Purpose: To quantify the impact of isocenter location on treatment plan quality for intensity-modulated stereotactic treatment of small intracranial lesions.
Methods and materials: For 18 patients previously treated by stereotactic-intensity modulated radiosurgery (IMRS) or intensity-modulated radiation therapy (IMRT), a retrospective virtual planning study was conducted wherein the impact of isocenter location on plan quality was measured. Treatment indications studied included six arteriovenous malformations, six acoustic neuromas, and six intracranial metastases, ranging in volume from 0.71 to 3.21 cm(3) (mean = 2.26 cm(3)), 1.08 to 2.84 cm(3) (mean = 1.73 cm(3)), and 0.19 to 2.30 cm(3) (mean = 0.79 cm(3)), respectively. Variation of isocenter location causes the geometric grid of pencil beams into which the target is segmented for intensity-modulated treatment to be altered. The impact of this pencil-beam-grid redefinition on achievable conformity index was quantified for three collimators (Varian Millennium 120; BrainLab MM3; Nomos binary Mimic) and three treatment planning systems (TPS; Varian Eclipse v6.5; BrainLab BrainScan v5.31; Best-Nomos Corvus v6.2), resulting in the evaluation of 3,446 treatment plans.
Results: For all patients, collimator, and TPS combinations studied, a significant variation in plan quality was observed as a function of isocenter and pencil-beam-grid relocation. Optimization of isocenter location resulted in treatment plan conformity variations as large as 109% (min = 15%, mean = 51%, max = 109%).
Conclusion: Optimization of isocenter location for IMRT/IMRS treatment of small intracranial lesions in which pencil-beam dimensions are comparable to target dimensions, can result in significant improvements in treatment plan quality.