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 cm(3)) 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 cm(3)) 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 V12 Gy parameters. RESULTS: The treatment workflow was commissioned and able to localize within 1mm. 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.
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 cm(3)) 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 cm(3)) 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 V12 Gy parameters. RESULTS: The treatment workflow was commissioned and able to localize within 1mm. 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.
Authors: Chuxiong Ding; Brian Hrycushko; Louis Whitworth; Xiang Li; Lucien Nedzi; Bradley Weprin; Ramzi Abdulrahman; Babu Welch; Steve B Jiang; Zabi Wardak; Robert D Timmerman Journal: Med Phys Date: 2017-08-12 Impact factor: 4.071
Authors: Ryan Kelly; Anthony Conte; M Nathan Nair; Jean-Marc Voyadzis; Amjad Anaizi; Sean Collins; Christopher Kalhorn; Andrew Stemer; Jeffery Mai; Rocco Armonda; Jonathan Lischalk; Frank Berkowitz; Vikram Nayar; Kevin McGrail; Brian Timothy Collins Journal: Front Oncol Date: 2020-11-30 Impact factor: 6.244
Authors: Franziska Loebel; Antonio Pontoriero; Anne Kluge; Giuseppe Iatì; Gueliz Acker; Markus Kufeld; Alberto Cacciola; Stefano Pergolizzi; Sergio Vinci; Sara Lillo; Ran Xu; Carmen Stromberger; Volker Budach; Peter Vajkoczy; Carolin Senger; Alfredo Conti Journal: PLoS One Date: 2022-09-22 Impact factor: 3.752