Evaluation of Hybrid Arc and Volumetric-Modulated Arc Therapy Treatment Plans for Fractionated Stereotactic Intracranial Radiotherapy

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Purpose: The study was aimed to compare hybrid arc and volumetric-modulated arc therapy treatment plans for fractionated stereotactic radiotherapy of brain tumors. Methods: Treatment plans of 22 patients were studied. Hybrid arc and volumetric-modulated arc therapy plans were generated using Brainlab iPlanDose and Varian Eclipse treatment planning systems, respectively, with 6 MV photon beams on a Varian TrueBeam STx linear accelerator (Palo Alto, CA). Prescription dose was 54 Gy. The fractionation was 1.8 Gy per fraction and 30 fractions in total, or 2 Gy per fraction and 27 fractions in total. Planning target volume ranged from 2.4 to 28.6 cm 3 . Dose conformity index, gradient index, homogeneity index, and maximum doses in organs at risk were compared. Wilcoxon signed rank test was used to determine statistical significance in paired comparison. Results: Conformity indexes of hybrid arc and volumetric-modulated arc therapy plans are 1.10 ± 0.10 and 1.14 ± 0.07, respectively ( P = .4); gradient indexes are 5.02 ± 1.20 and 5.64 ± 1.28, respectively ( P = .0001); homogeneity indexes are 1.02 ± 0.01 and 1.05 ± 0.01, respectively ( P = .0001); brainstem maximum doses are 53.87 ± 1.63 Gy and 54.06 ± 3.17 Gy, respectively ( P = .1); and optic chiasm maximum doses are 53.86 ± 1.28 Gy and 53.95 ± 1.81, respectively ( P = .4). The monitor unit efficiencies of hybrid arc and volumetric-modulated arc therapy plans are 2.57 ± 0.25 MU/cGy and 2.68 ± 0.24 MU/cGy, respectively ( P = .2). The differences of conformity index, gradient index, and homogeneity index between hybrid arc and volumetric-modulated arc therapy plans are small: 0.08 ± 0.05, 0.65 ± 0.46, and 0.02 ± 0.01, respectively. The maximum doses in organs at risks are similar between hybrid arc and volumetric-modulated arc therapy plans. Hybrid arc and volumetric-modulated arc therapy plans, which have similar monitor unit efficiencies, present similar dosimetric results in the fractionated intracranial radiotherapy.

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