compare the VMAT and DCAT techniques for radiosurgery of single brain metastasis. Materials and Methods: The VMAT- and DCAT-based radiosurgical plans of 28 patients presenting with single brain metastasis were compared in terms of conformity index (CI), gradient index (GI), heterogeneity index (HI), Paddick CI (CIPaddick), high-dose spillage (HDS%), monitor units (MUs), and beam-on times. The dosimetric verification of the plans was measured with the new transmission detector Dolphin and assessed in the Compass software. Results: For the whole study population, the CI (1.12 vs. 1.21; P = 0.011), GI (4.41 vs. 4.61; P < 0.001), and HDS% (6.83 vs. 13.06; P < 0.001) were all found to be significantly better with VMAT. Similar results were found between the two techniques in terms of HI (VMAT 1.46 vs. DCAT 1.44; P = 0.065) and CIPaddick (VMAT 1.07 vs. DCAT 1.12; P = 0.0103). On the other hand, the DCAT plans were found to offer 25.1% lower MU (3178 vs. 4242; P < 0.001) and 19.9% lower beam-on times (411 vs. 326 s; P < 0.001) compared to VMAT plans. For pretreatment plan verification, in gamma analyses, ≥90% pass was achieved for the criteria of 3% dose difference (DD)-3-mm distance to agreement (DTA), 2% DD-2-mm DTA, and 3% DD-1-mm DTA. Conclusions: The results of our present dosimetric study implied that the VMAT was capable to offer significantly more conformal stereotactic radiosurgery plans with steeper dose falloff beyond the target volume for single brain metastasis than the DCAT, which attained at the cost of significantly higher MU and beam-on times.

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