Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.
Strahlenther Onkol. 2018 Sep;194(9):843-854. doi: 10.1007/s00066-018-1314-2. Epub 2018 May 25.
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.
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.
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).
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.
研究不同计划和交付系统产生的脊柱放射外科治疗计划的质量。比较包括机器人交付和强度调制弧形治疗（IMAT）方法。使用具有相同系统的多个中心来减少基于个人计划能力的偏差。该研究使用一系列三个复杂的脊柱病变，以最大限度地提高各种方法之间的计划质量差异。
来自 12 个具有各种治疗计划系统的治疗计划和脊柱放射外科领域的国际公认专家参与了该研究。对于一个复杂的脊柱病变，将结果与之前使用仅圆形锥体为 CyberKnife 放射外科（CKRS）生成的基准计划进行比较。对于另外两个病例，一个是三个椎体浸润的多个小病变，一个是单个椎体病变用综合增强治疗，将结果与使用 CKRS 最佳实践指南生成的基准计划进行比较。所有计划均基于先前建立的排名系统进行评分。
所有 12 个中心都可以达到平等（n=4）或优于（n=8）基准计划。对于多个病变和单个椎体病变，只有 12 个中心中的 5 个和 3 个分别达到平等或优于最佳实践基准计划。然而，目标和关键结构剂量学的绝对差异很小，并且强烈依赖于规划者而不是系统。总体而言，基于龙门架的 IMAT 具有简单的规划技术（两个共面弧形）可产生更快的治疗效果，并且显著优于静态龙门架强度调制放射治疗（IMRT）和多叶准直器（MLC）或非 MLC CKRS 治疗计划质量，无论系统如何（4 分制的平均排名为 1.2 与 3.1，p=0.002）。
在这个规划挑战中，所有系统和所有参与中心都实现了复杂脊柱放射外科的高质量计划。本研究得出结论，与之前确立的 CKRS 基准相比，简单的 IMAT 技术可以产生明显更好的计划质量。
