STEREOTACTIC RADIOTHERAPY OF INTRACRANIAL TUMORS: A COMPARISON OF INTENSITY-MODULATED RADIOTHERAPY AND DYNAMIC CONFORMAL ARC

Purpose: Intensity-modulated radiotherapy (IMRT) and dynamic conformal arc (DCA) are two state-of-the-art techniques for linac-based stereotactic radiotherapy (SRT) using the micromultileaf collimator. The purpose of this planning study is to examine the relative merits of these techniques in the treatment of intracranial tumors. Materials and Methods: SRT treatment plans were made for 25 patients with a glioma or meningioma. For all patients, we made an IMRT and a DCA plan. Plans were evaluated using: target coverage, conformity index (CI), homogeneity index (HI), doses in critical structures, number of monitor units needed, and equivalent uniform dose (EUD) in planning target volume (PTV) and critical structures. Results: In the overall comparison of both techniques, we found adequate target coverage in all cases; a better mean CI with IMRT in concave tumors (p = 0.027); a better mean HI with DCA in meningiomas, complex tumors, and small (< 92 mL) tumors (p = 0.000, p = 0.005, and p = 0.005, respectively); and a higher EUD in the PTV with DCA in convex tumors (gliomas) and large tumors (p = 0.000 and p = 0.003, respectively). In all patients, significantly more monitor units were needed with IMRT. The results of the overall comparison did not enable us to predict the preference for one of the techniques in individual patients. The DCA plan was acceptable in 23 patients and the IMRT plan in 19 patients. DCA was preferred in 18 of 25 patients. Conclusions: DCA is our preferred SRT technique for most intracranial tumors. Tumor type, size, or shape do not predict a preference for DCA or IMRT. (C) 2009 Elsevier Inc.