Use of jaw tracking in intensity modulated and volumetric modulated arc radiation therapy for spine stereotactic radiosurgery

Purpose: This study was conducted to evaluate the advantages of jaw tracking for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in spine radiosurgery. Methods and materials: VMAT and IMRT plans were retrospectively generated for 10 RTOG 0631 spine radiosurgery protocol patients. A total of 8 plans for each patient were created for a Varian TrueBeam equipped with a Millennium 120 multileaf collimator. Plans were created to compare IMRT and VMAT plans with and without jaw tracking, as well as with different flattening-filter-free energies: 6 MV unflattened (6U) and 10 MV unflattened (10U). The plans were prescribed to the 90% isodose line to either 16 or 18 Gy in 1 fraction. Planning target volume coverage, conformity index, dose to the spinal cord, and distance to falloff from the 90% to 50% isodose line were evaluated. Ion chamber and film measurements were performed to verify calculated dose distributions. Results: Jaw tracking decreased spinal cord dose for both IMRT and VMAT plans, but a larger decrease was seen with the IMRT plans (P =004 vs P =04). The average D_10% for the spinal cord (dose that covered 10% of the spinal cord) was least for the 6U IMRT plan with jaw tracking and was greatest for the 10U IMRT plan without jaw tracking. Measurements showed greater than 98.5% agreement for planar dose gamma analysis and less than 2.5% for point dose analysis. Conclusions: The addition of jaw tracking to IMRT and VMAT can decrease spinal cord dose without a change in calculation accuracy. A lower dose to the spinal cord was achieved with 6U than with 10U, although in some cases, 10U may be justified.