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Optimizing SRS for Brain Metastases: Understanding the Volume-Gradient Index Relationship.

Tia Popescu-Bârhală1,2, Ionuţ Dumitru2, Mihai-Ştefan Bârhală1,2

  • 1Faculty of Physics, University of Bucharest, Atomiștilor Street 405, 077125 Măgurele, Romania.

Journal of Clinical Medicine
|November 27, 2025
PubMed
Summary

Target volume significantly impacts Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy (SRT) plan quality metrics like Gradient Index (GI) and Gradient Measure (GM). Multiple targets also influence these metrics.

Keywords:
evaluationquality metricsstereotactic radiotherapytreatment planning

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiosurgery

Background:

  • Developing high-quality dosimetric standards for SRS-SRT plans is crucial.
  • Key questions involve selecting plan quality metrics, identifying influential factors, and optimizing plan geometry.
  • This study focuses on factors influencing plan quality metrics.

Purpose of the Study:

  • To establish a framework for generating high-quality SRS-SRT plans.
  • To identify key factors influencing plan quality metrics.
  • To understand the relationship between target volume and plan quality.

Main Methods:

  • Retrospective analysis of 200 SRS-SRT target volumes from two institutions.
  • Development of Linear Regression models to assess plan quality metric variability.
  • Statistical analysis to identify the most significant regressors.

Main Results:

  • Target volume (TV) and multiple targets (MT) were identified as primary influences on plan quality.
  • Doubling TV significantly decreases Gradient Index (GI) and moderately increases Gradient Measure (GM).
  • The models explained 85% of GI variation and 84% of GM variation.

Conclusions:

  • Gradient Index (GI) is a more sensitive metric than Gradient Measure (GM) for small lesions in sub-CC SRS targets.
  • Dose per fraction did not significantly affect plan quality metrics.
  • Treating multiple targets increases GI and GM, independent of target volume.