Dosimetric Comparison of Robotic and Conventional Linac-Based Stereotactic Lung Irradiation in Early-Stage Lung Cancer

Abstract

We aimed to compare dosimetric characteristics of conventional linear accerator-based treatment plans to those created using the robotic CyberKnife® (CK) treatment planning system for patients with early-stage lung cancer. Eight early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT) using a conventional linac-based (LIN) system were included in this study. New treatment plans were created for the patients with the CK treatment planning system in order to compare the two platforms' dosimetric characteristics. Planning computed tomographies (CT) were obtained in three phases: free-breathing, full exhalation and inhalation. The three GTVs were then added together for internal target volume (ITV) with LIN, whereas no ITV was used for CK. Planning target volumes (PTV) were constituted by adding 5-mm margin to GTV and ITV. Treatment plan was 54 Gy in three fractions. Five-field, seven-field, and dynamic-conformal arc planning techniques were used in LIN plans. Plans were compared according to dose heterogenity (Dmax-maximum dose), volume of 54 Gy (V54) and 27 Gy isodose (V27), conformity index (CI54 and CI27) and lung volumes. PTVs were significantly smaller in CK plans (p = 0.012). Dmax was significantly lower in ARC plans (p = 0.01). Among all plans, CK had significantly tightest isodose shell received 54 Gy and 27 Gy (p = 0.0001). Among LIN plans, V54 was significantly (p = 0.03) smaller in ARC plans; but no difference was observed for V27 values. LIN plans have better plan quality (CI27 and CI54) than CK. No statistically significant difference was observed for lung volumes. CK plans had superior V54 and V27 values compared to LIN plans due to smaller PTV. LIN plans had better CI27 and CI54 values. Advantages of LIN treatment were no neccessity for fiducial marker use, which may cause pneumothorax, and significantly shorter beam-on treatment times. Both CK and LIN methods are suitable for lung SBRT.