Dosimetric evaluation of four‐dimensional dose distributions of CyberKnife and volumetric‐modulated arc radiotherapy in stereotactic body lung radiotherapy

Advanced image‐guided stereotatic body lung radiotherapy techniques using volumetric‐modulated arc radiotherapy (VMAT) with four‐dimensional cone‐beam computed tomography (4D CBCT) and CyberKnife with real‐time target tracking have been clinically implemented by different authors. However, dosimetric comparisons between these techniques are lacking. In this study, 4D CT scans of 14 patients were used to create VMAT and CyberKnife treatment plans using 4D dose calculations. The GTV and the organs at risk (OARs) were defined on the end‐exhale images for CyberKnife planning and were then deformed to the midventilation images (MidV) for VMAT optimization. Direct 4D Monte Carlo dose optimizations were performed for CyberKnife ([Formula: see text]). Four‐dimensional dose calculations were also applied to VMAT plans to generate the 4D dose distributions ([Formula: see text]) on the exhale images for direct comparisons with the [Formula: see text] plans. [Formula: see text] and [Formula: see text] showed comparable target conformity ([Formula: see text] vs. [Formula: see text]). GTV mean doses were significantly higher with [Formula: see text]. Statistical differences of dose volume metrics were not observed in the majority of OARs studied, except for esophagus, with [Formula: see text] yielding marginally higher [Formula: see text] than [Formula: see text]. The normal tissue volumes receiving 80%, 50%, and 30% of the prescription dose ([Formula: see text] , and [Formula: see text]) were higher with [Formula: see text] , whereas [Formula: see text] yielded slightly higher [Formula: see text] in posterior lesions than [Formula: see text]. VMAT resulted in much less monitor units and therefore greater delivery efficiency than CyberKnife. In general, it was possible to produce dosimetrically acceptable plans with both techniques. The selection of treatment modality should consider the dosimetric results as well as the patient's tolerance of the treatment process specific to the SBRT technique. PACS numbers: 87.53.Ly, 87.55.km