Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR

Objective: To investigate the plan quality of tri-Co-60 intensity-modulated radiation therapy (IMRT) plans for spine stereotactic ablative radiotherapy (SABR). Methods: A total of 20 patients with spine metastasis were retrospectively selected. For each patient, a tri-Co-60 IMRT plan and a volumetric-modulated arc therapy (VMAT) plan were generated. The spinal cords were defined based on MR images for the tri-Co-60 IMRT, while isotropic 1-mm margins were added to the spinal cords for the VMAT plans. The VMAT plans were generated with 10-MV flattening filter-free photon beams of TrueBeam STx™ (Varian Medical Systems, Palo Alto, CA), while the tri-Co-60 IMRT plans were generated with the ViewRay™ system (ViewRay inc., Cleveland, OH). The initial prescription dose was 18Gy (1 fraction). If the tolerance dose of the spinal cord was not met, the prescription dose was reduced until the spinal cord tolerance dose was satisfied. Results: The mean dose to the target volumes, conformity index and homogeneity index of the VMAT and tri-Co-60 IMRT were 17.860.8 vs 13.763.9Gy, 0.856 0.20 vs 1.5861.29 and 0.0960.04 vs 0.2460.19, respectively. The integral doses and beam-on times were 16,57061768 vs 22,08762.986Gycm3 and 3.9561.13 vs 48.82610.44 min, respectively. Conclusion: The tri-Co-60 IMRT seems inappropriate for spine SABR compared with VMAT. Advances in knowledge: For spine SABR, the tri-Co-60 IMRT is inappropriate owing to the large penumbra, large leaf width and low dose rate of the ViewRay system.