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Purpose There is no consensus on the optimal prescription isodose line ( IDL) in CyberKnife ( CK) SRS. We designed a strategy to search for optimal CK plans at different levels of IDLs and investigated the dosimetric impact on the quality of CK plans. Methods and materials The retrospective study consisted of 13 CK patients with 16 brain tumors. The mean volume and size of the tumors was 9.7 ± 10.4 cc and 30.3 ± 10.9 mm, respectively. Four shells were created at distances of 2-3 mm to 60 mm from the target. The constraint dose of the innermost shell (D1) was the primary optimization parameter. For isolated brain tumors, D1 started from the prescription dose and gradually reduced after optimization started over. The optimal plans were reached when the coverage started to degrade and the desired IDL was achieved. For eight tumors abutting an OAR, both the D1 and constraint dose to the OAR were gradually pushed until an optimal plan was reached for the desired IDL. Results For the isolated tumors, the V5 Gy, V10 Gy, V15 Gy, V20 Gy, and V25 Gy of low IDL (49.6 ± 2.1%) plans were on average 23.6%, 28.6%, 33.8%, 26.2%, and 10.6% lower, respectively, comparing to the high IDL (88.6 ± 1.3%) plans. The Conformality Index ( CI) of the low IDL plans outperformed the high IDL plans (mean: 1.15 vs. 1.24), except for a lesion under 0.5 cc. The quality of the middle IDL plans (69.6 ± 1.5%) was close to the low IDL plans. Similar results were observed for tumors abutting an OAR. Conclusions Low IDL plans outperformed high IDL plans for all metrics in tumors > 0.5 cc. The lower dose exposure of normal brain tissue and better CI could potentially reduce radiation necrosis while the higher maximum dose could improve local control. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the dosimetric feasibility of accelerated partial breast irradiation (APBI) using CyberKnife. Methods: Fourteen previously treated patients with early-stage breast cancer were selected for a retrospective study. Six of these patients had been treated to 38.5 Gy in 10 fractions in a phase III accelerated partial breast trial and the rest of the patients were treated to 50.4 Gy in 28 fractions. In this planning study, the guidelines in the protocol for the phase III partial breast trial were followed for organ delineation and CyberKnife planning. The achievable dosimetric parameters from all CyberKnife plans were compared to Intensity-modulated radiation therapy (IMRT) and 3D-CRT methods. The reproducibility of the dose delivery with and without respiratory motion was assessed through delivering a patient plan to a breast phantom. Different dose calculation algorithms were also compared between ray tracing and Monte Carlo. Results: For all the patients in the study, the dosimetric parameters met the guidelines from the NSABP B39/RTOG 0413 protocol strictly. The mean PTV volume covered by 100% of the prescription dose was 95.7 ± 0.7% (94.7%-97.1%). The mean maximal dose was 104 ± 2% of the prescription dose. The mean V50% and mean V100% to the ipsilateral normal breast were 23.1 ± 11.6% and 9.0 ± 5.8%, respectively. The conformity index of all plans was 1.14 ± 0.04. The maximum dose to the contralateral breast varied from 1.3 cGy to 111 cGy. The mean V5% and mean V30% to the contralateral and ipsilateral lungs were 1.0 ± 1.6% and 1.3 ± 1.2%, respectively. In our study, the mean V5% to the heart was 0.2 ± 0.5% for right-sided tumors and 9.4 ± 10.1% for left-sided tumors. Compared with IMRT and 3D-CRT planning, the PTV coverage from CyberKnife planning was the highest, and the ratio of V20% to V100% of the breast from CyberKnife planning was the smallest. The heart and lung doses were similar in all the techniques except that the V5% for the lung and heart in CyberKnife planning was slightly higher. Conclusions: The dosimetric feasibility of APBI using CyberKnife was investigated in this retrospective study. All the dosimetric parameters strictly met the guidelines from the NSABP B39/RTOG 0413 protocol. With advanced real-time tracking capability, CyberKnife should provide better target coverage and spare nearby critical organs for APBI treatment. [ABSTRACT FROM AUTHOR]

Purpose: Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients.Methods and Materials: In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3.Results: Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%).Conclusions: Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers. [ABSTRACT FROM AUTHOR]