Robust and optimal dose distribution for brain metastases with robotic radiosurgery system: recipe for an inflection...

Purpose.This study aims to establish a robust dose prescription methodology in stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for brain metastases, considering geometrical uncertainty and minimising dose exposure to the surrounding normal brain tissue.Methods and Materials.Treatment plans employing 40%-90% isodose lines (IDL) at 10% IDL intervals were created for variously sized brain metastases. The plans were constructed to deliver 21 Gy in SRS. Robustness of each plan was analysed using parameters such as the near minimum dose to the tumour, the near maximum dose to the normal brain, and the volume of normal brain irradiated above 14 Gy.Results.Plans prescribed at 60% IDL demonstrated the least variation in the near minimum dose to the tumour and the near maximum dose to the normal brain under conditions of minimal geometrical uncertainty relative to tumour radius. When the IDL-percentage prescription was below 60%, geometrical uncertainties led to increases in these doses. Conversely, they decreased with IDL-percentage prescriptions above 60%. The volume of normal brain irradiated above 14 Gy was lowest at 60% IDL, regardless of geometrical uncertainty.Conclusions.To enhance robustness against geometrical uncertainty and to better spare healthy brain tissue, a 60% IDL prescription is recommended in SRS and SRT for brain metastases using a robotic radiosurgery system.