STEREOTAXIC RADIOTHERAPY OF IRREGULAR TARGETS - A COMPARISON BETWEEN STATIC CONFORMAL BEAMS AND NONCOPLANAR ARCS

Stereotactic radiotherapy using a linear accelerator is usually equated with the technique of delivery using multiple non-coplanar arcs, which achieves a spherical dose distribution. As the majority of intracranial lesions are not spherical, a range of schematized tumour shapes were planned to assess the role of static conformal beams in the treatment of irregular lesions. A sphere and 2 ellipsoids, ranging from 20 to 50 mm maximum diameter located intracranially were planned using 3, 4, and 6 non-coplanar static beams with conformal blocks and were compared with four 120-degrees non-coplanar arcs. Comparison of the plans was made by the relative sparing of normal tissue outside the target volume using three-dimensional dose-volume distributions. Non-coplanar arcs spared more normal tissue at low isodoses and achieved the best high dose sparing for spherical targets. For the majority of irregular targets, 3 and 4 static beams spared more tissue at doses greater-than-or-equal-to 50% and greater-than-or-equal-to 80% than the arc technique. For all irregular volumes, maximum sparing of normal tissue to isodoses greater-than-or-equal-to 50% and greater-than-or-equal-to 80% of the treatment isodose was obtained with 6 static conformal beams. We conclude that irregularly shaped tumours suitable for stereotactic radiotherapy with a linear accelerator are better treated with conformal static non-coplanar beams rather than with the multiple arc technique.