Comparative study of dynamic conformal arc therapy and volumetric modulated arc therapy for treating single brain metastases: A retrospective analysis of dosimetric and clinical outcomes

• Published in: Physics and imaging in radiation oncology Vol. 30; p. 100591
• Main Authors: Chambrelant, Isabelle, Jarnet, Delphine, Le Fèvre, Clara, Kuntz, Laure, Jacob, Julian, Jenny, Catherine, Noël, Georges
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2024; Elsevier
• Subjects: Dosimetric indexes; Dynamic conformal arc therapy; Original; Single brain metastasis; Stereotactic radiation therapy; Volumetric modulated arc therapy; HI; LINAC; RPA; VMAT; MLC; MRI; LR; GTV; BMs; DS-GPA; Stereotactic radiation therapy; KPS; PTV; SRT; TPS; Volumetric modulated arc therapy; Dynamic conformal arc therapy; GI; Single brain metastasis; Dosimetric indexes; WBRT; CI; DCAT; CR; DVH; RN
• ISSN: 2405-6316; 2405-6316
• DOI: 10.1016/j.phro.2024.100591

[Display omitted] •No significant differences in toxicity or recurrence between volumetric modulated arc therapy (VMAT) and dynamic conformal arc therapy (DCAT).•Rare direct clinical comparison of VMAT and DCAT.•DCAT provided better gradient index, while VMAT exhibited superior conformity index.•DCAT allows a sharper dose falloff outside planning target volume, vital for potential brain re-irradiation. Stereotactic radiation therapy (SRT) is commonly used to treat brain metastases (BMs). This retrospective study compared two SRT techniques, dynamic conformal arc therapy (DCAT) and volumetric modulated arc therapy (VMAT), for single BM treatments. Data of patients treated between January 2010 and June 2020 were considered. Patients with multiple BMs, resected BMs, reirradiation, whole-brain radiation therapy and brainstem metastases were excluded. We focused our analysis on 97 patients who received 23.1 Gy in three fractions. Acute toxicities and follow-up outcomes were recorded. Dosimetric data were analyzed in two subgroups (PTV ≤ 10 cc and PTV > 10 cc). DCAT and VMAT were used in 70 (72.2 %) and 27 (27.8 %) patients, respectively. Acute toxicities were not significantly different between groups (p = 0.259), and no difference was detected in the incidence rate of radionecrosis, local recurrence and cerebral recurrence (p > 0.999, p > 0.999 and p = 0.682, respectively). PTV coverage was better with DCAT for small volumes (PTV ≤ 10 cc). Mean conformity index (CI) was significantly higher with VMAT and mean gradient index (GI) was significantly lower with DCAT whatever volume subgroups (p < 0.001). DCAT had more heterogeneous plans and VMAT required more monitor units. DCAT resulted in reduced low and intermediate doses, whereas VMAT led to decreased high doses. DCAT and VMAT are two effective and safe SRT techniques for BMs treatment. In the era of re-irradiation, it is important to reduce the doses delivered to healthy tissues. Further prospective studies are needed to validate these findings.