Consensus Contouring Guidelines for Postoperative Completely Resected Cavity Stereotactic Radiosurgery for Brain Metastases

Soliman, Hany; Ruschin, Mark; Angelov, Lilyana; Brown, Paul D.; Chiang, Veronica; Kirkpatrick, John P.; Lo, Simon S.; Mahajan, Anita; Oh, Kevin; Sheehan, Jason P.; Soltys, Scott G.; Sahgal, Arjun

doi:10.1016/j.ijrobp.2017.09.047

Cited by 162 publications

(107 citation statements)

References 19 publications

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“…While stereotactic radiotherapy was most frequently employed to treat gross disease, some respondents reported stereotactic radiotherapy treatment of microscopic disease after incomplete surgical resections or in the treatment of highly locally invasive tumor types such as injection site sarcoma and bladder tumors. Selecting stereotactic radiotherapy for treatment of microscopic disease is an emerging application in the human radiation oncology in the setting of CNS metastasis but its utility in other microscopic settings is unclear.…”

Section: Discussionmentioning

confidence: 99%

A survey of stereotactic radiation therapy in veterinary medicine

Dunfield

Turek

Buhr

et al. 2018

Vet Radiology Ultrasound

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Radiotherapy plays an important role in curative and palliative cancer treatment. As a novel radiation delivery technique, stereotactic radiotherapy utilizes three-dimensional-conformal treatment planning, high-precision beam delivery technology, and patient specific position verification to target tumors, often in one to five high-dose fractions. Currently, there is no consensus about best stereotactic radiotherapy practices in veterinary radiotherapy. The objective of this study was to document the breadth of perspectives, techniques, and applications of stereotactic radiotherapy in veterinary medicine. We conducted an online survey of American College of Veterinary Radiology members specializing in radiation oncology to assess how, when, and why stereotactic radiotherapy is being used. Both stereotactic radiotherapy users and nonusers completed the survey. The overall response and survey completion rates were 54% (67/123) and 87% (58/67), respectively. Overall, 55% of respondents reported providing stereotactic radiotherapy at their facility, with a median of 4.5 canine cases and one feline case per month. Delivery methods included C-arm linear accelerator with multi-leaf collimator, helical tomotherapy, and CyberKnife. Nonpituitary intracranial tumors, pituitary tumors, and sinonasal tumors were the most common cancers treated using stereotactic radiotherapy in both species. The most common fractionation scheme was three fractions of 10 Gy/fraction. The results of this survey suggest common availability of stereotactic radiotherapy in veterinary radiation facilities. These results provide valuable information regarding current stereotactic radiotherapy practices in veterinary medicine, and may provide an initial step toward standardizing methods and establishing consensus guidelines.

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Section: Discussionmentioning

confidence: 99%

A survey of stereotactic radiation therapy in veterinary medicine

Dunfield

Turek

Buhr

et al. 2018

Vet Radiology Ultrasound

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Due to the heterogeneity seen in prospective trials, a set of guidelines proposed by Soliman et al [4] were created based on the surveyed opinion of 10 experts within the field. Even amongst experts, there was no clear consensus on the use of additional CTV margin, with 2 recommending a 1-mm margin, 4 recommending a 2-mm margin, and 4 recommending no margin [4]. Thus, we aimed to look at patterns of local recurrence in a series of patients treated at our institution, with no additional margin for CTV, no routine coverage of dural margin, and heterogeneity of coverage of the surgical tract.…”

Section: Discussionmentioning

confidence: 99%

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Tumor Cavity Recurrence after Stereotactic Radiosurgery of Surgically Resected Brain Metastases: Implication of Deviations from Contouring Guidelines

McDermott¹,

Hack²,

Cifarelli³

et al. 2019

Stereotact Funct Neurosurg

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Background: Significant heterogeneity exists in target volumes for postoperative stereotactic radiosurgery (SRS) for brain metastases. A set of contouring guidelines was recently published, and we investigated the impact of deviations. Methods: Patients (n = 41) undergoing single-fraction Gamma Knife SRS following surgical resection of brain metastases from 2011 to 2017 were retrospectively reviewed. SRS included the entire contrast-enhancing cavity with heterogeneity in inclusion of the surgical tract and no routine margin along the dura or clinical target volume margin. Follow-up MR imaging was fused with SRS plans to assess patterns of failure. Results: The median follow-up was 11.1 months with a median prescription of 18 Gy. There were 5 local failures: infield (n = 3, 60%), surgical tract (n = 1, 20%), and marginal > 5 mm from the resection cavity (n = 1, 20%). No marginal failures < 5 mm or dural margin failures were noted. For deep lesions (n = 13), 62% (n = 8) had the entire tract covered. The only tract recurrence was in a deep lesion without coverage of the surgical tract (n = 1/5). Conclusion: In this small preliminary experience, despite no routine inclusion of the dural tract or bone flap, no failures were noted in these locations. Omission of the surgical tract in deep lesions may increase failure rates.

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“…9 These trials establish the role of postoperative SRS for resected BMs; however, the suboptimal local controls with postoperative SRS in these studies (72% and 61%) underscore efforts to optimize SRS dose, fractionation, and technique in the postoperative setting. 47 Secondary analyses of the data set from the EORTC 22952 showed no OS benefit with addition of WBRT irrespective of extracranial disease status or NSCLC prognostic group 48 and provide a counterpoint to a prior JROSG-991 analysis suggesting improved OS with WBRT in these patients. 49 An update of the JLGK-0901 prospective study of SRS alone for one to 10 BMs demonstrated good cognitive preservation and low rates of SRS toxicity.…”

Section: Bmsmentioning

confidence: 91%