{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:38:05Z","timestamp":1789731485637,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: This study was designed as a dosimetric feasibility analysis to compare hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) using 3D-CRT, IMRT, and VMAT techniques, with particular attention to clinical applicability in resource-limited settings. While 3D-CRT was used as a reference for conventional WBRT, the primary aim was to determine whether IMRT can serve as an effective and accessible alternative to VMAT for HA-WBRT in centers without advanced technology infrastructure. Methods: Fifteen patients undergoing WBRT for symptom relief were planned using 3D-CRT, IMRT, and VMAT on the Elekta Monaco 6.1.4.0 system. Key organs at risk (OARs) such as the optic nerves, chiasm, eyes, and lenses were considered in the treatment planning. Plans were evaluated based on PTV dose distribution, Conformity Index (CI), Homogeneity Index (HI), and OAR dose constraints (RTOG 0933, NRG-CC001). Gamma pass rate analysis (3%\/3 mm) was performed for the IMRT and VMAT plans. Results: IMRT and VMAT significantly reduced the hippocampal dose compared to 3D-CRT, with similar PTV coverage and OAR sparing. The mean Dmax for the hippocampus was 15.4 Gy for IMRT and 15.5 Gy for VMAT compared to 31.2 Gy for 3D-CRT. The D100% for the hippocampus was 7.5 Gy for IMRT and 7.6 Gy for VMAT, both well below the RTOG 0933 threshold of 9 Gy, while 3D-CRT delivered 30.3 Gy. Additionally, IMRT and VMAT delivered lower doses to the optic nerves and chiasm. QA results showed gamma pass rates above 96% for all plans. This study focused solely on treatment-planning and dosimetric feasibility without evaluating patient outcomes or clinical follow-up. Conclusions: HA-WBRT with IMRT and VMAT significantly reduced the hippocampal dose while maintaining optimal PTV coverage. VMAT is preferred for its balance of efficacy, protection, and treatment time, while IMRT represents a feasible approach for facilities without VMAT, though it requires stricter dose control and longer treatment times.<\/jats:p>","DOI":"10.3390\/cancers17233744","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T11:47:22Z","timestamp":1763984842000},"page":"3744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hippocampal-Avoidance Whole-Brain Radiotherapy: Dosimetric Comparison of 3D-CRT, IMRT, and VMAT for Brain Metastases from Lung Cancer"],"prefix":"10.3390","volume":"17","author":[{"given":"Le Ba","family":"Thach","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Phuc Thinh General Hospital, Thanh Hoa 440000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3776-500X","authenticated-orcid":false,"given":"Mai Thi","family":"Thao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Phuc Thinh General Hospital, Thanh Hoa 440000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Viet","family":"Nghia","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Phuc Thinh General Hospital, Thanh Hoa 440000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tran Nhat","family":"My","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Phuc Thinh General Hospital, Thanh Hoa 440000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-8105","authenticated-orcid":false,"given":"Duong Thanh","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Faculty of Medicine, Nguyen Tat Thanh University, 298-300A Nguyen Tat Thanh Street, Ward 13, District 4, Ho Chi Minh City 700000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9709-2754","authenticated-orcid":false,"given":"Nissren","family":"Tamam","sequence":"additional","affiliation":[{"name":"Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, P.O Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0830-4706","authenticated-orcid":false,"given":"Abdelmoneim","family":"Sulieman","sequence":"additional","affiliation":[{"name":"Biomedical Physics Department, Research and Innovation, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia"},{"name":"Department of Radiological Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1501-1760","authenticated-orcid":false,"given":"Hiba","family":"Omer","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P. O. Box 1982, Dammam 34212, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind","family":"Toufig","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Radiology, College of Medicine, King Faisal University, Hofouf 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-5242","authenticated-orcid":false,"given":"David","family":"Bradley","sequence":"additional","affiliation":[{"name":"Applied Radiation Physics and Technologies Group, CCDCU, Sunway University, Petaling Jaya 46150, Malaysia"},{"name":"School of Mathematics and Physics, University of Surrey, Guildford GU2 7XH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3246","DOI":"10.21037\/jtd-2019-rbmlc-06","article-title":"WBRT for brain metastases from non-small cell lung cancer: For whom and when?\u2014Contemporary point of view","volume":"13","author":"Rucinska","year":"2021","journal-title":"J. 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