Dosimetric comparison between single and double isocenters VMAT for SRT with multiple targets

Abstract The focal irradiation approach for brain metastasis (BMs) Stereotactic Radiosurgery (SRS) or Stereotactic Radiotherapy (SRT) has emerged as an important modality for multiple BMs. This study aimed to evaluate the dosimetric effects between single isocentre (SI) and double isocentres (DI) VMAT SRT of multiple brain metastases. Eighteen VMAT SRT plans with varying lesions size, number and distance were simulated on patient CT image using Eclipse treatment planning system version 15. The plan consists of 3 techniques in: 2 coplanar arcs SI, 1 coplanar combine with 2 non-coplanar arcs SI and 2 non-coplanar and 1 coplanar arc DI. The VMAT plans were generated with 21Gy prescription dose to all lesions in 3 fractions. The plans were evaluated in terms of Gradient index (Paddick GI), Conformity index (Paddick CI), and Homogeneity index (ICRU HI) for PTV and V12Gy and V6Gy for normal brain. The same dose constraints were used to optimize for all cases. On the average result from 3 techniques, 3 arcs SI plans and DI were better in GI (14.79±5.83, 13.70±4.72) and CI (0.63±0.08, 0.62±0.09) than 2 arcs SI (17.56±6.15, 0.62±0.11), while HI values was comparable for all techniques. For normal brain, V12Gy for 2 arcs and 3 arcs SI plans were comparable with DI and the volumes of normal brain receiving 6 Gy in 3 arcs SI and DI (77.40 ± 34.30 cm3, 68.94 ± 30.50 cm3) were better than 2 arcs SI (108.10 ± 57.20 cm3). Moreover, the number of arcs, monitoring units and treatment time were also increased and inconvenience in practice in DI. In conclusion, 3 arcs non-coplanar SI VMAT technique presents the suitable in dosimetric evaluation in 2-5 lesions metastases SRT.