Does intensity-modulated stereotactic radiotherapy achieve superior target conformity than conventional stereotactic radiotherapy in different intracranial tumours?

AIMS: To compare the dosimetric outcome of various conventional stereotactic radiotherapy (SRT) techniques with intensity-modulated stereotactic radiotherapy (IMSRT) in brain tumours of varying shape, size, location and proximity to organs at risk (OARs).
MATERIALS AND METHODS: Fused computed tomography and magnetic resonance imaging datasets of four patients with different brain tumours previously treated with non-coplanar static conformal fields (SCF) were re-planned on the BrainScan treatment planning system using non-coplanar conformal arcs (CA), dynamic conformal arcs (DCA) and IMSRT with coplanar (IMSRT_CP) or non-coplanar (IMSRT_NCP) beam arrangement. Beam shaping and intensity modulation were carried out using a BrainLab micromultileaf collimator. The primary objective for each plan was to encompass >or=99% of the planning target volume (PTV) by >95% of the prescribed dose while minimising the dose to OARs.
RESULTS: The mean PTV coverage in SCF, CA, DCA, IMSRT_NCP and IMSRT_CP was 99.2, 99.5, 99.4, 99.2 and 99.2%, respectively. The highest dose within the target was <107% of the prescribed dose in all plans. Conformity was found to vary depending on the shape and location of the target. The best mean conformity index, ranging from 0.74 (CA) to 0.84 (IMSRT_NCP) was observed in spherical tumours. Among the three conventional SRT techniques, DCA and SCF appeared comparable (mean conformity index 0.72 and 0.71, respectively) and more conformal than CA (mean conformity index 0.67). In all cases, IMSRT showed better target conformity than conventional SRT techniques with a mean conformity index of 0.83 for non-coplanar and 0.81 for coplanar beam arrangement. The maximum improvement in conformity index was observed for IMSRT_NCP in complex, concave and irregularly shaped targets. The volume of normal brain and other OARs irradiated to high (>or=80%) and low (>or=30%) dose varied depending on the tumour shape, size, and location, but was essentially comparable in all three conventional SRT techniques. IMSRT (both coplanar as well as non-coplanar) reduced the volume of normal brain being irradiated to moderate to high doses compared with conventional SRT techniques, more so for large and irregular targets.
CONCLUSIONS: DCA and SCF are preferred conventional SRT techniques in terms of target conformity and reduction of doses to OARs. The use of IMSRT_NCP further improves conformity and reduces doses to OARs in a range of brain tumours commonly considered for stereotactic irradiation.