Bartek Jiri, Wangerid Theresa, Pettersson-Segerlind Jenny, Benmakhlouf Hamza, Förander Petter
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Neurology, St.Göran Hospital, Stockholm, Sweden.
Clin Neurol Neurosurg. 2019 Oct;185:105487. doi: 10.1016/j.clineuro.2019.105487. Epub 2019 Aug 12.
Adaptive Hybrid Surgery Analysis (AHSA, Brainlab, Munich, Germany) is a software application generating in real-time conceptual dose plans for tumor residuals but has so far not been assessed for usability in a Gamma Knife (Elekta, Stockholm, Sweden) radiosurgery practice. We aimed to compare AHSA stereotactic radiosurgery dose plans with Leksell Gamma Plan (LGP, Elekta, Stockholm, Sweden) plans for adjuvant radiosurgical treatment of Vestibular Schwannoma (VS) residuals.
In this retrospective comparative study, we compared the automatically calculated AHSA dose plans with clinical LGP treatment plans in 13 patients radiosurgically treated for VS residuals. We first created an LGP template based on our specific constraints to organs at risk (OAR), and a tumor prescription volume coverage of minimum 98%. As most proximal anatomy at risk is not manually contoured in our practice, OARs (i.e. brainstem, optic apparatus and cochlea) in the planning images were automatically segmented in Elements Anatomical Mapping and imported into the AHSA software for re-planning and comparison with the LGP dose plans.
There was no significant difference in tumor coverage and conformity index between the LGP and AHSA dose planning data, with the mean and maximal dose to the brainstem slightly higher in the latter.
The AHSA dose plans for adjuvant radiosurgical treatment of VS residuals were comparable to those of LGP used in our Gamma Knife practice, confirming the usability of AHSA in the management of Vestibular Schwannoma in a Gamma Knife practice.
自适应混合手术分析（AHSA，Brainlab，慕尼黑，德国）是一款能为肿瘤残留实时生成概念性剂量计划的软件应用程序，但迄今为止尚未在伽玛刀（Elekta，斯德哥尔摩，瑞典）放射外科实践中对其可用性进行评估。我们旨在比较AHSA立体定向放射外科剂量计划与Leksell伽玛计划（LGP，Elekta，斯德哥尔摩，瑞典）计划，用于前庭神经鞘瘤（VS）残留的辅助放射外科治疗。
在这项回顾性比较研究中，我们将13例接受VS残留放射外科治疗患者的自动计算的AHSA剂量计划与临床LGP治疗计划进行了比较。我们首先基于对危及器官（OAR）的特定限制以及至少98%的肿瘤处方体积覆盖率创建了一个LGP模板。由于在我们的实践中大多数近端危险解剖结构不是手动勾勒的，所以在规划图像中的OAR（即脑干、视觉器官和耳蜗）在Elements解剖映射中自动分割，并导入到AHSA软件中进行重新规划，并与LGP剂量计划进行比较。
LGP和AHSA剂量规划数据在肿瘤覆盖率和适形指数方面没有显著差异，后者对脑干的平均剂量和最大剂量略高。
用于VS残留辅助放射外科治疗的AHSA剂量计划与我们伽玛刀实践中使用的LGP剂量计划相当，证实了AHSA在伽玛刀实践中管理前庭神经鞘瘤的可用性。
