A quantitative comparison of radiosurgical treatment parameters in vestibular schwannomas: the Leksell Gamma Knife Perfexion versus Model 4C

Purpose The world’s first Gamma Knife Perfexion (PFX) was installed in Marseille in July 2006. The aim of this study was to investigate the impact of the PFX technology on the quality of dose planning for vestibular schwannomas (VS). Methods When the PFX was first introduced, a comparative randomized prospective study of 200 patients was conducted. Seventy-eight of the 200 patients in that study had VS, of whom 38 were randomized to treatment with the Gamma Knife Model 4C (group 4C) and 40 were randomized to treatment with PFX (group P1). The authors also incorporated a matched group of 40 patients with VS consecutively treated with PFX after the initial learning curve period (group P2). Dose planning was compared and evaluated by measuring the conformity index (CI), selectivity index (SI), gradient index (GI), energy index (EI), unit isocenters (UI) and cochlear dose. Patients were also stratified into subgroups according to target volume (≥0.5 ml). Results In the whole population, CI, EI and cochlear dose were significantly better in group P2 (CI = 0.917, EI = 1.35, cochlear dose = 3.55) than in group 4C (CI = 0.864, EI = 1.27, cochlear dose = 5.10). In the subgroup of lesions ≥0.5 ml, CI, GI, EI, UI and cochlear dose in group P2 (CI = 0.929, GI = 2.67, EI = 1.37, UI = 10.6, cochlear dose = 3.55) were significantly better than in group 4C (CI = 0.874, GI = 2.85, EI = 1.30, UI = 14.5, cochlear dose = 5.10). Conclusions The investigation of the dose planning capabilities of the PFX on a cohort of VS demonstrates a better conformity and energy distribution, with better cochlear sparing and without any particular drawback. In addition, there is an improvement in peripheral dose gradient in larger lesions. Further clinical studies will be required before drawing any conclusions about the clinical benefit achieved by these dose planning improvements.