ArticleJournal of applied clinical medical physics2025
Stratified dosimetric comparison between high-definition multileaf collimator-based D2SRS and robotic radiosurgery in the treatment of brain metastases.
Article in Journal of applied clinical medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Stratified dosimetric comparison between high-definition multileaf collimator-based D2SRS and robotic radiosurgery in the treatment of brain metastases.Journal of applied clinical medical physics · 2025Article
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5 authors.
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Abstract
purposeTo compare dosimetric characteristics and treatment efficiency between the high-definition multileaf collimator (HD-MLC) system and robotic radiosurgery (RRS) for brain metastases, with stratified analysis by lesion count.
methodsTwenty-nine patients (12 single [SBM], 17 multiple [MBM] brain metastases) treated with RRS (CyberKnife) were re-planned using a linear accelerator (LINAC) with 2.5-mm micro-MLC (D2SRS system). Key indices included target parameters (RTOG conformity index [RTOG CI], Paddick conformity index [Paddick CI], homogeneity index [HI], gradient index [GI], dose at 2 cm outside the target [D2cm]) and normal brain doses (V12Gy, V20Gy, V30Gy). The Wilcoxon signed-rank test was used (p < 0.05).
resultsIn SBM, RTOG CI, Paddick CI, and GI showed no significant differences, but Paddick CI favored RRS for tumor volume (TV) < 80 cc and D2SRS for TV > 80 cc. D2SRS had better HI (0.08 ± 0.02 vs. 0.12 ± 0.03, p < 0.01); RRS had lower D2cm (18.2 ± 5.5 Gy vs. 23.8 ± 6.7 Gy, p = 0.008), V12Gy (5.3 ± 2.1 cc vs. 8.7 ± 3.5 cc, p < 0.01), and V20Gy (18.47 ± 21.17 cc vs. 35.30 ± 53.85 cc, p = 0.015), with similar V30Gy. D2SRS had shorter treatment time (TT) (8.2 ± 2.1 min vs. 26.8 ± 7.8 min, p < 0.01). In MBM, D2SRS outperformed RRS in RTOG CI (1.12 ± 0.21 vs. 1.45 ± 0.33, p = 0.007), Paddick CI (0.85 ± 0.11 vs. 0.68 ± 0.14, p = 0.007), and HI (0.07 ± 0.02 vs. 0.13 ± 0.03, p = 0.03). RRS had lower V12Gy (38.5 ± 12.6 cc vs. 48.1 ± 15.3 cc, p = 0.017), V20Gy (14.5 ± 4.2 cc vs. 21.3 ± 6.8 cc, p = 0.04), and V30Gy (14.99 ± 20.81 cc vs. 18.49 ± 23.19 cc, p = 0.026). D2SRS reduced TT by 77.3% (12.4 ± 3.5 min vs. 54.6 ± 15.2 min, p < 0.01). No significant differences in Dmax of the brainstem, optic nerves, or lenses were found.
conclusionRRS provides better normal brain protection in both groups, while D2SRS shows superior conformity and efficiency in MBM. Clinical selection should depend on lesion burden.
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