Feasibility of treatment planning with HyperArc stereotactic radiosurgery methods for ocular tumors

Chase Cochran; Shane McCarthy; William St. Clair; Damodar Pokhrel

doi:10.1002/acm2.70399

Feasibility of treatment planning with HyperArc stereotactic radiosurgery methods for ocular tumors

Chase Cochran, Shane McCarthy, William St. Clair, Damodar Pokhrel

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose/objectives: Currently, ocular disease is primarily managed with COMS plaque brachytherapy. Various stereotactic radiosurgery (SRS) platforms have also been employed, yet widespread access remains a challenge. Herein, we demonstrate the feasibility of using the HyperArc SRS system to provide an additional platform for the treatment of ocular malignancies. Materials/methods: Twenty previously treated COMS patients with ocular melanoma were selected for a retrospective HyperArc SRS planning study. The average gross tumor volume (GTV) derived from MRI was 1.19 ± 0.60 cc. Planning target volumes (PTV) were generated from a 2 mm expansion of the GTVs. HyperArc plans were created for a TrueBeam LINAC (6MV-FFF) with the Encompass support system and used the AcurosXB algorithm for dose calculation. A dose of 25 Gy was prescribed to the PTVs and all plans were normalized such that PTVD95% = 25 Gy. All organs at risk (OARs) were spared adequately. Patient-specific quality assurance (QA) and an independent Monte Carlo (MC) second check was performed for all SRS plans. Results: HyperArc plans demonstrated high conformality Paddick conformity index (PCI = 0.84 ± 0.04) with steep dose gradient index (GI = 3.29 ± 0.38). Compared to the HyTEC standard (12.1 Gy), it adequately spared the optic nerve(s) (Dmax = 7.18 ± 1.26 Gy, p < 0.001). Adequate PTV coverage (D99% = 23.80 ± 0.46 Gy) was achieved with a mean GTV dose of 27.54 ± 0.47 Gy. Maximum dose to critical OARs were controlled: brain (6.00 ± 1.50 Gy), optic nerve (7.18 ± 1.26 Gy), and ipsilateral lens (9.36 ± 5.67 Gy). Average beam-on time was under 9 min. End-to-end QA results showed a 99.00 ± 0.59% pass rate (2%/2 mm γ-criteria), with a MC check showing 97.81 ± 1.24% agreement with the AcurosXB algorithm (2%/2 mm). Conclusion: HyperArc SRS plans provided adequate target coverage, acceptable OARs sparing, and offer a fast, safe, and non-invasive treatment option for ocular tumors. Clinical implementation of this novel methodology is ongoing at our institution.

Original language	English
Article number	e70399
Journal	Journal of Applied Clinical Medical Physics
Volume	26
Issue number	12
DOIs	https://doi.org/10.1002/acm2.70399
State	Published - Dec 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.

Funding

The authors of this manuscript would like to thank all anonymous reviewers for their constructive comments and feedback for improving the clarity of this clinical paper. This work was partially supported by the grant from Varian Medical Systems (Palo Alto, CA).

Funders	Funder number
Varian Medical Systems

Keywords

HyperArc VMAT
Ocular/Intraocular Tumors
SRS
end-to-end test

ASJC Scopus subject areas

Radiation
Instrumentation
Radiology Nuclear Medicine and imaging

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10.1002/acm2.70399

Cite this

@article{17bfc633e4d841e29d69cd2cbeec633e,

title = "Feasibility of treatment planning with HyperArc stereotactic radiosurgery methods for ocular tumors",

abstract = "Purpose/objectives: Currently, ocular disease is primarily managed with COMS plaque brachytherapy. Various stereotactic radiosurgery (SRS) platforms have also been employed, yet widespread access remains a challenge. Herein, we demonstrate the feasibility of using the HyperArc SRS system to provide an additional platform for the treatment of ocular malignancies. Materials/methods: Twenty previously treated COMS patients with ocular melanoma were selected for a retrospective HyperArc SRS planning study. The average gross tumor volume (GTV) derived from MRI was 1.19 ± 0.60 cc. Planning target volumes (PTV) were generated from a 2 mm expansion of the GTVs. HyperArc plans were created for a TrueBeam LINAC (6MV-FFF) with the Encompass support system and used the AcurosXB algorithm for dose calculation. A dose of 25 Gy was prescribed to the PTVs and all plans were normalized such that PTVD95\% = 25 Gy. All organs at risk (OARs) were spared adequately. Patient-specific quality assurance (QA) and an independent Monte Carlo (MC) second check was performed for all SRS plans. Results: HyperArc plans demonstrated high conformality Paddick conformity index (PCI = 0.84 ± 0.04) with steep dose gradient index (GI = 3.29 ± 0.38). Compared to the HyTEC standard (12.1 Gy), it adequately spared the optic nerve(s) (Dmax = 7.18 ± 1.26 Gy, p < 0.001). Adequate PTV coverage (D99\% = 23.80 ± 0.46 Gy) was achieved with a mean GTV dose of 27.54 ± 0.47 Gy. Maximum dose to critical OARs were controlled: brain (6.00 ± 1.50 Gy), optic nerve (7.18 ± 1.26 Gy), and ipsilateral lens (9.36 ± 5.67 Gy). Average beam-on time was under 9 min. End-to-end QA results showed a 99.00 ± 0.59\% pass rate (2\%/2 mm γ-criteria), with a MC check showing 97.81 ± 1.24\% agreement with the AcurosXB algorithm (2\%/2 mm). Conclusion: HyperArc SRS plans provided adequate target coverage, acceptable OARs sparing, and offer a fast, safe, and non-invasive treatment option for ocular tumors. Clinical implementation of this novel methodology is ongoing at our institution.",

keywords = "HyperArc VMAT, Ocular/Intraocular Tumors, SRS, end-to-end test",

author = "Chase Cochran and Shane McCarthy and \{St. Clair\}, William and Damodar Pokhrel",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.",

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doi = "10.1002/acm2.70399",

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volume = "26",

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T1 - Feasibility of treatment planning with HyperArc stereotactic radiosurgery methods for ocular tumors

AU - Cochran, Chase

AU - McCarthy, Shane

AU - St. Clair, William

AU - Pokhrel, Damodar

PY - 2025/12

Y1 - 2025/12

N2 - Purpose/objectives: Currently, ocular disease is primarily managed with COMS plaque brachytherapy. Various stereotactic radiosurgery (SRS) platforms have also been employed, yet widespread access remains a challenge. Herein, we demonstrate the feasibility of using the HyperArc SRS system to provide an additional platform for the treatment of ocular malignancies. Materials/methods: Twenty previously treated COMS patients with ocular melanoma were selected for a retrospective HyperArc SRS planning study. The average gross tumor volume (GTV) derived from MRI was 1.19 ± 0.60 cc. Planning target volumes (PTV) were generated from a 2 mm expansion of the GTVs. HyperArc plans were created for a TrueBeam LINAC (6MV-FFF) with the Encompass support system and used the AcurosXB algorithm for dose calculation. A dose of 25 Gy was prescribed to the PTVs and all plans were normalized such that PTVD95% = 25 Gy. All organs at risk (OARs) were spared adequately. Patient-specific quality assurance (QA) and an independent Monte Carlo (MC) second check was performed for all SRS plans. Results: HyperArc plans demonstrated high conformality Paddick conformity index (PCI = 0.84 ± 0.04) with steep dose gradient index (GI = 3.29 ± 0.38). Compared to the HyTEC standard (12.1 Gy), it adequately spared the optic nerve(s) (Dmax = 7.18 ± 1.26 Gy, p < 0.001). Adequate PTV coverage (D99% = 23.80 ± 0.46 Gy) was achieved with a mean GTV dose of 27.54 ± 0.47 Gy. Maximum dose to critical OARs were controlled: brain (6.00 ± 1.50 Gy), optic nerve (7.18 ± 1.26 Gy), and ipsilateral lens (9.36 ± 5.67 Gy). Average beam-on time was under 9 min. End-to-end QA results showed a 99.00 ± 0.59% pass rate (2%/2 mm γ-criteria), with a MC check showing 97.81 ± 1.24% agreement with the AcurosXB algorithm (2%/2 mm). Conclusion: HyperArc SRS plans provided adequate target coverage, acceptable OARs sparing, and offer a fast, safe, and non-invasive treatment option for ocular tumors. Clinical implementation of this novel methodology is ongoing at our institution.

AB - Purpose/objectives: Currently, ocular disease is primarily managed with COMS plaque brachytherapy. Various stereotactic radiosurgery (SRS) platforms have also been employed, yet widespread access remains a challenge. Herein, we demonstrate the feasibility of using the HyperArc SRS system to provide an additional platform for the treatment of ocular malignancies. Materials/methods: Twenty previously treated COMS patients with ocular melanoma were selected for a retrospective HyperArc SRS planning study. The average gross tumor volume (GTV) derived from MRI was 1.19 ± 0.60 cc. Planning target volumes (PTV) were generated from a 2 mm expansion of the GTVs. HyperArc plans were created for a TrueBeam LINAC (6MV-FFF) with the Encompass support system and used the AcurosXB algorithm for dose calculation. A dose of 25 Gy was prescribed to the PTVs and all plans were normalized such that PTVD95% = 25 Gy. All organs at risk (OARs) were spared adequately. Patient-specific quality assurance (QA) and an independent Monte Carlo (MC) second check was performed for all SRS plans. Results: HyperArc plans demonstrated high conformality Paddick conformity index (PCI = 0.84 ± 0.04) with steep dose gradient index (GI = 3.29 ± 0.38). Compared to the HyTEC standard (12.1 Gy), it adequately spared the optic nerve(s) (Dmax = 7.18 ± 1.26 Gy, p < 0.001). Adequate PTV coverage (D99% = 23.80 ± 0.46 Gy) was achieved with a mean GTV dose of 27.54 ± 0.47 Gy. Maximum dose to critical OARs were controlled: brain (6.00 ± 1.50 Gy), optic nerve (7.18 ± 1.26 Gy), and ipsilateral lens (9.36 ± 5.67 Gy). Average beam-on time was under 9 min. End-to-end QA results showed a 99.00 ± 0.59% pass rate (2%/2 mm γ-criteria), with a MC check showing 97.81 ± 1.24% agreement with the AcurosXB algorithm (2%/2 mm). Conclusion: HyperArc SRS plans provided adequate target coverage, acceptable OARs sparing, and offer a fast, safe, and non-invasive treatment option for ocular tumors. Clinical implementation of this novel methodology is ongoing at our institution.

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Feasibility of treatment planning with HyperArc stereotactic radiosurgery methods for ocular tumors

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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