Brain metastases (BM) represent an important cause of morbidity and mortality being the most common intracranial tumors in adults. Their incidence is rising for several reasons: an aging population, better systemic treatment and better diagnostic imaging techniques allowing the detection of smaller metastases in asymptomatic patients. Traditionally, the most widely used treatment for patients with multiple BM is whole brain radiation therapy (WBRT), which remains a source of debate because, although distant brain control rates have been shown to be greater with WBRT, it has no impact on overall survival and the negative effects on cognition and quality of life are higher. Radiosurgery plays a significant role in the modern management of BM. We analyzed 38 patients with multiple BM (13 with more than one treatment, totalizing 61 cases) treated with CyberKnife® (CK) in the Radioncology Department Júlio Teixeira SA, from August 2016 to February 2019, for a total of 178 lesions. The average volume was 9,2cc (0,01-73,2). Total dose ranged 18-30Gy delivered in 1–5 fractions. The average nCI was 1,23 (0,19-1,69). Tumor coverage of at least 95% was obtained by prescribing the therapeutic dose to isodose lines ranging from 69–90%. Whole brain tissue was outlined as a critical structure. The average volume of 14Gy (single fraction) and 23Gy (multiple fractions) for normal brain tissue was 6,35cc and 12,4cc, respectively. The treatment was well tolerated, with improvement or resolution of the initial neurological symptoms. Among all radiosurgical platforms the CK offers the advantage of delivering with stereotactic precision high doses of radiation without the invasive attachment of a localizing frame. As a result, in many cases, became the method of choice for treating multiple brain metastases. The attractive therapeutic profile of CK radiosurgery is reflected by a high tumor control and low toxicity allowing retreatment for recurrent metastases.
Background and purpose: The association of hyperthermia with radiotherapy has been shown to be a valid approach in the treatment of locoregional recurrence of previously irradiated malignant tumors. The purpose of the present study is to describe the initial experience of the Radiation Oncology Department Júlio Teixeira SA (CUF Institute) and the Medical Oncology Service (Hospital CUF Porto) in the treatment of these lesions, reporting the first cases treated in Portugal with this therapeutic approach. Material and methods: The authors performed a retrospective analysis of the 18 patients, 16 females and 2 males, with unresectable tumor recurrences, in previously irradiated areas, treated with radiotherapy associated with hyperthermia between May 2016 and March 2017, totalizing 25 treatments. Breast disease was the most frequent, accounting for 72% of cases. Results: The median follow-up period was 4, 5 months. The complete response rate was 44%. A favorable response was observed in all treatments, with decrease in pain, bleeding and infection, with and no grade 3 toxicities. Conclusions: The results are encouraging, with improved quality of life and patient self-esteem with acceptable toxicity. The combined treatment of hyperthermia and radiotherapy seems to be a valid option in the local control of recurrent unresectable neoplasms at previously irradiated sites, whose therapeutic options are limited.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.