Multiple choice.

Top Line: As our sophistication for treating multiple brain mets has increased over the past decade (hippocampal-sparing, cough, cough) so has the time from patient presentation to beam on.

They Study: Enter tech companies with 8-digit annual revenues: Varian and Brainlab have each developed software to deliver radiation treatment to multiple mets using a single isocenter (limiting patient time on the table) and automated planning software (limiting time from simulation to treatment). This practical study compares plan quality between two multiple met radiosurgery planning platforms: Varian’s RapidArc at as used at UAB and Brainlab’s Multiple Metastases Element (MME) at Thomas Jefferson. Both institutions employ automated planning software (e.g., HyperArc) that generates plans within 20-30 minutes, and both treat on machines with high-def MLCs (2.5 mm in width at center of field). Across 217 evaluated mets, the conformity index was slightly favorable for RapidArc (1.21) when compared to MME (1.38). The volume of brain receiving 12 and 8 Gy was lower with RapidArc but the volume receiving 5 Gy and mean brain dose was lower with MME. Finally, RapidArc occupies slightly less time on the schedule with average beam-on times of 3-4 minutes with a median of 4 table positions compared to 6-9 minutes and 5 positions with MME.

TBL: RapidArc achieves excellent conformity at high dose levels while MME achieves slightly more conformal low dose levels, but either choice can be a big help in streamlining your machine schedule. | Liu, Adv Radiat Oncol 2020