Clinical Outcomes of Upfront Stereotactic Radiosurgery Alone for Patients With 5 to 15 Brain Metastases

Hughes, Ryan T.; McTyre, E.; LeCompte, M.C.; Cramer, Christina K.; Munley, Michael T.; Laxton, Adrian W.; Tatter, Stephen B.; Ruiz, Jimmy; Pasche, Boris; Watabe, Kounosuke; Chan, Michael D.

doi:10.1093/neuros/nyy276

Cited by 24 publications

(26 citation statements)

References 34 publications

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“…Stereotactic radiosurgery is an established treatment for patients with one to four metastases 2–4 . Prospective and retrospective studies have reported on its feasibility and clinical benefit also for patients with ≥5 metastases 5–7 …”

Section: Introductionmentioning

confidence: 99%

Consistency of small‐field dosimetry, on and off axis, in beam‐matched linacs used for stereotactic radiosurgery

Muñoz

Kron

Petasecca

et al. 2021

J Applied Clin Med Phys

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Purpose Stereotactic radiosurgery (SRS) can be delivered with a standard linear accelerator (linac). At institutions having more than one linac, beam matching is common practice. In the literature, there are indications that machine central axis (CAX) matching for broad fields does not guarantee matching of small fields with side ≤2 cm. There is no indication on how matching for broad fields on axis translates to matching small fields off axis. These are of interest to multitarget single‐isocenter (MTSI) SRS planning and the present work addresses that gap in the literature. Methods We used 6 MV flattening filter free (FFF) beams from four Elekta VersaHD® linacs equipped with an Agility™ multileaf collimator (MLC). The linacs were strictly matched for broad fields on CAX. We compared output factors (OPFs) and effective field size, measured concurrently using a novel 2D solid‐state dosimeter “Duo” with a spatial resolution of 0.2 mm, in square and rectangular static fields with sides from 0.5 to 2 cm, either on axis or away from it by 5 to 15 cm. Results Among the four linacs, OPF for fields ≥1 × 1 cm2 ranged 1.3% on CAX, whereas off axis a maximum range of 1.9% was observed at 15 cm. A larger variability in OPF was noted for the 0.5 × 0.5 cm2 field, with a range of 5.9% on CAX, which improved to a maximum of 2.3% moving off axis. Two linacs showed greater consistency with a range of 1.4% on CAX and 2.2% at 15 cm off axis. Between linacs, the effective field size varied by <0.04 cm in most cases, both on and off axis. Tighter matching was observed for linacs with a similar focal spot position. Conclusions Verification of small‐field consistency for matched linacs used for SRS is an important task for dosimetric validation. A significant benefit of concurrent measurement of field size and OPF allowed for a comprehensive assessment using a novel diode array. Our study showed the four linacs, strictly matched for broad fields on CAX, were still matched down to a field size of 1 x 1 cm2 on and off axis.

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Section: Introductionmentioning

confidence: 99%

Consistency of small‐field dosimetry, on and off axis, in beam‐matched linacs used for stereotactic radiosurgery

Muñoz

Kron

Petasecca

et al. 2021

J Applied Clin Med Phys

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“…Some studies showed that SRS obtained good local control and less cognitive deterioration in treating 1 to 3 brain metastases [19,20]. Hughes RT et al reported that SRS alone adapted to treat these patients with 5 to 15 BM [21]. Recently, Robin TP et al found that BM patients with ALKr may be uniquely suited to bene t from SRS [20].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Alectinib in NSCLC With Brain Metastasis Patient Refractory to Radiotherapy After Resistance to Crizotinib: A Case Report and Literature Review

ZHOU

Zeng

Sun

et al. 2021

Preprint

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Background: Brain metastasis is the common place of tumor recurrence after resistance to crizotinib. The therapeutic modes on brain metastasis of ALK-positive NSCLC require multidisciplinary approach, including target therapy, chemotherapy and radiotherapy. Until to nowadays, there isn`t optimal therapeutic recommendations for these patients. Radiotherapy is the vital treatment for brain metastasis.Case presentation: We reported one ALK-positive NSCLC patient with brain metastasis after crizotinib. ALK rearrangement wasn`t found in blood sample of the patient by NGS. According to NCCN guideline, we gave the patient whole brain radiotherapy. It was unexpected that the number of brain metastasis increased after whole brain radiotherapy. After that, the patient was empirically used alectinib after radiotherapy failure. It achieved unexpected success in our patient. Conclusions: We got some enlightenment form the patient. Firstly, liquid biopsy is complementary to tissue biopsy in NSCLC, mainly in EGFR mutation. However, ALK detection should use tissue biopsy as much as possible. Secondly, we suggest the brain metastasis patient of NSCLC use the second generation TKI, such as alectinib, ceritinib, after resistance to crizotinib whether ALKr is positive or negative in liquid biopsy. Lastly, we believe that combined radiotherapy with TKIs is an optimal mode in the BM patient of NSCLC after resistance to crizotinib.

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“… 37 , 41 However, numerous studies have treated patients with larger volumes of tumor volume (up to 30 cc) with SRS and achieved excellent outcomes. 36 , 46 , 47 There is also evidence that using radiosurgery results in a lower dose to the hippocampus compared to HA-WBRT. 36 , 48 Figure 2 demonstrates a patient with 30 brain lesions treated with radiosurgery with very little dose to the hippocampus (<4 Gy mean) and a low brain dose of 8 Gy.…”

Section: Radiotherapymentioning

confidence: 99%

Multidisciplinary patient-centered management of brain metastases and future directions

Palmer

Trifiletti

Gondi

et al. 2020

Neuro-Oncology Advances

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The incidence of brain metastasis is increasing as improvements in systemic therapy lead to increased survival. This provides new and challenging clinical decisions for patients who are trying to balance the risk of recurrence or progression with treatment-related side effects, and it requires appropriate management strategies from multidisciplinary teams. Improvements in prognostic assessment and systemic therapy with increasing activity in the brain allow for individualized care to better guide the use of local therapies and/or systemic therapy. Here, we review the current landscape of brain-directed therapy for the treatment of brain metastasis in the context of recent improved systemic treatment options. We also discuss emerging treatment strategies including targeted therapies for patients with actionable mutations, immunotherapy, modern whole-brain radiation therapy, radiosurgery, surgery, and clinical trials.

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Clinical Outcomes of Upfront Stereotactic Radiosurgery Alone for Patients With 5 to 15 Brain Metastases

Abstract: SRS for 5 to 15 BM is well tolerated without evidence of an associated increase in toxicity, treatment failure, or salvage therapy. Further prospective, randomized studies are warranted to clarify the role of SRS for these patients.

Cited by 24 publications

References 34 publications

Consistency of small‐field dosimetry, on and off axis, in beam‐matched linacs used for stereotactic radiosurgery

Consistency of small‐field dosimetry, on and off axis, in beam‐matched linacs used for stereotactic radiosurgery

Treatment of Alectinib in NSCLC With Brain Metastasis Patient Refractory to Radiotherapy After Resistance to Crizotinib: A Case Report and Literature Review

Multidisciplinary patient-centered management of brain metastases and future directions

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