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Purpose <p>Single-isocenter multitarget stereotactic radiosurgery (SIMT SRS) offers enhanced clinical efficiency for treating multiple brain metastases. However, it introduces additional uncertainties, such as off-center dose and beam profile inaccuracies, as well as quality assurance (QA) challenges, complicating its implementation. This study aims to evaluate different SIMT SRS approaches.</p> Methods <p>We collected and analyzed SIMT SRS protocol and infrastructure parameters from 23&#xa0;radiotherapy centers across Germany, Austria, and Switzerland, encompassing immobilization systems, computed tomography (CT) protocols, linear accelerators, treatment planning systems, beam configurations, imaging techniques, and QA practices. Consensus, deviations, and compliance with current guidelines were assessed. Subsequent studies will include on-site measurements, evaluation of treatment plan quality and delivery accuracy, and correlation of these findings with the analyzed protocols to identify potential links between protocol parameters and clinical outcomes.</p> Results <p>There is consensus (at least 80% agreement) for a&#xa0;CT slice thickness of ≤ 1 mm, the need for six-degree-of-freedom patient setup correction, and noncoplanar treatment. There is notable variability for intrafraction imaging (used by 70%), minimum accepted planning target volume diameter (ranging from 2–10 mm), SRS QA, and general plan parameters, such as photon energy and number of treatment fields. There is also high variability in employed linear accelerator models and treatment planning systems.</p> Conclusion <p>These findings highlight a&#xa0;lack of standardization in SIMT SRS practices. Combined with future measurements correlating protocols to treatment quality, our study will provide a&#xa0;foundation for recommendations to support the safe and standardized implementation of SIMT SRS.</p>

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Multicenter multiplatform pattern-of-practice analysis of single-isocenter multitarget stereotactic radiosurgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月10日

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  • Benedikt Thomann,
  • Tobias Fechter,
  • Johannes Fischer,
  • Armin Runz,
  • Julian Roers,
  • Ute Ludwig,
  • Melanie Grehn,
  • Maximilian Grohmann,
  • Christian Ziemann,
  • Michael Judge,
  • Wolfgang Baus,
  • Michelle Grahle,
  • Matthias Walke,
  • Bastian Bathen,
  • Janett Köhn,
  • Paul Käthner,
  • Maya Shariff,
  • Rebecca Matthis,
  • Jens Fleckenstein,
  • Sascha Großmann,
  • Tino Streller,
  • Simon Howitz,
  • Marlen Priegnitz,
  • Rocco Weigel,
  • Peter Winkler,
  • Oliver Blanck,
  • Daniela Schmitt,
  • Jurgen Beck,
  • Marcia Machein,
  • Evangelos Pappas,
  • Ilinca Popp,
  • Michael Reiner,
  • Christian P. Karger,
  • Christos Moustakis,
  • Michael Bock,
  • Anca-Ligia Grosu,
  • Dimos Baltas

摘要

Purpose

Single-isocenter multitarget stereotactic radiosurgery (SIMT SRS) offers enhanced clinical efficiency for treating multiple brain metastases. However, it introduces additional uncertainties, such as off-center dose and beam profile inaccuracies, as well as quality assurance (QA) challenges, complicating its implementation. This study aims to evaluate different SIMT SRS approaches.

Methods

We collected and analyzed SIMT SRS protocol and infrastructure parameters from 23 radiotherapy centers across Germany, Austria, and Switzerland, encompassing immobilization systems, computed tomography (CT) protocols, linear accelerators, treatment planning systems, beam configurations, imaging techniques, and QA practices. Consensus, deviations, and compliance with current guidelines were assessed. Subsequent studies will include on-site measurements, evaluation of treatment plan quality and delivery accuracy, and correlation of these findings with the analyzed protocols to identify potential links between protocol parameters and clinical outcomes.

Results

There is consensus (at least 80% agreement) for a CT slice thickness of ≤ 1 mm, the need for six-degree-of-freedom patient setup correction, and noncoplanar treatment. There is notable variability for intrafraction imaging (used by 70%), minimum accepted planning target volume diameter (ranging from 2–10 mm), SRS QA, and general plan parameters, such as photon energy and number of treatment fields. There is also high variability in employed linear accelerator models and treatment planning systems.

Conclusion

These findings highlight a lack of standardization in SIMT SRS practices. Combined with future measurements correlating protocols to treatment quality, our study will provide a foundation for recommendations to support the safe and standardized implementation of SIMT SRS.