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

Kraft, Johannes; Timmeren, Janita E. van; Mayinger, Michael; Frei, Simon; Borsky, Kim; Stark, L. S.; Krayenbuehl, J.; Zamburlini, M.; Gückenberger, Matthias; Tanadini‐Lang, Stephanie; Andratschke, Nicolaus

doi:10.1016/j.radonc.2021.03.022

Cited by 30 publications

(21 citation statements)

References 46 publications

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“… 28 In the present study, even with a 12 cm median maximum distant between targets (maximum 15 cm), excellent local control was observed, highlighting the accuracy of SIMT delivery, as Kraft et al have also shown. 29 In addition, local control rates per lesion with hypofractionated SRS were similar to that for single-fraction treatment (98% vs 93%, P = NS), in line with results from previous studies. 30 , 31 , 32 Thus, hypofractionated SRS techniques appear appropriate for larger lesions and those near critical structures without compromise of local tumor control.…”

Section: Discussionsupporting

confidence: 89%

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Buckley¹,

Herndon²,

Allen³

et al. 2021

Advances in Radiation Oncology

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Section: Discussionsupporting

confidence: 89%

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Buckley¹,

Herndon²,

Allen³

et al. 2021

Advances in Radiation Oncology

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“…An alternative approach is to increase the PTV margin with increasing distance from the isocentre to account for any uncertainties. However, a recently published series did not find that local failure correlated with increasing distance of the target from the isocentre using an image-guided frameless approach with patient positioning in 6DoF, a uniform 1mm PTV margin and a median distance to isocentre of 4.7cm (0.2-10) ( 62 ). A third reason for using more than one isocentre in our patients is that the SI technique could not combine different fractionation schedules.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

et al. 2022

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PurposeStereotactic 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.MethodsPatients 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.Results36 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.ConclusionWith 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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“…With regard to adding a margin to the GTV to compensate for these errors, 1 mm seems to be sufficient from the point of view of physical aspects [ 46 , 48 ]. Kraft et al reported that clinical outcomes of SI-STI-MBM using 6D positioning correction with a 1 mm margin added to create PTV [ 37 ]. In their report, the local control rate at 12 months was 94%, and the distance between the isocenter and tumors had little effect on local control.…”

Section: Specific Consideration Points In Si-sti-mbm; Offset and Smal...mentioning

confidence: 99%

Single isocenter stereotactic irradiation for multiple brain metastases: current situation and prospects

2022

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The prognosis of patients with brain metastases has dramatically improved, and long-term tumor control and reduction of the risk of late toxicities, including neurocognitive dysfunction, are important for patient quality of life. Stereotactic irradiation for multiple brain metastases, rather than whole-brain radiotherapy, can result in high local control rate with low incidence of neurocognitive deterioration and leukoencephalopathy. Recent advances in radiotherapy devices, treatment-planning systems, and image-guided radiotherapy can realize single isocenter stereotactic irradiation for multiple brain metastases (SI-STI-MBM), in which only one isocenter is sufficient to treat multiple brain metastases simultaneously. SI-STI-MBM has expanded the indications for linear accelerator-based stereotactic irradiation and considerably reduced patient burden. This review summarizes the background, methods, clinical outcomes, and specific consideration points of SI-STI-MBM. In addition, the prospects of SI-STI-MBM are addressed.

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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

Cited by 30 publications

References 46 publications

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

Single isocenter stereotactic irradiation for multiple brain metastases: current situation and prospects

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