Christos Moustakis1, Mark K H Chan2, Jinkoo Kim3, Joakim Nilsson4, Alanah Bergman5, Tewfik J Bichay6,7, Isabel Palazon Cano8, Savino Cilla9, Francesco Deodato10, Raffaela Doro11, Jürgen Dunst2,12, Hans Theodor Eich13, Pierre Fau14,15, Ming Fong16, Uwe Haverkamp13, Simon Heinze17, Guido Hildebrandt18, Detlef Imhoff19, Erik de Klerck20, Janett Köhn19, Ulrike Lambrecht21, Britta Loutfi-Krauss19, Fatemeh Ebrahimi13, Laura Masi11, Alan H Mayville6, Ante Mestrovic5, Maaike Milder20, Alessio G Morganti22, Dirk Rades23, Ulla Ramm19, Claus Rödel19, Frank-Andre Siebert2, Wilhelm den Toom20, Lei Wang24, Stefan Wurster25,26, Achim Schweikard27, Scott G Soltys24, Samuel Ryu3, Oliver Blanck2,25. 1. Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. christos.moustakis@ukmuenster.de. 2. Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany. 3. Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA. 4. Department of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden. 5. Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada. 6. Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA. 7. Wayne State University School of Medicine, Detroit, MI, USA. 8. Department of Medical Physics, Hospital Ruber Internacional, Madrid, Spain. 9. Fondazione di Ricerca e Cura "Giovanni Paolo II", Medical Physics Unit, Catholic University of Sacred Heart, Campobasso, Italy. 10. Fondazione di Ricerca e Cura "Giovanni Paolo II", Radiation Oncology Unit, Catholic University of Sacred Heart, Campobasso, Italy. 11. Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy. 12. Department of Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark. 13. Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. 14. University of Aix Marseille, Marseille, France. 15. Physics Department, Institut Paoli Calmettes, Marseille, France. 16. Vancouver Cancer Centre, Department of Radiation Therapy, BC Cancer Agency, Vancouver, BC, Canada. 17. Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 18. Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany. 19. Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. 20. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 21. Department of Radiation Oncology, University Clinic Erlangen, Erlangen, Germany. 22. Radiation Oncology Department, DIMES University of Bologna-S. Orsola Malpighi Hospital, Bologna, Italy. 23. Department of Radiation Oncology, University Clinic Schleswig-Holstein, Lübeck, Germany. 24. Department of Radiation Oncology, Stanford University, Stanford, CA, USA. 25. Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany. 26. Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany. 27. Institute for Robotic and Cognitive Systems, University of Lübeck, Lübeck, Germany.
Abstract
PURPOSE: To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. METHODS: Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. RESULTS: All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). CONCLUSIONS: High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.
PURPOSE: To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. METHODS: Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. RESULTS: All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). CONCLUSIONS: High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.
Authors: U Ramm; J Köhn; R Rodriguez Dominguez; J Licher; N Koch; E Kara; C Scherf; C Rödel; C Weiß Journal: Phys Med Date: 2013-07-11 Impact factor: 2.685
Authors: Joseph J Foy; Robin Marsh; Randall K Ten Haken; Kelly C Younge; Matthew Schipper; Yilun Sun; Dawn Owen; Martha M Matuszak Journal: Pract Radiat Oncol Date: 2017-03-02
Authors: Christian C Okoye; Ravi B Patel; Shaakir Hasan; Tarun Podder; Anton Khouri; Jeffrey Fabien; Yuxia Zhang; Donald Dobbins; Jason W Sohn; Jiankui Yuan; Min Yao; Mitchell Machtay; Andrew E Sloan; Jonathan Miller; Simon S Lo Journal: Technol Cancer Res Treat Date: 2015-01-28
Authors: Christoph Fürweger; Christian Drexler; Markus Kufeld; Alexander Muacevic; Berndt Wowra; Alexander Schlaefer Journal: Int J Radiat Oncol Biol Phys Date: 2010-04-13 Impact factor: 7.038
Authors: Christoph Fürweger; Christian Drexler; Alexander Muacevic; Berndt Wowra; Erik C de Klerck; Mischa S Hoogeman Journal: J Appl Clin Med Phys Date: 2014-07-08 Impact factor: 2.102
Authors: David Krug; Oliver Blanck; Thomas Demming; Matthias Dottermusch; Karoline Koch; Markus Hirt; Laura Kotzott; Adrian Zaman; Lina Eidinger; Frank-Andre Siebert; Jürgen Dunst; Hendrik Bonnemeier Journal: Strahlenther Onkol Date: 2019-10-31 Impact factor: 3.621
Authors: Maria-Lisa Wilhelm; Mark K H Chan; Benedikt Abel; Florian Cremers; Frank-Andre Siebert; Stefan Wurster; David Krug; Robert Wolff; Jürgen Dunst; Guido Hildebrandt; Achim Schweikard; Dirk Rades; Floris Ernst; Oliver Blanck Journal: Strahlenther Onkol Date: 2020-06-25 Impact factor: 3.621
Authors: Olaf Wittenstein; Patrick Hiepe; Lars Henrik Sowa; Elias Karsten; Iris Fandrich; Juergen Dunst Journal: Strahlenther Onkol Date: 2019-04-29 Impact factor: 3.621
Authors: Jose R Teruel; Martha Malin; Elisa K Liu; Allison McCarthy; Kenneth Hu; Bejamin T Cooper; Erik P Sulman; Joshua S Silverman; David Barbee Journal: J Appl Clin Med Phys Date: 2020-09-23 Impact factor: 2.102