Characterisation of dose distribution in linear accelerator-based intracranial stereotactic radiosurgery with the dynamic conformal arc technique: consideration of the optimal method for dose prescription and evaluation

The purpose of this study was to characterise dose distribution in linear accelerator-based intracranial stereotactic radiosurgery using the dynamic conformal arc technique, and to validate the pertinence of dose prescription to the specific percentage isodose surface (IDS).73 plans for brain metastases were reviewed and replanned with a uniform method for target definition and treatment planning.In all cases except 1 the dose prescription to the 80% IDS satisfied the criteria of the standardised prescription IDS as previously proposed. However, both of the planning target volume (PTV) coverage values for the 80% and 90% IDSs and the PTV D99 and D95 (IDS receiving at least 99% or 95% of the PTV) were inconsistent and significantly increased as a function of the PTV size. The 80% IDS for a PTV of more than 5 cm(3) achieved adequate PTV coverage without a leaf margin. The dose conformity for 80% IDS gradually worsened as the PTV increased, whereas that for the PTV D99 or D95 improved as a function of the PTV size. The addition of a leaf margin attained 100% PTV coverage for 80% IDS, while leading to a poorer dose conformity.The dose prescription to the specific percentage IDS does not necessarily guarantee consistent target coverage, D99 and D95, and desirable dose conformity in proportion to the target volume. The dose prescription and evaluation at the specific target coverage would therefore be preferable as an objective method in order to report the "marginal dose" and to clearly compare the planning parameters with those from other modalities.