{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:30:30Z","timestamp":1783549830177,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study was to investigate the dosimetric differences between non-coplanar volumetric modulated arc therapy (VMAT) and non-coplanar fixed-field intensity-modulated radiotherapy (IMRT) in hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost (HA-WBRT+SIB) for brain metastases using the Monaco treatment planning system (TPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A total of 22 patients with brain metastases were retrospectively enrolled. Two radiotherapy treatment plans were designed for each patient: non-coplanar VMAT and non-coplanar fixed field IMRT. The dose distribution of targets and organs at risk (OAR), the number of monitor units (MUs), and pre-treatment plan verification were compared between the two plans while meeting the prescribed dose requirements of the target volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences in V<jats:sub>50<\/jats:sub>, V<jats:sub>55<\/jats:sub>, D<jats:sub>max<\/jats:sub>, heterogeneity index (HI) and conformity index (CI) of target PGTV between the two plans (<jats:italic>p<\/jats:italic>&amp;gt;0.05). For PTV-brain-SIB, there was no significant difference in D<jats:sub>98%<\/jats:sub> between IMRT and VMAT (<jats:italic>p<\/jats:italic>=0.103). VMAT significantly improved the V<jats:sub>30<\/jats:sub> of PTV-brain-SIB (<jats:italic>p<\/jats:italic>&amp;lt;0.001), decreased HI (<jats:italic>p<\/jats:italic>=0.003), and increased CI (<jats:italic>p<\/jats:italic>&amp;lt;0.001). There were no significant differences in the D<jats:sub>max<\/jats:sub> to the brain stem, left and right lens, optic chiasm, pituitary gland, and left and right hippocampus between the two plans (<jats:italic>p<\/jats:italic>&amp;gt;0.05). Compared with IMRT, VMAT significantly reduced the D<jats:sub>max<\/jats:sub> to the left and right eyes (<jats:italic>p<\/jats:italic>&amp;lt;0.001) and significantly increased the D<jats:sub>max<\/jats:sub> to the right inner ear (<jats:italic>p<\/jats:italic>=0.010). There was no significant difference in the D<jats:sub>max<\/jats:sub> to the left inner ear between VMAT and IMRT (<jats:italic>p<\/jats:italic>=0.458). Compared with IMRT, VMAT significantly reduced the D<jats:sub>max<\/jats:sub> to the left optic nerve (<jats:italic>p<\/jats:italic>=0.006), but significantly increased the D<jats:sub>max<\/jats:sub> to the right optic nerve (<jats:italic>p<\/jats:italic>=0.001). There was no significant difference in the D<jats:sub>max<\/jats:sub> to the left and right hippocampus between VMAT and IMRT (<jats:italic>p<\/jats:italic>&amp;gt;0.05), but VMAT significantly increased the D<jats:sub>100%<\/jats:sub> (<jats:italic>p<\/jats:italic>&amp;lt;0.05) compared with IMRT. Compared with VMAT, IMRT significantly reduced the MU (<jats:italic>p<\/jats:italic>&amp;lt;0.001) but VMAT has a higher treatment efficiency than IMRT, with an average reduction of 41 seconds (294.1 \u00b1 16.4 s for VMAT, 335.8 \u00b1 34.9 s for IMRT, <jats:italic>p<\/jats:italic>&amp;lt;0.001). Under the conditions of 3%\/2 mm, and 2%\/2 mm, the gamma passing rate of the IMRT QA was improved compared to VMAT, with an average increase of 0.6%, <jats:italic>p<\/jats:italic>=0.013, and 1.7%, <jats:italic>p<\/jats:italic>&amp;lt;0.001, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Both non-coplanar VMAT and non-coplanar fixed field IMRT based on the Monaco TPS produce clinically acceptable results for HA-WBRT+SIB in patients with brain metastases. Compared with IMRT, VMAT has better dose distribution in the target volume and treatment efficiency, but IMRT can better protect the hippocampus and reduce the number of MUs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1428329","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T07:01:55Z","timestamp":1737615715000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A dosimetric comparison of non-coplanar volumetric modulated arc therapy and non-coplanar fixed field intensity modulated radiation therapy in hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost for brain metastases"],"prefix":"10.3389","volume":"14","author":[{"given":"Huaqu","family":"Zeng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinZhi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongyou","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shukui","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunbei","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-022-01312-w","article-title":"Update on the management of brain metastasis","volume":"19","author":"Singh","year":"2022","journal-title":"Neurotherapeutics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noac148","article-title":"Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) for small cell lung cancer reduces hippocampal atrophy compared to conventional PCI","volume":"25","author":"de Ruiter","year":"2022","journal-title":"Neuro Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.03.032","article-title":"Whole brain radiotherapy with hippocampal avoidance and simultaneous integrated boost for 1-3 brain metastases: a feasibility study using volumetric modulated arc therapy","volume":"76","author":"Hsu","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.4103\/jmp.jmp_75_21","article-title":"Pediatric craniospinal irradiation \u2013 The implementation and use of normal tissue complication probability in comparing photon versus proton planning","volume":"46","author":"Shobana","year":"2021","journal-title":"J Med Phys"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15123193","article-title":"PRO: do we still need whole-brain irradiation for brain metastases","volume":"15","author":"Popp","year":"2023","journal-title":"Cancers"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.576700","article-title":"Whole brain radiation therapy plus focal radiation boost may generate better survival benefit for brain metastases from non-small cell lung cancer","volume":"10","author":"Ni","year":"2020","journal-title":"Front Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.09.013","article-title":"Why avoid the hippocampus? 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