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Zheng D, Yoon J, Jung H, Lemus OMD, Gou L, Zhou Y, Usuki KY, Hardy S, Milano MT. How Does the Number of Brain Metastases Correlate With Normal Brain Exposure in Single-Isocenter Multitarget Multifraction Stereotactic Radiosurgery. Adv Radiat Oncol 2024; 9:101499. [PMID: 38681891 PMCID: PMC11047183 DOI: 10.1016/j.adro.2024.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/11/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose To investigate the relationship between normal brain exposure in LINAC-based single-isocenter multitarget multifraction stereotactic radiosurgery or stereotactic radiation therapy (SRT) and the number or volume of treated brain metastases, especially for high numbers of metastases. Methods and Materials A cohort of 44 SRT patients with 709 brain metastases was studied. Renormalizing to a uniform prescription of 27 Gy in 3 fractions, normal brain dose volume indices, including V23 Gy (volume receiving >23 Gy), V18 Gy (volume receiving >18 Gy), and mean dose, were evaluated on these plans against the number and the total volume of targets for each plan. To compare with exposures from whole-brain radiation therapy (WBRT), the SRT dose distributions were converted to equivalent dose in 3 Gy fractions (EQD3) using an alpha-beta ratio of 2 Gy. Results With increasing number of targets and increasing total target volume, normal brain exposures to dose ≥18 Gy increases, and so does the mean normal brain dose. The factors of the number of targets and the total target volume are both significant, although the number of targets has a larger effect on the mean normal brain dose and the total target volume has a larger effect on V23 Gy and V18 Gy. The EQD3 mean normal brain dose with SRT planning is lower than conventional WBRT. On the other hand, SRT results in higher hot spot (ie, maximum dose outside of tumor) EQD3 dose than WBRT. Conclusions Based on clinical SRT plans, our study provides information on correlations between normal brain exposure and the number and total volume of targets. As SRT becomes more greatly used for patients with increasingly extensive brain metastases, more clinical data on outcomes and toxicities is necessary to better define the normal brain dose constraints for high-exposure cases and to optimize the SRT management for those patients.
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Affiliation(s)
- Dandan Zheng
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Jihyung Yoon
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Hyunuk Jung
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Olga Maria Dona Lemus
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Lang Gou
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Yuwei Zhou
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Kenneth Y. Usuki
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Sara Hardy
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Michael T. Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
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Rathbone M, O’Hagan C, Wong H, Khan A, Cook T, Rose S, Heseltine J, Escriu C. Intracranial Efficacy of Atezolizumab, Bevacizumab, Carboplatin, and Paclitaxel in Real-World Patients with Non-Small-Cell Lung Cancer and EGFR or ALK Alterations. Cancers (Basel) 2024; 16:1249. [PMID: 38610927 PMCID: PMC11011096 DOI: 10.3390/cancers16071249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Contrary to Pemetrexed-containing chemo-immunotherapy studies, Atezolizumab, Bevacizumab, Carboplatin, and Paclitaxel (ABCP) treatment has consistently shown clinical benefit in prospective studies in patients with lung cancer and actionable mutations, where intracranial metastases are common. Here, we aimed to describe the real-life population of patients fit to receive ABCP after targeted therapy and quantify its clinical effect in patients with brain metastases. Patients treated in Cheshire and Merseyside between 2019 and 2022 were identified. Data were collected retrospectively. A total of 34 patients with actionable EGFR or ALK alterations had treatment with a median age of 59 years (range 32-77). The disease control rate was 100% in patients with PDL1 ≥ 1% (n = 10). In total, 19 patients (56%) had brain metastases before starting ABCP, 17 (50%) had untreated CNS disease, and 4 (22%) had PDL1 ≥ 1%. The median time to symptom improvement was 12.5 days (range 4-21 days), with 74% intracranial disease control rates and 89.5% synchronous intracranial (IC) and extracranial (EC) responses. IC median Progression Free Survival (mPFS) was 6.48 months, EC mPFS was 10.75 months, and median Overall Survival 11.47 months. ABCP in real-life patients with brain metastases (treated or untreated) was feasible and showed similar efficacy to that described in patients without actionable mutations treated with upfront chemo-immunotherapy.
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Affiliation(s)
- Marcus Rathbone
- School of Medicine, University of Liverpool, Liverpool L69 3BX, UK; (M.R.); (C.O.)
| | - Conor O’Hagan
- School of Medicine, University of Liverpool, Liverpool L69 3BX, UK; (M.R.); (C.O.)
| | - Helen Wong
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
| | - Adeel Khan
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
| | - Timothy Cook
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
| | - Sarah Rose
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
| | - Jonathan Heseltine
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
| | - Carles Escriu
- School of Medicine, University of Liverpool, Liverpool L69 3BX, UK; (M.R.); (C.O.)
- The Clatterbridge Cancer Centre, Liverpool L7 8YA, UK; (H.W.); (A.K.); (T.C.); (S.R.)
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Stambaugh C, Wang AY, Kim E, Mignano JE, Melhus CS, Rodrigues R, Huber K, Stambaugh N, Wu J. Survival and Radiation Dose Differences Between Single Versus Multi-Session Gamma Knife Stereotactic Radiosurgery in Patients Treated for Multiple (≥10) Brain Metastases. Cureus 2023; 15:e46901. [PMID: 37954747 PMCID: PMC10638890 DOI: 10.7759/cureus.46901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE To explore whether treatment with multiple Gamma Knife sessions (mGK) resulted in different survival outcomes or cumulative radiation doses compared to single session Gamma Knife (sGK) in patients who have been treated for ≥10 brain metastases (BMs). METHODS Thirty-five patients with ≥10 BMs treated with Gamma Knife stereotactic radiosurgery (GK SRS) were identified and separated into sGK vs. mGK cohorts. Survival outcomes and dosimetry data were compared between the two groups. Recursive partitioning analysis (RPA) classes were used to further stratify patients. RESULTS mGK patients survived longer from the first GK treatment (p<0.009). By RPA class, patients with class 1 had a prolonged survival from BM diagnosis than those in classes 2 and 3 (p=0.004). However, survival was not significantly different between the classes from the first GK treatment (p=0.089). Stratified by mGK vs. sGK and RPA classes, sGK patients in RPA class 1 had the longest survival from BM diagnosis but the worst survival from GK treatment. mGK patients in any RPA class had the best survival from the first GK treatment. For patients with RPA class 2+3, mGK was associated with longer survival from both BM diagnosis and first treatment. Statistical but not clinical differences between the mGK vs. sGK groups were observed in the max dose to the targets and cochlea, and the V40Gy whole brain dose. CONCLUSIONS mGK may be beneficial if GK is initiated early at first BM diagnosis vs. sGK initiated late. Future research is required to confirm these findings and explore additional areas of interest, such as quality-of-life and economic considerations.
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Affiliation(s)
| | - Andy Y Wang
- Neurosurgery, Tufts University School of Medicine, Boston, USA
| | - Edward Kim
- Neurosurgery, Tufts University School of Medicine, Boston, USA
| | | | | | - Rahul Rodrigues
- Neurosurgery, Tufts University School of Medicine, Boston, USA
| | - Kathryn Huber
- Radiation Oncology, Tufts Medical Center, Boston, USA
| | | | - Julian Wu
- Neurosurgery, Tufts Medical Center, Boston, USA
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Byun J, Kim JH. Revisiting the Role of Surgical Resection for Brain Metastasis. Brain Tumor Res Treat 2023; 11:1-7. [PMID: 36762802 PMCID: PMC9911712 DOI: 10.14791/btrt.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Brain metastasis (BM) is the most common type of brain tumor in adults. The contemporary management of BM remains challenging. Advancements in systemic cancer treatment have increased the survival of patients with cancer. Although the treatment of BM is still complicated, advances in radiotherapy, including stereotactic radiosurgery and chemotherapy, have improved treatment outcomes. Surgical resection is the traditional treatment for BM and its role in the surgical resection of BM has been well established. However, refinement of the surgical resection technique and strategy for BM is needed. Herein, we discuss the evolving role of surgery in patients with BM and the future of BM treatment.
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Affiliation(s)
- Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Kraft J, Weick S, Breuer K, Lutyj P, Bratengeier K, Exner F, Richter A, Tamihardja J, Lisowski D, Polat B, Flentje M. Treatment plan comparison for irradiation of multiple brain metastases with hippocampal avoidance whole brain radiotherapy and simultaneous integrated boost using the Varian Halcyon and the Elekta Synergy platforms. Radiat Oncol 2022; 17:192. [DOI: 10.1186/s13014-022-02156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/06/2022] [Indexed: 11/24/2022] Open
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Zirone L, Bonanno E, Borzì GR, Cavalli N, D’Anna A, Galvagno R, Girlando A, Gueli AM, Pace M, Stella G, Marino C. HyperArc TM Dosimetric Validation for Multiple Targets Using Ionization Chamber and RT-100 Polymer Gel. Gels 2022; 8:gels8080481. [PMID: 36005082 PMCID: PMC9407338 DOI: 10.3390/gels8080481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple brain metastases single-isocenter stereotactic radiosurgery (SRS) treatment is increasingly employed in radiotherapy department. Before its use in clinical routine, it is recommended to perform end-to-end tests. In this work, we report the results of five HyperArcTM treatment plans obtained by both ionization chamber (IC) and polymer gel. The end-to-end tests were performed using a water equivalent Mobius Verification PhantomTM (MVP) and a 3D-printed anthropomorphic head phantom PseudoPatient® (PP) (RTsafe P.C., Athens, Greece); 2D and 3D dose distributions were evaluated on the PP phantom using polymer gel (RTsafe). Gels were read by 1.5T magnetic resonance imaging (MRI). Comparison between calculated and measured distributions was performed using gamma index passing rate evaluation by different criteria (5% 2 mm, 3% 2 mm, 5% 1 mm). Mean point dose differences of 1.01% [min −0.77%−max 2.89%] and 0.23% [min 0.01%−max 2.81%] were found in MVP and PP phantoms, respectively. For each target volume, the obtained results in terms of gamma index passing rate show an agreement >95% with 5% 2 mm and 3% 2 mm criteria for both 2D and 3D distributions. The obtained results confirmed that the use of a single isocenter for multiple lesions reduces the treatment time without compromising accuracy, even in the case of target volumes that are quite distant from the isocenter.
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Affiliation(s)
- Lucia Zirone
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Elisa Bonanno
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Giuseppina Rita Borzì
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Nina Cavalli
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Alessia D’Anna
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Rosaria Galvagno
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Andrea Girlando
- Radiotherapy Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy;
| | - Anna Maria Gueli
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
| | - Martina Pace
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
| | - Giuseppe Stella
- Department of Physics and Astronomy E. Majorana, University of Catania, 95123 Catania, Italy; (A.D.); (R.G.); (A.M.G.)
- Correspondence: ; Tel.: +39-328-1847570
| | - Carmelo Marino
- Medical Physics Department, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (L.Z.); (E.B.); (G.R.B.); (N.C.); (M.P.); (C.M.)
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Keek SA, Beuque M, Primakov S, Woodruff HC, Chatterjee A, van Timmeren JE, Vallières M, Hendriks LEL, Kraft J, Andratschke N, Braunstein SE, Morin O, Lambin P. Predicting Adverse Radiation Effects in Brain Tumors After Stereotactic Radiotherapy With Deep Learning and Handcrafted Radiomics. Front Oncol 2022; 12:920393. [PMID: 35912214 PMCID: PMC9326101 DOI: 10.3389/fonc.2022.920393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThere is a cumulative risk of 20–40% of developing brain metastases (BM) in solid cancers. Stereotactic radiotherapy (SRT) enables the application of high focal doses of radiation to a volume and is often used for BM treatment. However, SRT can cause adverse radiation effects (ARE), such as radiation necrosis, which sometimes cause irreversible damage to the brain. It is therefore of clinical interest to identify patients at a high risk of developing ARE. We hypothesized that models trained with radiomics features, deep learning (DL) features, and patient characteristics or their combination can predict ARE risk in patients with BM before SRT.MethodsGadolinium-enhanced T1-weighted MRIs and characteristics from patients treated with SRT for BM were collected for a training and testing cohort (N = 1,404) and a validation cohort (N = 237) from a separate institute. From each lesion in the training set, radiomics features were extracted and used to train an extreme gradient boosting (XGBoost) model. A DL model was trained on the same cohort to make a separate prediction and to extract the last layer of features. Different models using XGBoost were built using only radiomics features, DL features, and patient characteristics or a combination of them. Evaluation was performed using the area under the curve (AUC) of the receiver operating characteristic curve on the external dataset. Predictions for individual lesions and per patient developing ARE were investigated.ResultsThe best-performing XGBoost model on a lesion level was trained on a combination of radiomics features and DL features (AUC of 0.71 and recall of 0.80). On a patient level, a combination of radiomics features, DL features, and patient characteristics obtained the best performance (AUC of 0.72 and recall of 0.84). The DL model achieved an AUC of 0.64 and recall of 0.85 per lesion and an AUC of 0.70 and recall of 0.60 per patient.ConclusionMachine learning models built on radiomics features and DL features extracted from BM combined with patient characteristics show potential to predict ARE at the patient and lesion levels. These models could be used in clinical decision making, informing patients on their risk of ARE and allowing physicians to opt for different therapies.
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Affiliation(s)
- Simon A. Keek
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Manon Beuque
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Sergey Primakov
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Henry C. Woodruff
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Janita E. van Timmeren
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Vallières
- Medical Physics Unit, Department of Oncology, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lizza E. L. Hendriks
- Department of Pulmonary Diseases, GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Johannes Kraft
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Steve E. Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Olivier Morin
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Radiology and Nuclear Medicine, GROW – School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
- *Correspondence: Philippe Lambin,
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Clinical outcomes of patients with multiple courses of radiosurgery for brain metastases from non-small cell lung cancer. Sci Rep 2022; 12:10712. [PMID: 35739135 PMCID: PMC9226031 DOI: 10.1038/s41598-022-13853-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
We investigated the long-term clinical outcomes of patients who underwent multiple courses (≥ 5) of gamma knife radiosurgery (GKRS) due to recurrent brain metastases (BM) from non-small cell lung cancer (NSCLC). Between December 2001 and July 2019, consecutive 2571 patients underwent GKRS for BM from NSCLC. Clinical and radiological outcomes were investigated in 76 patients who underwent GKRS ≥ 5 times. The median follow-up period after the diagnosis of NSCLC was 54.6 months (range 14.5–159.1 months). The median number of GKRS procedures per patient was six (range 5–15). Actuarial post-GKRS survival rates at 1, 2, 3, 4, and 5 years following initial GKRS were 88.1%, 79.5%, 65.3%, 51.4%, and 37.3%, respectively. No significant difference in overall survival was observed between patients (n = 22) with whole-brain radiotherapy (WBRT) and patients (n = 54) without WBRT (p = 0.076). The incidence of radiation-induced leukoencephalopathy was 64% and 18% in patients with and without WBRT, respectively (p < 0.0001). Multiple courses of SRS are a tolerable and effective treatment option for recurrent BM from NSCLC. Repeat SRS may be an alternative treatment option to avoid or delay WBRT.
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Rogers SJ, Lomax N, Alonso S, Lazeroms T, Riesterer O. Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature. Front Oncol 2022; 12:866542. [PMID: 35619914 PMCID: PMC9128547 DOI: 10.3389/fonc.2022.866542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) is now mainstream for patients with 1-4 brain metastases however the management of patients with 5 or more brain metastases remains controversial. Our aim was to evaluate the clinical outcomes of patients with 5 or more brain metastases and to compare with published series as a benchmarking exercise. Methods Patients with 5 or more brain metastases treated with a single isocentre dynamic conformal arc technique on a radiosurgery linac were identified from the institutional database. Endpoints were local control, distant brain failure, leptomeningeal disease and overall survival. Dosimetric data were extracted from the radiosurgery plans. Series reporting outcomes following SRS for multiple brain metastases were identified by a literature search. Results 36 patients, of whom 35 could be evaluated, received SRS for 5 or more brain metastases between February 2015 and October 2021. 25 patients had 5-9 brain metastases (group 1) and 10 patients had 10-15 brain metastases (group 2). The mean number of brain metastases in group 1 was 6.3 (5-9) and 12.3 (10-15) in group 2. The median cumulative irradiated volume was 4.6 cm3 (1.25-11.01) in group 1 and 7.2 cm3 (2.6-11.1) in group 2. Median follow-up was 12 months. At last follow-up, local control rates per BM were 100% and 99.8% as compared with a median of 87% at 1 year in published series. Distant brain failure was 36% and 50% at a median interval of 5.2 months and 7.4 months after SRS in groups 1 and 2 respectively and brain metastasis velocity at 1 year was similar in both groups (9.7 and 11). 8/25 patients received further SRS and 7/35 patients received whole brain radiotherapy. Median overall survival was 10 months in group 1 and 15.7 months in group 2, which compares well with the 7.5 months derived from the literature. There was one neurological death in group 2, leptomeningeal disease was rare (2/35) and there were no cases of radionecrosis. Conclusion With careful patient selection, overall survival following SRS for multiple brain metastases is determined by the course of the extracranial disease. SRS is an efficacious and safe modality that can achieve intracranial disease control and should be offered to patients with 5 or more brain metastases and a constellation of good prognostic factors.
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Affiliation(s)
- Susanne J Rogers
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Nicoletta Lomax
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Sara Alonso
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Tessa Lazeroms
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
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Kraft J, van Timmeren JE, Frei S, Mayinger M, Borsky K, Kirchner C, Stark LS, Tanadini-Lang S, Wolpert F, Weller M, Woodruff HC, Guckenberger M, Andratschke N. Comprehensive summary and retrospective evaluation of prognostic scores for patients with newly diagnosed brain metastases treated with upfront radiosurgery in a modern patient collective. Radiother Oncol 2022; 172:23-31. [PMID: 35489445 DOI: 10.1016/j.radonc.2022.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numerous prognostic scores (PS) for patients with brain metastases (BM) have been developed. Recently, PS based on laboratory parameters were introduced to better predict overall survival (OS). A comprehensive comparison of the wide range of scores in a modern patient collective is still missing. MATERIALS AND METHODS Twelve PS considering clinical parameters only at the time of BM diagnosis were calculated for 470 patients receiving upfront SRS between January 2014 and March 2020. In a subcohort of 310 patients where a full laboratory dataset was available five additional prognostic scores were compared. Restricted mean survival time (RMST), partial likelihood and c-index were calculated as metrics for performance evaluation. Univariable and multivariable analysis were used to identify prognostic factors for OS. RESULTS The median OS of the whole cohort was 15.8 months (95% C.I.: 13.4-20.1). All prognostic scores performed well in separating patients into different prognostic groups. RPA achieved the highest c-index, whereas GGS achieved highest partial likelihood with evaluation in the total cohort. With incorporation of the laboratory scores the recently suggested EC-GPA achieved highest c-index and highest partial likelihood. A prognostic score solely based on the assessment of performance status achieved considerable high performance as either 3- or 4-tiered score. Multivariable analysis revealed performance status, systemic disease status and laboratory parameters to be significantly associated with OS among variates included in prognostic scores. CONCLUSION Although recent PS incorporating laboratory parameters show convincing performance in predicting overall survival, older scores relying on clinical parameters only are still valid and appealing as they are easier to calculate, and as overall performance is almost equal. Moreover, a score just based on performance status is not significantly inferior and should at least be assessed for informed decision making.
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Affiliation(s)
- Johannes Kraft
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University Hospital Würzburg, Germany.
| | - Janita E van Timmeren
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Simon Frei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Kim Borsky
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Corinna Kirchner
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Luisa Sabrina Stark
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Wolpert
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
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Wegener S, Schindhelm R, Sauer OA. Implementing corrections of isocentric shifts for the stereotactic irradiation of cerebral targets: Clinical validation. J Appl Clin Med Phys 2022; 23:e13577. [PMID: 35234345 PMCID: PMC9121032 DOI: 10.1002/acm2.13577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose: Any Linac will show geometric imprecisions, including non‐ideal alignment of the gantry, collimator and couch axes, and gantry sag or wobble. Their angular dependence can be quantified and resulting changes of the dose distribution predicted (Wack, JACMP 20(5), 2020). We analyzed whether it is feasible to correct geometric shifts during treatment planning. The successful implementation of such a correction procedure was verified by measurements of different stereotactic treatment plans. Methods: Isocentric shifts were quantified for two Elekta Synergy Agility Linacs using the QualiForMed ISO‐CBCT+ module, yielding the shift between kV and MV isocenters, the gantry flex and wobble as well as the positions of couch and collimator rotation axes. Next, the position of each field's isocenter in the Pinnacle treatment planning system was adjusted accordingly using a script. Fifteen stereotactic treatment plans of cerebral metastases (0.34 to 26.53 cm3) comprising 9–11 beams were investigated; 54 gantry and couch combinations in total. Unmodified plans and corrected plans were measured using the Sun Nuclear SRS‐MapCHECK with the Stereophan phantom and evaluated using gamma analysis. Results: Geometric imprecisions, such as shifts of up to 0.8 mm between kV and MV isocenter, a couch rotation axis 0.9 mm off the kV isocente,r and gantry flex with an amplitude of 1.1 mm, were found. For eight, mostly small PTVs D98 values declined more than 5% by simulating these shifts. The average gamma (2%/2 mm, absolute, global, 20% threshold) was reduced from 0.53 to 0.31 (0.32 to 0.30) for Linac 1 (Linac 2) when including the isocentric corrections. Thus, Linac 1 reached the accuracy level of Linac 2 after correction. Conclusion: Correcting for Linac geometric deviations during the planning process is feasible and was dosimetrically validated. The dosimetric impact of the geometric imperfections can vary between Linacs and should be assessed and corrected where necessary.
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Affiliation(s)
- Sonja Wegener
- Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Robert Schindhelm
- Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Otto A Sauer
- Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
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12
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Effect of brain radiotherapy strategies on prognosis of patients with EGFR-mutant lung adenocarcinoma with brain metastasis. J Transl Med 2021; 19:486. [PMID: 34847914 PMCID: PMC8638426 DOI: 10.1186/s12967-021-03161-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Epidermal growth factor receptor (EGFR)-mutant lung cancers have a high risk of developing brain metastases (BM). Whole brain radiotherapy (WBRT), local radiotherapy, and WBRT + Boost are frequently used for treatment of BM. This retrospective study aimed to evaluate the difference in efficacy of these radiotherapy modes in patients with EGFR-mutant lung adenocarcinoma with BMs. Further, we determined the optimal radiotherapy regimen for patients based on Lung-molGPA. Methods and materials We retrospectively enrolled 232 patients with EGFR-mutant lung adenocarcinoma with BMs. Patients were divided into three groups based on the different modes of brain radiotherapy: WBRT group, local radiotherapy group, and WBRT + Boost group. Graded prognostic assessment for lung cancer using molecular markers (Lung molGPA), overall survival (OS), and intracranial progression-free survival (iPFS) were calculated. Kaplan–Meier was used to compare iPFS and OS in different groups. Results The median OS for the WBRT (n = 84), local radiotherapy (n = 65), and WBRT + Boost (n = 83) cohorts was 32.8, 59.1, and 41.7 months, respectively (P = 0.0002). After stratification according to the Lung-molGPA score, the median OS for the WBRT (n = 56), local radiotherapy (n = 19), and WBRT + Boost (n = 28) cohorts was 32.5, 30.9, and 30.8 months, respectively, in subgroup with score 1–2 (P = 0.5097). In subgroup with score 2.5–4, the median OS for the WBRT (n = 26), local radiotherapy (n = 45), and WBRT + Boost (n = 54) cohorts was 32, 68.4, and 51 months, respectively (P = 0.0041). Conclusion The present study showed that in patients with EGFR-mutant lung adenocarcinoma with BM, local radiotherapy and WBRT + Boost perform similarly well both in the subgroups with low and high scores of Lung-molGPA. Considering the side effect caused by whole brain radiotherapy, we recommended local radiotherapy as optimal brain radiation mode for those subtype lung cancer patients.
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Punchak M, Miranda SP, Gutierrez A, Brem S, O'Rourke D, Lee JYK, Shabason JE, Petrov D. Resecting the dominant lesion: Patient outcomes after surgery and radiosurgery vs stand-alone radiosurgery in the setting of multiple brain metastases. Clin Neurol Neurosurg 2021; 211:107016. [PMID: 34823154 DOI: 10.1016/j.clineuro.2021.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/17/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain metastases are the most common central nervous system (CNS) tumors, occurring in 300,000 people per year in the US. While there are immediate local benefits to surgical resection for dominant lesions, including reduction of tumor burden and edema, the survival benefits of surgical resection, over radiosurgery, remains unclear. METHODS The University of Pennsylvania Health System database was retrospectively reviewed for patients presenting with multiple brain metastases from 1/1/16-8/31/18 with one dominant lesion > 2 cm in diameter, who underwent initial treatment with either resection of the dominant lesion or Gamma Knife radiosurgery (GKS). Inclusion criteria were age > 18, > 1 brain metastasis, and presence of a dominant lesion (>2 cm). We analyzed factors associated with mortality. RESULTS 129 patients were identified (surgery=84, GKS=45). The median number of intracranial metastases was 3 (IQR: 2-5). The median diameter of the largest lesion was 31 mm (IQR: 25-38) in the surgery group vs 21 mm (IQR: 20-24) in the GKS group (p < 0.001). Mortality did not differ between surgery and GKS patients (69.1% vs 77.8%, p = 0.292). In a multivariate survival analysis, there was no difference in mortality between the surgery and GKS cohorts (aHR: 1.35, 95% CI: 0.74-2.45 p = 0.32). Pre-operative KPS (aHR: 0.97, 95% CI: 0.95-0.99, p = 0.004), CNS radiotherapy (aHR: 0.33, 95% CI: 0.19-0.56 p < 0.001), chemotherapy (aHR: 0.27, 95% CI: 0.15-0.47, p < 0.001), and immunotherapy (aHR: 0.41, 95% CI: 0.25-0.68, p = 0.001) were associated with decreased mortality. CONCLUSION In our institution, patients with multiple brain metastases and one symptomatic dominant lesion demonstrated similar survival after GKS when compared with up-front surgical resection of the dominant lesion.
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Affiliation(s)
- Maria Punchak
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - Stephen P Miranda
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - Alexis Gutierrez
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - Steven Brem
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - Donald O'Rourke
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA
| | - Jacob E Shabason
- Deparment of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, USA
| | - Dmitriy Petrov
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, USA.
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14
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Madhugiri VS, Moiyadi A, Nagella AB, Singh V, Shetty P. A Questionnaire-based Survey of Clinical Neuro-oncological Practice in India. Neurol India 2021; 69:659-664. [PMID: 34169864 DOI: 10.4103/0028-3886.319199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Neuro-oncology is a relatively young subspecialty of neurosurgery. 2018 was the 10th year since the founding of the Indian Society of Neuro-oncology. Objective To assess patterns in neuro-oncology practice in India. Methods This was an online survey covering various domains of neuro-oncology such as demographics and practice setting, protocols for the medical management of patients with brain tumors, protocols for surgery and the perioperative period (including antibiotic prophylaxis, dural closure techniques, etc.), technological adjuncts used for brain/spine tumors (including intraoperative neurologic monitoring-IONM), and management protocols for certain specific clinical scenarios. Results The response rate was 13%. Although 37% of the respondents' institutions could be considered as having reasonable surgical volumes (>1 procedure/day), only about half of these had high volumes of malignant brain tumor surgery. A wide variation was seen in medical management, perioperative protocols, use of adjuncts and intraoperative technologies, and paradigms for specific clinical scenarios. Conclusions There is a need to standardize the protocols in neuro-oncology. This could be achieved by strengthening the formal training process in surgical neuro-oncology.
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Affiliation(s)
- Venkatesh S Madhugiri
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Aliasgar Moiyadi
- Division of Neurosurgery, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, Maharashtra, India
| | - Amrutha Bindu Nagella
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Vikram Singh
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Prakash Shetty
- Division of Neurosurgery, Neuro-Oncology Disease Management Group, Tata Memorial Centre (TMH and ACTREC), Mumbai, Maharashtra, India
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15
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Nieder C, Mannsåker B, Yobuta R. Validation of a Graded Prognostic Model in Patients With Brain Metastases Treated With Whole-brain Radiotherapy Instead of Radiosurgery. In Vivo 2021; 35:1569-1572. [PMID: 33910837 DOI: 10.21873/invivo.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyze the survival predictions obtained from a recent graded prognostic model developed and validated in Japan. PATIENTS AND METHODS This was a retrospective single-institution analysis of 249 patients, managed with whole-brain radiotherapy for brain metastases. The sum of scores was calculated as in the Japanese study. The following parameters were included: number of brain metastases, volume of the largest lesion, sex, Karnofsky performance status, primary cancer type, control of primary cancer, and presence of extra-cerebral metastases. RESULTS Median overall survival was 3.0 months (95% CI= 2.6-3.4 months). The median sum of scores was 12, range=0-29. Statistically significant differences were observed between all prognostic strata. CONCLUSION The graded prognostic model is also applicable to patients treated with whole-brain rather than stereotactic radiotherapy.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Bård Mannsåker
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Rosalba Yobuta
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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16
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Decabooter E, Swinnen AC, Öllers MC, Göpfert F, Verhaegen F. Operation and calibration of the novel PTW 1600SRS detector for the verification of single isocenter stereotactic radiosurgery treatments of multiple small brain metastases. Br J Radiol 2021; 94:20210473. [PMID: 34111967 PMCID: PMC8248213 DOI: 10.1259/bjr.20210473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The aim of this work was to evaluate the operation of the 1600SRS detector and to develop a calibration procedure for verifying the dose delivered by a single isocenter stereotactic radiosurgery (SRS) treatment of small multiple brain metastases (BM). Methods: 14 clinical treatment cases were selected with the number of BM ranging from 2 to 11. The dosimetric agreement was investigated between the calculated and the measured dose by an OCTAVIUS 1600SRS array detector in an OCTAVIUS 4D phantom equipped with dedicated SRS top. The cross-calibration procedure deviated from the manufacturer’s as it applied field sizes and dose rates corresponding to the volumetric modulated arc therapy segments in each plan. Results: Measurements with a plan specific cross-calibration showed mean ± standard deviation (SD) agreement scores for cut-off values 50%, 80%, 95%, of 98.6 ± 1.7%, 96.5 ± 4.6%, 97.3 ± 4.4% for the 6 MV plans respectively, and 98.6 ± 1.5%, 96.6 ± 4.0% 96.4 ± 6.3%, for the 6 MV flattening filter free (FFF) plans respectively. Using the default calibration procedure instead of the plan specific calibration could lead to a combined systematic dose offset of 4.1% for our treatment plans. Conclusion: The 1600SRS detector array with the 4D phantom offers an accurate solution to perform routine quality assurance measurements of single isocenter SRS treatments of multiple BM. This work points out the necessity of an adapted cross-calibration procedure. Advances in knowledge: A dedicated calibration procedure enables accurate dosimetry with the 1600SRS detector for small field single isocenter SRS treatment of multiple brain metastases for a large amount of BM.
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Affiliation(s)
- Esther Decabooter
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ans Cc Swinnen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michel C Öllers
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Frank Verhaegen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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17
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Calvo‐Ortega J, Greer PB, Hermida‐López M, Moragues‐Femenía S, Laosa‐Bello C, Casals‐Farran J. Validation of virtual water phantom software for pre-treatment verification of single-isocenter multiple-target stereotactic radiosurgery. J Appl Clin Med Phys 2021; 22:241-252. [PMID: 34028955 PMCID: PMC8200437 DOI: 10.1002/acm2.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/05/2021] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to benchmark the accuracy of the VIrtual Phantom Epid dose Reconstruction (VIPER) software for pre-treatment dosimetric verification of multiple-target stereotactic radiosurgery (SRS). VIPER is an EPID-based method to reconstruct a 3D dose distribution in a virtual phantom from in-air portal images. Validation of the VIPER dose calculation was assessed using several MLC-defined fields for a 6 MV photon beam. Central axis percent depth doses (PDDs) and output factors were measured with an ionization chamber in a water tank, while dose planes at a depth of 10 cm in a solid flat phantom were acquired with radiochromic films. The accuracy of VIPER for multiple-target SRS plan verification was benchmarked against Monte Carlo simulations. Eighteen multiple-target SRS plans designed with the Eclipse treatment planning system were mapped to a cylindrical water phantom. For each plan, the 3D dose distribution reconstructed by VIPER within the phantom was compared with the Monte Carlo simulation, using a 3D gamma analysis. Dose differences (VIPER vs. measurements) generally within 2% were found for the MLC-defined fields, while film dosimetry revealed gamma passing rates (GPRs) ≥95% for a 3%/1 mm criteria. For the 18 multiple-target SRS plans, average 3D GPRs greater than 93% and 98% for the 3%/2 mm and 5%/2 mm criteria, respectively. Our results validate the use of VIPER as a dosimetric verification tool for pre-treatment QA of single-isocenter multiple-target SRS plans. The method requires no setup time on the linac and results in an accurate 3D characterization of the delivered dose.
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Affiliation(s)
- Juan‐Francisco Calvo‐Ortega
- Servicio de Oncología RadioterápicaHospital QuirónsaludBarcelonaSpain
- Servicio de Oncología RadioterápicaHospital Universitari DexeusBarcelonaSpain
| | - Peter B. Greer
- Department of Radiation OncologyCalvary Mater Newcastle HospitalNewcastleNSW2298Australia
- School of Mathematical and Physical SciencesUniversity of NewcastleNewcastleNSW2300Australia
| | | | - Sandra Moragues‐Femenía
- Servicio de Oncología RadioterápicaHospital QuirónsaludBarcelonaSpain
- Servicio de Oncología RadioterápicaHospital Universitari DexeusBarcelonaSpain
| | - Coral Laosa‐Bello
- Servicio de Oncología RadioterápicaHospital QuirónsaludBarcelonaSpain
- Servicio de Oncología RadioterápicaHospital Universitari DexeusBarcelonaSpain
| | - Joan Casals‐Farran
- Servicio de Oncología RadioterápicaHospital QuirónsaludBarcelonaSpain
- Servicio de Oncología RadioterápicaHospital Universitari DexeusBarcelonaSpain
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Kraft J, van Timmeren JE, Mayinger M, Frei S, Borsky K, Stark LS, Krayenbuehl J, Zamburlini M, Guckenberger M, Tanadini-Lang S, Andratschke N. Distance to isocenter is not associated with an increased risk for local failure in LINAC-based single-isocenter SRS or SRT for multiple brain metastases. Radiother Oncol 2021; 159:168-175. [PMID: 33798610 DOI: 10.1016/j.radonc.2021.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/07/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the impact of the distance between treatment isocenter and brain metastases on local failure in patients treated with a frameless linear-accelerator-based single-isocenter volumetric modulated arc (VMAT) SRS/SRT for multiple brain metastases. METHODS AND MATERIALS Patients treated with SRT for brain metastases (BM) between April 2014 and May 2019 were included in this retrospective study. BM treated with a single-isocenter multiple-target (SIMT) SRT were evaluated for local recurrence-free intervals in dependency to their distance to the treatment isocenter. A Cox-regression model was used to investigate different predictor variables for local failure. Results were compared to patients treated with a single-isocenter-single-target (SIST) approach. RESULTS In total 315 patients with a cumulative number of 1087 BM were analyzed in this study of which 140 patients and 708 BM were treated with SIMT SRS/SRT. Median follow-up after treatment was 13.9 months for SIMT approach and 11.9 months for SIST approach. One-year freedom from local recurrence was 87% and 94% in the SIST and SIMT group, respectively. Median distance to isocenter (DTI) was 4.7 cm (range 0.2-10.5) in the SIMT group. Local recurrence-free interval was not associated with the distance to the isocenter in univariable or multivariable Cox-regression analysis. Multivariable analysis revealed only volume as an independent significant predictor for local failure (p-value <0.05). CONCLUSION SRS/SRT using single-isocenter VMAT for multiple targets achieved high local metastases control rates irrespective of distance to the isocenter, supporting efficacy of single-isocenter stereotactic radiation therapy for multiple brain metastases.
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Affiliation(s)
- Johannes Kraft
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University Hospital Wuerzburg, Germany.
| | - Janita E van Timmeren
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Simon Frei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Kim Borsky
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Luisa Sabrina Stark
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Jerome Krayenbuehl
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Mariangela Zamburlini
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
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19
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Kraft J, Mayinger M, Willmann J, Brown M, Tanadini-Lang S, Wilke L, Guckenberger M, Andratschke N. Management of multiple brain metastases: a patterns of care survey within the German Society for Radiation Oncology. J Neurooncol 2021; 152:395-404. [PMID: 33620657 PMCID: PMC7997832 DOI: 10.1007/s11060-021-03714-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The treatment of brain metastases (BM) has changed considerably in recent years and in particular, the management of multiple BM is currently undergoing a paradigm shift and treatment may differ from current guidelines. This survey was designed to analyze the patterns of care in the management of multiple BM. METHODS An online survey consisting of 36 questions was distributed to the members of the German Society for Radiation Oncology (DEGRO). RESULTS In total, 193 physicians out of 111 institutions within the German Society for Radiation oncology responded to the survey. Prognostic scores for decision making were not used regularly. Whole brain radiotherapy approaches (WBRT) are the preferred treatment option for patients with multiple BM, although stereotactic radiotherapy treatments are chosen by one third depending on prognostic scores and overall number of BM. Routine hippocampal avoidance (HA) in WBRT is only used by a minority. In multiple BM of driver-mutated non-small cell lung cancer origin up to 30% favor sole TKI therapy as upfront treatment and would defer upfront radiotherapy. CONCLUSION In multiple BM WBRT without hippocampal avoidance is still the preferred treatment modality of choice regardless of GPA and mutational status, while SRT is only used in patients with good prognosis. Evidence for both, SRS and hippocampal avoidance radiotherapy, is growing albeit the debate over the appropriate treatment in multiple BM is yet not fully clarified. Further prospective assessment of BM management-ideally as randomized trials-is required to align evolving concepts with the proper evidence and to update current guidelines.
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Affiliation(s)
- Johannes Kraft
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland.
| | - Michael Mayinger
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | - Jonas Willmann
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | - Michelle Brown
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | | | - Lotte Wilke
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
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20
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Alongi F, Nicosia L, Figlia V, Giaj-Levra N, Cuccia F, Mazzola R, Ricchetti F, Rigo M, Vitale C, De Simone A, Naccarato S, Sicignano G, Gurrera D, Corradini S, Ruggeri R. Long-term disease outcome and volume-based decision strategy in a large cohort of multiple brain metastases treated with a mono-isocentric linac-based Stereotactic Radiosurgery technique. Clin Transl Oncol 2021; 23:1561-1570. [PMID: 33570720 DOI: 10.1007/s12094-020-02550-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Radiosurgery (SRS) is an effective treatment option for brain metastases (BMs). Long-term results of the first worldwide experience with a mono-isocentric, non-coplanar, linac-based stereotactic technique in the treatment of multiple BMs are reported. METHODS patients with multiple BMs, life expectancy > 3 months, and good performance status (≤ 2) were treated with simultaneous SRS with volumetric modulated arc technique. Data were retrospectively evaluated. RESULTS 172 patients accounting for 1079 BMs were treated at our institution from 2017 to 2020. The median number of treated metastases was 4 (range 2-22). Primary tumor histology was: lung (44.8%), breast (32%), and melanoma (9.4%). The 2-year LPFS was 71.6%, respectively. A biological effective dose (BED) ≥ 51.3 Gy10 correlated with higher local control. Uncontrolled systemic disease and melanoma histology were independent prognostic factors correlated with decreased iPFS. Patients with > 10 BMs had a trend towards shorter iPFS (p = 0.055). 31 patients received multiple SRS courses (2-7) in case of intracranial progression. The median iOS was 22.4 months. Brainstem metastases and total PTV > 7.1 cc correlated with shorter iOS. The 1- and 2-year WBRT-free survival was 83.2% and 61.1%, respectively. CONCLUSION Long-term results in a large patient population treated with a mono-isocentric, dedicated technique demonstrated its effectiveness and safety also in the case of multiple courses. The shortened treatment time and the possibility to safely spare healthy brain tissue allows the safe treatment of patients with a large number of metastases and to deliver multiple courses of SRS. In selected cases, the administration of WBRT can be delayed.
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Affiliation(s)
- F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy.
| | - V Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - N Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - F Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - R Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - F Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - M Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - C Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - A De Simone
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - S Naccarato
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - G Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - D Gurrera
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
| | - S Corradini
- Radiation Oncology Department, University Hospital, LMU Munich, Munich, Germany
| | - R Ruggeri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy
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21
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Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study. J Med Imaging Radiat Sci 2021; 52:214-222. [PMID: 33549504 DOI: 10.1016/j.jmir.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
AIM To analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases. METHODS Breast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital's RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed. RESULTS 255 females with WBRT (n = 206) or SRS (n = 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT fractionation regimen was 3 Gy × 10. SRS was most often single fractions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1-73) relative to 23 (CI 0-78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metastases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis. CONCLUSION WBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.
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22
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Medikonda R, Srivastava S, Kim T, Xia Y, Kim J, Jackson C, Weingart J, Mukherjee D, Bettegowda C, Gallia G, Brem H, Redmond K, Stearns V, Kleinberg L, Lim M. Development of new brain metastases in triple negative breast cancer. J Neurooncol 2021; 152:333-338. [PMID: 33512631 DOI: 10.1007/s11060-021-03702-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brain metastases are common in patients with breast cancer, and those with triple negative status have an even higher risk. Triple negative status is currently not considered when managing brain metastases. OBJECTIVE To determine whether triple negative breast cancer (TNBC) patients with brain metastases have a higher burden of intracranial disease and whether WBRT has a survival benefit in this cohort of patients. METHODS We conducted a retrospective cohort study with 85 patients meeting the inclusion criteria. RESULTS 25% of patients had TNBC. 95% of the patients in this study received SRS and 48% received WBRT. The average number of new brain metastases from time of initial brain imaging to radiation therapy was 0.67 ± 1.1 in the non-TNBC status patients and 2.6 ± 3.7 in the triple negative status patients (p = 0.001). A cox proportional hazards model showed that WBRT does not significantly affect overall survival in patients with TNBC (HR 1.48; 95% CI 0.47-4.67; p = 0.50). CONCLUSION Our findings highlight the highly aggressive intracranial nature of TNBC. The rate of new brain metastasis formation is higher in TNBC patients compared to non-TNBC patients. Furthermore, there is no survival benefit for WBRT in TNBC patients. These findings are relevant for clinicians planning brain radiation for TNBC patients as they may find more brain metastases at the time of brain radiation than they anticipated based on initial brain imaging.
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Affiliation(s)
- Ravi Medikonda
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Siddhartha Srivastava
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Timothy Kim
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Jennifer Kim
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Christopher Jackson
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Jon Weingart
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Gary Gallia
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Henry Brem
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA
| | - Kristin Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- Department Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Neurosurgery Oncology, Radiation Oncology, Otolaryngology, Institute of NanoBiotechnology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 123, Baltimore, MD, 21287, USA.
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23
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Ni M, Liu W, Jiang A, Wang Y, Sheng Y, Zeng H, Liu N, Li L, Qi Y, Wang Y, Yu J, Yuan S. Whole Brain Radiation Therapy Plus Focal Radiation Boost May Generate Better Survival Benefit for Brain Metastases From Non-small Cell Lung Cancer. Front Oncol 2020; 10:576700. [PMID: 33194690 PMCID: PMC7606935 DOI: 10.3389/fonc.2020.576700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Owing to improved systemic therapies, the survival of patients with non-small cell lung cancer (NSCLC) was prolonged, and the risk of brain metastases was consequently increased. This study aims to compare different radiotherapy for brain metastases in patients with NSCLC. Materials and methods The patients with NSCLC who were treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for brain metastases at three medical centers between January 2012 and December 2017 were retrospectively analyzed. Results Of the 684 eligible patients, 217 received WBRT plus focal radiation boost (WBRT+boost), 324 received WBRT, and 143 received SRS. Patients with WBRT+boost lived longer than those with WBRT (median overall survival (OS), 22.2 vs 13.7 months, P < 0.001) or SRS (22.2 vs 17.3 months, P = 0.011). In subgroup analyses, the survival advantage of WBRT+boost was more obvious among patients with 1 to 3 brain metastases or who received targeted therapy than did SRS. From pair-wise comparisons of intracranial progression-free survival (iPFS), WBRT+boost was also superior to WBRT (12.9 vs 10.6 months, P = 0.028) and SRS (12.9 vs 9.1 months, P = 0.001). Conclusions Patients who were treated with WBRT+boost experienced significantly longer OS and iPFS than those with WBRT or SRS alone. WBRT+boost should be a preferred strategy for brain metastases in NSCLC patients.
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Affiliation(s)
- Meng Ni
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Wenju Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Aijun Jiang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yanxing Sheng
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, China
| | - Haiyan Zeng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ning Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Li Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yiqiang Qi
- Department of Radiation Oncology, ZiBo Central Hospital, Zibo, China
| | - Yu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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24
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Glatzer M, Faivre-Finn C, De Ruysscher D, Widder J, Van Houtte P, Troost EGC, Slotman BJ, Ramella S, Pöttgen C, Peeters STH, Nestle U, McDonald F, Le Pechoux C, Dziadziuszko R, Belderbos J, Ricardi U, Manapov F, Lievens Y, Geets X, Dieckmann K, Guckenberger M, Andratschke N, Süveg K, Putora PM. Role of radiotherapy in the management of brain metastases of NSCLC - Decision criteria in clinical routine. Radiother Oncol 2020; 154:269-273. [PMID: 33186683 DOI: 10.1016/j.radonc.2020.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whole brain radiotherapy (WBRT) is a common treatment option for brain metastases secondary to non-small cell lung cancer (NSCLC). Data from the QUARTZ trial suggest that WBRT can be omitted in selected patients and treated with optimal supportive care alone. Nevertheless, WBRT is still widely used to treat brain metastases secondary to NSCLC. We analysed decision criteria influencing the selection for WBRT among European radiation oncology experts. METHODS Twenty-two European radiation oncology experts in lung cancer as selected by the European Society for Therapeutic Radiation Oncology (ESTRO) for previous projects and by the Advisory Committee on Radiation Oncology Practice (ACROP) for lung cancer were asked to describe their strategies in the management of brain metastases of NSCLC. Treatment strategies were subsequently converted into decision trees and analysed for agreement and discrepancies. RESULTS Eight decision criteria (suitability for SRS, performance status, symptoms, eligibility for targeted therapy, extra-cranial tumour control, age, prognostic scores and "Zugzwang" (the compulsion to treat)) were identified. WBRT was recommended by a majority of the European experts for symptomatic patients not suitable for radiosurgery or fractionated stereotactic radiotherapy. There was also a tendency to use WBRT in the ALK/EGFR/ROS1 negative NSCLC setting. CONCLUSION Despite the results of the QUARTZ trial WBRT is still widely used among European radiation oncology experts.
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Affiliation(s)
- Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, United Kingdom
| | - Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Paul Van Houtte
- Department of Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers, VUMC, The Netherlands
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany
| | - Stephanie T H Peeters
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Cecile Le Pechoux
- Departement Oncologie Radiotherapie, Gustave Roussy, Villejuif, France
| | | | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Farkhad Manapov
- Department of Radiation Oncology, LMU Klinikum, University of Munich, Germany
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Belgium
| | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, MIRO - IREC Lab, UCL, Belgium
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Krisztian Süveg
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland
| | - Paul M Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland
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25
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Kishi N, Nakamura M, Hirashima H, Mukumoto N, Takehana K, Uto M, Matsuo Y, Mizowaki T. Validation of the clinical applicability of knowledge-based planning models in single-isocenter volumetric-modulated arc therapy for multiple brain metastases. J Appl Clin Med Phys 2020; 21:141-150. [PMID: 32951337 PMCID: PMC7592973 DOI: 10.1002/acm2.13022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/01/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To validate the clinical applicability of knowledge-based (KB) planning in single-isocenter volumetric-modulated arc therapy (VMAT) for multiple brain metastases using the k-fold cross-validation (CV) method. METHODS This study comprised 60 consecutive patients with multiple brain metastases treated with single-isocenter VMAT (28 Gy in five fractions). The patients were divided randomly into five groups (Groups 1-5). The data of Groups 1-4 were used as the training and validation dataset and those of Group 5 were used as the testing dataset. Four KB models were created from three of the training and validation datasets and then applied to the remaining Groups as the fourfold CV phase. As the testing phase, the final KB model was applied to Group 5 and the dose distributions were calculated with a single optimization process. The dose-volume indices (DVIs), modified Ian Paddick Conformity Index (mIPCI), modulation complexity scores for VMAT plans (MCSv), and the total number of monitor units (MUs) of the final KB plan were compared to those of the clinical plan (CL) using a paired Wilcoxon signed-rank test. RESULTS In the fourfold CV phase, no significant differences were observed in the DVIs among the four KB plans (KBPs). In the testing phase, the final KB plan was statistically equivalent to the CL, except for planning target volumes (PTVs) D2% and D50% . The differences between the CL and KBP in terms of the PTV D99.5% , normal brain, and Dmax to all organs at risk (OARs) were not significant. The KBP achieved a lower total number of MUs and higher MCSv than the CL with no significant difference. CONCLUSIONS We demonstrated that a KB model in a single-isocenter VMAT for multiple brain metastases was equivalent in dose distribution, MCSv, and total number of MUs to a CL with a single optimization.
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Affiliation(s)
- Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Information Technology and Medical Engineering, Division of Medical Physics, Graduate School of Medicine, Human Health Sciences, Kyoto University, Kyoto, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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26
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques.SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments.The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations.Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests.Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition).This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.
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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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27
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Systemic Therapies for Melanoma Brain Metastases: A Primer for Radiologists. J Comput Assist Tomogr 2020; 44:346-355. [PMID: 32217896 DOI: 10.1097/rct.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this article is to provide a primer for radiologists outlining the modern systemic therapies used in melanoma brain metastases, including tyrosine kinase inhibitors and immune checkpoint inhibitors. The role of radiologic treatment response evaluation will be discussed from the standpoint of both modern systemic therapies and more traditional treatments. CONCLUSION Understanding the role of systemic treatments in melanoma brain metastases is critical for oncologic imaging interpretation in this unique patient population.
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28
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Lee SR, Roh TH, Jeong DH, You N, Jang AH, Seo MR, Choung JH, Park B, Kim SH. A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases. Stereotact Funct Neurosurg 2020; 98:278-285. [PMID: 32408303 DOI: 10.1159/000507338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study aimed to investigate the prognostic factors for patients with brain metastases undergoing radiosurgical treatment and to introduce a simple and practical scoring system for the prediction of survival time. METHODS We retrospectively analyzed data for 311 patients treated with Gamma Knife radiosurgery at a single institute. The mean age at time of treatment was 60 years (range 23-86 years), and the median Karnofsky performance status (KPS) score was 90 (range 60-100). Using a new prognostic index, the prognostic index for brain metastases (PIBM), the patients were categorized into 3 groups according to the primary tumor status and KPS score. We performed survival analysis and compared the prognostic ability of the PIBM with other published indices. RESULTS During the median follow-up duration of 8.2 months (range 0.1-109 months), the median overall survival time was 9.1 months. Stable primary tumor status (hazard ratio [HR] 0.497, 95% confidence interval [CI] 0.321-0.769, p = 0.002) and KPS score ≥90 (HR 1.407, 95% CI 1.018-1.946, p = 0.039) significantly predicted longer overall survival. The PIBM showed the lowest Akaike information criterion value and the highest integrated area under the curve value compared with other prognostic indices. CONCLUSIONS The PIBM may be a more accurate prognostic indicator than other published indices. Although this new and practical prognostic index requires further validation in larger cohort studies, we suggest that the PIBM could be useful to predict survival time and inform appropriate management of patients with brain metastases.
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Affiliation(s)
- Sang Ryul Lee
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Tae Hoon Roh
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Hwan Jeong
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Republic of Korea
| | - Namkyu You
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ae Hwa Jang
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Mi Ra Seo
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Hee Choung
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Se-Hyuk Kim
- Gamma Knife Center, Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea,
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29
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Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys 2020; 21:63-72. [PMID: 32237274 PMCID: PMC7324699 DOI: 10.1002/acm2.12866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
To evaluate the accuracy of a commercial optical surface tracking (OST) system and to demonstrate how it can be implemented to monitor patient positioning during non‐coplanar single isocenter stereotactic treatments of brain metastases. A 3‐camera OST system was used (Catalyst HD™, C‐RAD) on a TruebeamSTx with a 6DoF couch. The setup accuracy and agreement between the OST system, and CBCT and kV‐MV imaging at couch angles 0° and 270°, respectively, were examined. Film measurements at 3 depths in the Rando‐Alderson phantom were performed using a single isocenter non‐coplanar VMAT plan containing 4 brain lesions. Setup of the phantom was performed with CBCT at couch 0° and subsequently monitored by OST at other couch angles. Setup data for 7 volunteers were collected to evaluate the accuracy and reproducibility of the OST system at couch angles 0°, 45°, 90°, 315°, and 270°. These results were also correlated to the couch rotation offsets obtained by a Winston‐Lutz (WL) test. The Rando‐Alderson phantom, as well as volunteers, were fixated using open face masks (Orfit). For repeated tests with the Rando‐Alderson phantom, deviations between rotational and translational isocenter corrections for CBCT and OST systems are always within 0.2° (pitch, roll, yaw), and 0.1mm and 0.5mm (longitudinal, lateral, vertical) for couch positions 0° and 270°, respectively. Dose deviations between the film and TPS doses in the center of the 4 lesions were −1.2%, −0.1%, −0.0%, and −1.9%. Local gamma evaluation criteria of 2%/2 mm and 3%/1 mm yielded pass rates of 99.2%, 99.2%, 98.6%, 89.9% and 98.8%, 97.5%, 81.7%, 78.1% for the 4 lesions. Regarding the volunteers, the mean translational and rotational isocenter shift values were (0.24 ± 0.09) mm and (0.15 ± 0.07) degrees. Largest isocenter shifts were found for couch angles 45˚ and 90˚, confirmed by WL couch rotation offsets. Patient monitoring during non‐coplanar VMAT treatments of brain metastases is feasible with submillimeter accuracy.
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Affiliation(s)
| | | | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, the Netherlands
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Nieder C, Mannsåker B, Yobuta R. Late Brain Oligometastases Diagnosed at Least 36 Months after Cancer Detection are Associated with Favorable Survival Outcome. Cureus 2020; 12:e6553. [PMID: 32042526 PMCID: PMC6996465 DOI: 10.7759/cureus.6553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective The aim of this study was to investigate the impact of a long disease-free interval (at least 36 months from the first diagnosis of cancer) on survival in patients with brain oligometastases (maximum four lesions, no extracranial metastases). Methods This study involves a retrospective analysis in a group of 89 patients treated with different brain-directed approaches. Results We identified seven patients (8%) with an interval from cancer diagnosis to the development of brain metastases of at least 36 months. The median time interval was five months. The one-year survival rates were 80% (interval of at least 36 months) and 43% (shorter interval), respectively (p = 0.049). Correspondingly, a large difference in actuarial median survival was observed (39.9 months [95% confidence interval, 16.8-63.0 months] versus 9.7 months (95% confidence interval, 6.1-13.3 months). However, the two Kaplan-Meier curves were not statistically significantly different, p = 0.13. In addition to treatment-related differences, the two groups also differed with regard to the type of primary tumor (high versus low rates of non-small cell lung cancer) and gender. Conclusion Late dissemination was uncommon. The often applied strategy of effective local treatment for patients with brain-only oligometastases is warranted, especially if the disease-free interval had been at least 36 months. Larger studies are needed to fully understand the impact of confounding factors, such as gender and tumor biology.
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Han Z, Hacker F, Killoran J, Kukluk J, Aizer A, Zygmanski P. Optimization of MLC parameters for TPS calculation and dosimetric verification: application to single isocenter radiosurgery of multiple brain lesions using VMAT. Biomed Phys Eng Express 2019; 6:015004. [PMID: 33438592 DOI: 10.1088/2057-1976/ab57ce] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Linac and MLC-based stereotactic radiosurgery (SRS) using single-isocenter-multiple-target (SIMT) VMAT has become increasingly popular in the management of multi-focal cranial metastases. However, significant geometrical and dosimetric challenges exist due to the typically small target volumes and in most cases, non-isocentric locations. To the best of our knowledge, there hasn't been a study in the optimization of MLC parameters, in the context of SIMT SRS, to ensure TPS calculation accuracy. In this work, we set out to optimize the dosimetric leaf gap (DLG) for the HD MLC installed on dedicated stereotactic Varian STx systems using a diverse group of 21 clinical SRS and SBRT plans. These plans featured a broad range of target sizes and target-to-isocenter distances that are typical of the stereotactic cases treated on these systems. Dose discrepancies between TPS calculations and verification measurements using a previously validated diode array Delta4 (ScandiDos) were minimized in a balanced manner to accommodate the variety of stereotactic plans. A DLG of 0.6 mm was found to be 'optimal' for the HD MLC and for the 'typical' plans treated on our STx systems. The finding was independently verified using commercially available 3D polymer gel dosimeter CrystalBallTM (MGS Research Inc.). 3D verification for 6 SIMT SRS plans, consisted of 5 to 15 targets, achieved an average gamma score of 97.3% (σ = 2.0%) on 3%/2 mm criteria with a cutoff isodose level of 20%. We further examined the practice of routine dosimetric verifications including the selection of appropriate detectors and optimal gamma parameters. We found that the commonly used standard 3%/3 mm criteria would have resulted in all but 4 (out of 2840) clinical plans achieving a gamma score of 95% or better, and therefore, losing sensitivity to detect potential dosimetric discrepancies. Based on the characteristics of stereotactic plans, a more stringent distance-to-agreement parameter is needed.
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Affiliation(s)
- Zhaohui Han
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States of America
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Radiation-Induced Brain Aneurysms: Institutional Experience and State of the Art in the Contemporary Literature. World Neurosurg 2019; 135:339-351. [PMID: 31605840 DOI: 10.1016/j.wneu.2019.09.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Brain aneurysms (BAs) are the most common intracranial vascular condition, with an overall incidence of 1%-2%. Among the common causes of their initial formation and growth, the role of radiation therapy (RT) has been reported in some studies. The aim of the present study is to report the most relevant features of BA related to a previous cranial RT. METHODS Data deriving from 1 patient treated for RT-induced BA in our institution were added to reports of another 66 BAs retrieved from the literature. The following parameters were evaluated: age, sex, location, primary lesion, clinical presentation, dosage/amount of radiation delivered, type of treatment for the BA, dimension, morphology, chemotherapy, comorbidities, risk factors, and number of BAs. RESULTS The most commonly involved vessel was the internal carotid artery (34%). In general, the anterior circulation showed higher vulnerability compared with the posterior circulation and middle cerebral artery (56.7%). The average latency between RT and the first imaging showing the BA was 9.01 ± 6.85 years. Vessels coursing in the posterior cranial fossa showed a significant univariate association with lower X-ray dosages (P = 0.014) compared with the other locations. No statistically significant correlation between the continuous variables age, latency of BA appearance, RT delivered dose, and dimension of the BA was shown. CONCLUSIONS The apparent higher fragility of the vascular structures of the posterior cranial fossa was statistically outlined, and the X-ray dosage, the primary condition target of the RT, the age of the patients, and no statistically significant correlation were outlined. Biological factors could play a significant role.
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