• Int. J. Radiat. Oncol. Biol. Phys. · Sep 2009

    Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy.

    • Frank J Lagerwaard, Elles A P van der Hoorn, Wilko F A R Verbakel, Cornelis J A Haasbeek, Ben J Slotman, and Suresh Senan.
    • Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. fj.lagerwaard@vumc.nl
    • Int. J. Radiat. Oncol. Biol. Phys. 2009 Sep 1; 75 (1): 253-9.

    PurposeVolumetric modulated arc therapy (RapidArc [RA]; Varian Medical Systems, Palo Alto, CA) allows for the generation of intensity-modulated dose distributions by use of a single gantry rotation. We used RA to plan and deliver whole-brain radiotherapy (WBRT) with a simultaneous integrated boost in patients with multiple brain metastases.Methods And MaterialsComposite RA plans were generated for 8 patients, consisting of WBRT (20 Gy in 5 fractions) with an integrated boost, also 20 Gy in 5 fractions, to the brain metastases, and clinically delivered in 3 patients. Summated gross tumor volumes were 1.0 to 37.5 cm(3). RA plans were measured in a solid water phantom by use of Gafchromic films (International Specialty Products, Wayne, NJ).ResultsComposite RA plans could be generated within 1 hour. Two arcs were needed to deliver the mean of 1,600 monitor units with a mean "beam-on" time of 180 seconds. RA plans showed excellent coverage of planning target volume for WBRT and planning target volume for the boost, with mean volumes receiving at least 95% of the prescribed dose of 100% and 99.8%, respectively. The mean conformity index was 1.36. Composite plans showed much steeper dose gradients outside the brain metastases than plans with a conventional summation of WBRT and radiosurgery. Comparison of calculated and measured doses showed a mean gamma for double-arc plans of 0.30, and the area with a gamma larger than 1 was 2%. In-room times for clinical RA sessions were approximately 20 minutes for each patient.ConclusionsRA treatment planning and delivery of integrated plans of WBRT and boosts to multiple brain metastases is a rapid and accurate technique that has a higher conformity index than conventional summation of WBRT and radiosurgery boost.

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