Impact of tissue heterogeneity correction on Gamma Knife stereotactic radiosurgery of acoustic neuromas

Purpose/objectives: Treatment planning systems (TPS) for Gamma Knife stereotactic radiosurgery (GK-SRS) include TMR10 algorithms, which assumes tissue homogeneity equivalent to water, and collapsed-cone convolutional (CCC) algorithms, which accounts for tissue inhomogeneity. This study investigated dosimetric differences between TMR10 and CCC TPS for acoustic neuromas (ANs) treated with GK-SRS. Materials/methods: A retrospective review of 56 AN treated with GK-SRS was performed. All patients underwent MRI and CT imaging during their initial treatment and were planned using TMR10. Each plan was recalculated with CCC using electron density extracted from CT. Parameters of interest included D-max, D-min, D-50%, cochlea D-max, mean cochlea dose, target size, and laterality (>20 mm from central axis). Results: Median target volume of patients was 1.5 cc (0.3 cc-2.8 cc) with median dose of 12 Gy prescribed to the 50% isodose line. Compared to CCC algorithms, the TMR10 calculated dose was higher: D-max was higher by an average 6.2% (p < 0.001), D-min was higher by an average 3.1% (p < 0.032), D-50% was higher by an average of 11.3%. For lateralized targets, calculated D-max and D-50% were higher by 7.1% (p < 0.001) and 10.6% (p < 0.001), respectively. For targets <1 cc, D-max and D-50% were higher by 8.9% (p <= 0.009) and 12.1% (p <= 0.001), respectively. Cochlea D-max was higher, by an average of 20.1% (p < 0.001). Conclusion: There was a statistically significant dosimetric differences observed between TMR10 and CCC algorithms for AN GK-SRS, particularly in small and lateralized ANs. It may be important to note these differences when relating GK-SRS with standard heterogeneity-corrected SRS regimens.