TY - JOUR
T1 - Multi-staged robotic stereotactic radiosurgery for large cerebral arteriovenous malformations
AU - Ding, Chuxiong
AU - Solberg, Timothy D.
AU - Hrycushko, Brian
AU - Medin, Paul
AU - Whitworth, Louis
AU - Timmerman, Robert D.
PY - 2013/12
Y1 - 2013/12
N2 - Purpose To investigate a multi-staged robotic stereotactic radiosurgery (SRS) delivery technique for the treatment of large cerebral arteriovenous malformations (AVMs). The treatment planning process and strategies to optimize both individual and composite dosimetry are discussed. Methods Eleven patients with large (30.7 ± 19.2 cm3) AVMs were selected for this study. A fiducial system was designed for fusion of targets between planar angiograms and simulation CT scans. AVMs were contoured based on single contrast CT, MRI and orthogonal angiogram images. AVMs were divided into 3-8 sub-target volumes (3-7 cm3) for sequential treatment at 1-4 week intervals to a prescription dose of 16-20 Gy. Forward and inversely developed treatment plans were optimized for 95% coverage of the total AVM volume by dose summation from each sub-volume, while minimizing dose to surrounding tissues. Dose-volume analysis was used to evaluate the PTV coverage, dose conformality (CI), and R50 and V12Gy parameters. Results The treatment workflow was commissioned and able to localize within 1 mm. Inverse optimization outperformed forward planning for most patients for each index considered. Dose conformality was shown comparable to staged Gamma Knife treatments. Conclusion The CyberKnife system is shown to be a practical delivery platform for multi-staged treatments of large AVMs using forward or inverse planning techniques.
AB - Purpose To investigate a multi-staged robotic stereotactic radiosurgery (SRS) delivery technique for the treatment of large cerebral arteriovenous malformations (AVMs). The treatment planning process and strategies to optimize both individual and composite dosimetry are discussed. Methods Eleven patients with large (30.7 ± 19.2 cm3) AVMs were selected for this study. A fiducial system was designed for fusion of targets between planar angiograms and simulation CT scans. AVMs were contoured based on single contrast CT, MRI and orthogonal angiogram images. AVMs were divided into 3-8 sub-target volumes (3-7 cm3) for sequential treatment at 1-4 week intervals to a prescription dose of 16-20 Gy. Forward and inversely developed treatment plans were optimized for 95% coverage of the total AVM volume by dose summation from each sub-volume, while minimizing dose to surrounding tissues. Dose-volume analysis was used to evaluate the PTV coverage, dose conformality (CI), and R50 and V12Gy parameters. Results The treatment workflow was commissioned and able to localize within 1 mm. Inverse optimization outperformed forward planning for most patients for each index considered. Dose conformality was shown comparable to staged Gamma Knife treatments. Conclusion The CyberKnife system is shown to be a practical delivery platform for multi-staged treatments of large AVMs using forward or inverse planning techniques.
KW - Arteriovenous malformations
KW - CyberKnife
KW - Stereotactic radiosurgery
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U2 - 10.1016/j.radonc.2013.07.018
DO - 10.1016/j.radonc.2013.07.018
M3 - Article
C2 - 24021345
AN - SCOPUS:84890120582
SN - 0167-8140
VL - 109
SP - 452
EP - 456
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 3
ER -