ArticleAsian Pacific journal of cancer prevention : APJCP2025
Dosimetric Comparison of Stereotactic Radiosurgery and Stereotactic Radiotherapy Planning Techniques with Apex 2.5mm and Agility 5mm Multileaf Collimator for Intracranial Cancer.
Article in Asian Pacific journal of cancer prevention : APJCP, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveApex 2.5mm micro-Multileaf Collimator(mMLC) provides conformal dose distribution to the tumor in stereotactic radiosurgery (SRS)/stereotactic radiotherapy(SRT) treatments. Since it is an add-on device to the linear accelerator(LINAC), it requires extra commissioning for quality assurance(QA) and treatment. Agility is an in-built MLC having a 5mm multileaf collimator(MLC) width that is capable of providing better outcomes for SRS/SRT. Hence, this study compares the apex-based dynamic conformal arc therapy(DCAT) and agility-based volumetric-modulated arc therapy(VMAT) treatment plans using 6MV flattening filter-free(FFF) radiation beams.
methodsThe population included thirty patients with brain metastasis(BM) with median age of 58 years(35y-75y) treated between 2021 and 2024. The selected patients were grouped into five categories based on the dose to be delivered, with six patients in every group. The dose delivered in groups I, II, III, IV, and V were 16Gy/1fraction(Fr), 18Gy/1Fr, 20Gy/1Fr, 24Gy/1Fr, and 25Gy/5Fr respectively. Two treatment plans were generated for every patient using the apex-based DCAT and agility-based VMAT technique with 6 MV-FFF photon beam energy using Monaco(5.11.03) treatment planning system(TPS).
resultThe planning target volume(PTV) and gross tumor volume(GTV) coverage were excellent in both planning techniques. Conformity index(CI), gradient index(GI), selectivity index(SI), and coverage ratios were similar in both plans. The homogeneity index(HI) was superior with apex-based plans. Total monitor units(MUs) were higher in agility-based plans, resulting in high beam-on time.
conclusionAs the apex is an add-on device to the collimator of the LINAC machine, it requires additional time for commissioning and QA before the treatment. Agility, with in built 5mm MLC, does not require extra commissioning. Dosimetrically, the treatment plans achieved with agility were comparable with apex-based plans except for total MUs. If this is kept aside, 5mm MLC agility-based VMAT FFF plans are capable of giving good outcomes for SRS/SRT treatments.
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