Quantifying the Sensitivity of Target Dose on Intrafraction Displacement in Intracranial Stereotactic Radiosurgery

Jannie Schasfoort; Mark Ruschin; Arjun Sahgal; R. Lee MacDonald; Young Lee; Carola van Pul; Patrick Langenhuizen; Patrick Hanssens; Guus Beute; Frits Wittkamper; Jan Jakob Sonke

doi:10.1016/j.prro.2021.11.012

Quantifying the Sensitivity of Target Dose on Intrafraction Displacement in Intracranial Stereotactic Radiosurgery

Jannie Schasfoort (Corresponding author)
, Mark Ruschin
, Arjun Sahgal
, R. Lee MacDonald
, Young Lee
, Carola van Pul
, Patrick Langenhuizen
, Patrick Hanssens
, Guus Beute
, Frits Wittkamper
, Jan Jakob Sonke

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

220 Downloads (Pure)

Abstract

Purpose: Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. Methods and Materials: In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5 mm, ±1.0 mm, or ±1.5 mm. The effect on minimum dose to 99% of the target (D₉₉) and percent target coverage by prescription dose was quantified using mixed-effect modeling with variables: displacement, target volume, and location. Results: The effect on dose metrics is statistically larger for translational displacements compared with rotational displacements, and the effect of pitch rotations is statistically larger compared with yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6 cc) and translational nose-marker displacements of 0.5 mm, 1.0 mm, and 1.5 mm, D₉₉ decreased by 2.2%, 7.1%, and 13.0%, and coverage by 0.4%, 1.8%, and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5 mm, 1.0 mm, and 1.5 mm, D₉₉ decreased by 1.0%, 3.6%, and 6.9%, and coverage by 0.2%, 0.8%, and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D₉₉ decreased by 0.3%, 1.2%, and 2.5%, and coverage by 0.1%, 0.2%, and 0.5%, respectively. Conclusions: Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.

Original language	English
Pages (from-to)	e221-e231
Journal	Practical Radiation Oncology
Volume	12
Issue number	3
DOIs	https://doi.org/10.1016/j.prro.2021.11.012
Publication status	Published - 1 May 2022

Bibliographical note

Funding Information:
The authors thank Anton Olsson-Collentine from the Department of Methodology and Statistics at Tilburg University for his statistical support. Sources of support: This work had no specific funding. Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose.

Funding Information:
Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose.

Funding

The authors thank Anton Olsson-Collentine from the Department of Methodology and Statistics at Tilburg University for his statistical support. Sources of support: This work had no specific funding. Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose. Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose.

Keywords

Brain Neoplasms/radiotherapy
Humans
Motion
Radiometry
Radiosurgery/methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted/methods

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10.1016/j.prro.2021.11.012

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Cite this

@article{9a8eefe04d884f33aa4dd159109c03b6,

title = "Quantifying the Sensitivity of Target Dose on Intrafraction Displacement in Intracranial Stereotactic Radiosurgery",

abstract = "Purpose: Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. Methods and Materials: In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5 mm, ±1.0 mm, or ±1.5 mm. The effect on minimum dose to 99\% of the target (D99) and percent target coverage by prescription dose was quantified using mixed-effect modeling with variables: displacement, target volume, and location. Results: The effect on dose metrics is statistically larger for translational displacements compared with rotational displacements, and the effect of pitch rotations is statistically larger compared with yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6 cc) and translational nose-marker displacements of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 2.2\%, 7.1\%, and 13.0\%, and coverage by 0.4\%, 1.8\%, and 4.4\%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 1.0\%, 3.6\%, and 6.9\%, and coverage by 0.2\%, 0.8\%, and 1.9\%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D99 decreased by 0.3\%, 1.2\%, and 2.5\%, and coverage by 0.1\%, 0.2\%, and 0.5\%, respectively. Conclusions: Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.",

keywords = "Brain Neoplasms/radiotherapy, Humans, Motion, Radiometry, Radiosurgery/methods, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted/methods",

author = "Jannie Schasfoort and Mark Ruschin and Arjun Sahgal and MacDonald, \{R. Lee\} and Young Lee and \{van Pul\}, Carola and Patrick Langenhuizen and Patrick Hanssens and Guus Beute and Frits Wittkamper and Sonke, \{Jan Jakob\}",

note = "Funding Information: The authors thank Anton Olsson-Collentine from the Department of Methodology and Statistics at Tilburg University for his statistical support. Sources of support: This work had no specific funding. Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose. Funding Information: Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose. ",

year = "2022",

month = may,

day = "1",

doi = "10.1016/j.prro.2021.11.012",

language = "English",

volume = "12",

pages = "e221--e231",

journal = "Practical Radiation Oncology",

issn = "1879-8500",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - Quantifying the Sensitivity of Target Dose on Intrafraction Displacement in Intracranial Stereotactic Radiosurgery

AU - Schasfoort, Jannie

AU - Ruschin, Mark

AU - Sahgal, Arjun

AU - MacDonald, R. Lee

AU - Lee, Young

AU - van Pul, Carola

AU - Langenhuizen, Patrick

AU - Hanssens, Patrick

AU - Beute, Guus

AU - Wittkamper, Frits

AU - Sonke, Jan Jakob

N1 - Funding Information: The authors thank Anton Olsson-Collentine from the Department of Methodology and Statistics at Tilburg University for his statistical support. Sources of support: This work had no specific funding. Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose. Funding Information: Disclosures: Dr Ruschin is the coinventor of and owns associated intellectual property specific to the image guidance system on the Gamma Knife Icon. Dr Saghal reports the following: advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); board member of the International Stereotactic Radiosurgery Society (ISRS); past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), Brainlab, Medtronic Kyphon; research grant with Elekta AB; travel accommodations/expenses by Elekta, Varian, and BrainLAB. Dr Sahgal also belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac-based SRS Consortia. Dr MacDonald has an existing intellectual property license agreement with Brainlab AG for stereotactic radiosurgery dosimetric planning algorithms. Dr Langenhuizen reports nonfinancial support from Elekta AB, grants from ZonMW, grants from Elekta AB, outside the submitted work. Dr Beute reports personal fees from Elekta AB, outside the submitted work, and presidency of the Leksell Gamma Knife Society meeting in 2016. Dr Sonke reports grants from Elekta Oncology Systems AB and License fees from Elekta Oncology Systems AB, outside the submitted work. The remaining authors have nothing to disclose.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - Purpose: Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. Methods and Materials: In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5 mm, ±1.0 mm, or ±1.5 mm. The effect on minimum dose to 99% of the target (D99) and percent target coverage by prescription dose was quantified using mixed-effect modeling with variables: displacement, target volume, and location. Results: The effect on dose metrics is statistically larger for translational displacements compared with rotational displacements, and the effect of pitch rotations is statistically larger compared with yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6 cc) and translational nose-marker displacements of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 2.2%, 7.1%, and 13.0%, and coverage by 0.4%, 1.8%, and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 1.0%, 3.6%, and 6.9%, and coverage by 0.2%, 0.8%, and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D99 decreased by 0.3%, 1.2%, and 2.5%, and coverage by 0.1%, 0.2%, and 0.5%, respectively. Conclusions: Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.

AB - Purpose: Mask-immobilized stereotactic radiosurgery (SRS) using a gating window is an emerging technology. However, the amount of intracranial tumor motion that can be tolerated during treatment while satisfying clinical dosimetric goals is unknown. The purpose of this study was to quantify the sensitivity of target dose to tumor motion. Methods and Materials: In clinical SRS plans, where a nose marker was tracked as surrogate for target motion, translational and rotational target movements were simulated using nose-marker displacements of ±0.5 mm, ±1.0 mm, or ±1.5 mm. The effect on minimum dose to 99% of the target (D99) and percent target coverage by prescription dose was quantified using mixed-effect modeling with variables: displacement, target volume, and location. Results: The effect on dose metrics is statistically larger for translational displacements compared with rotational displacements, and the effect of pitch rotations is statistically larger compared with yaw rotations. The mixed-effect model for translations showed that displacement and target volume are statistically significant variables, for rotation the variable target distance to rotation axis is additionally significant. For mean target volume (12.6 cc) and translational nose-marker displacements of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 2.2%, 7.1%, and 13.0%, and coverage by 0.4%, 1.8%, and 4.4%, respectively. For mean target volume, mean distance midpoint-target to pitch axis (7.6cm), and rotational nose-marker displacement of 0.5 mm, 1.0 mm, and 1.5 mm, D99 decreased by 1.0%, 3.6%, and 6.9%, and coverage by 0.2%, 0.8%, and 1.9%, respectively. For rotational yaw axis displacement, mean distance midpoint-target axis (4.2cm), D99 decreased by 0.3%, 1.2%, and 2.5%, and coverage by 0.1%, 0.2%, and 0.5%, respectively. Conclusions: Simulated target displacements showed that sensitivity of tumor dose to motion depends on both target volume and target location. Suggesting that patient- and target-specific thresholds may be implemented for optimizing the balance between dosimetric plan accuracy and treatment prolongation caused by out-of-tolerance motion.

KW - Brain Neoplasms/radiotherapy

KW - Humans

KW - Motion

KW - Radiometry

KW - Radiosurgery/methods

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted/methods

UR - https://www.scopus.com/pages/publications/85125519502

U2 - 10.1016/j.prro.2021.11.012

DO - 10.1016/j.prro.2021.11.012

M3 - Article

C2 - 34929403

AN - SCOPUS:85125519502

SN - 1879-8500

VL - 12

SP - e221-e231

JO - Practical Radiation Oncology

JF - Practical Radiation Oncology

IS - 3

ER -

Quantifying the Sensitivity of Target Dose on Intrafraction Displacement in Intracranial Stereotactic Radiosurgery

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