Frameless Image-Guided Intracranial Stereotactic Radiosurgery: Clinical Outcomes for Brain Metastases

Breneman, John C.; Steinmetz, Ryan; Smith, A S; Lamba, Michael; Warnick, Ronald E.

doi:10.1016/j.ijrobp.2008.11.015

Cited by 61 publications

(51 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A 1-year local control rate of 80% was reported after frameless image-guided radiosurgery of brain metastases, comparable to results using the frame-based approach [10]. Daily CBCT for head and neck cancer enabled CTV-to-PTV margin reduction by ~50% [19], which could facilitate future studies on dose escalation and/or toxicity reduction.…”

Section: Clinical Resultssupporting

confidence: 52%

kV Cone-Beam CT-Based IGRT

et al. 2011

View full text Add to dashboard Cite

show abstract

Section: Clinical Resultssupporting

confidence: 52%

kV Cone-Beam CT-Based IGRT

et al. 2011

View full text Add to dashboard Cite

show abstract

“…These invasive immobilization devices are uncomfortable for the patient and require more time and manpower to simulate, plan, and deliver the treatment on the same day. Frameless stereotactic radiotherapy systems have become a popular treatment option for intracranial radiosurgery or radiotherapy due to less invasive patient immobilization, along with high accuracy in image guidance 8 , 9 , 10 , 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling

Keeling

Hossain

Jin

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

The purpose of this study is to evaluate patient setup accuracy and quantify individual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless 6D ExacTrac system. A statistical model is used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the Brainlab 6D ExacTrac system using the positioning shifts of 35 patients having cranial lesions. All these patients are immobilized with rigid head‐and‐neck masks, simulated with Brainlab localizer and planned with iPlan treatment planning system. Stereoscopic X‐ray images (XC) are acquired and registered to corresponding digitally reconstructed radiographs using bony‐anatomy matching to calculate 6D translational and rotational shifts. When the shifts are within tolerance (0.7 mm and 1°), treatment is initiated. Otherwise corrections are applied and additional X‐rays (XV) are acquired to verify that patient position is within tolerance. The uncertainties from the mask, localizer, IR ‐frame, X‐ray imaging, MV, and kV isocentricity are quantified individually. Mask uncertainty (translational: lateral, longitudinal, vertical; rotational: pitch, roll, yaw) is the largest and varies with patients in the range false(−2.07−3.71mm,−5.82−5.62mm,−5.84−3.61mm;−2.10−2.40∘,−2.23−2.60∘,and−2.7−3.00∘false) obtained from mean of XC shifts for each patient. Setup uncertainty in IR positioning (0.88, 2.12, 1.40 mm, and 0.64°, 0.83°, 0.96°) is extracted from standard deviation of XC. Systematic uncertainties of the frame (0.18, 0.25, −1.27mm, −0.32∘, 0.18°, and 0.47°) and localizer (−0.03, −0.01, 0.03 mm, and −0.03∘, 0.00°, −0.01∘) are extracted from means of all XV setups and mean of all XC distributions, respectively. Uncertainties in isocentricity of the MV radiotherapy machine are (0.27, 0.24, 0.34 mm) and kV imager (0.15, −0.4, 0.21 mm). A statistical model is developed to evaluate the individual and cumulative systematic and random positioning uncertainties induced by the different hardware and software components of the 6D ExacTrac system. The uncertainties from the mask, localizer, IR frame, X‐ray imaging, couch, MV linac, and kV imager isocentricity are quantified using statistical modeling.PACS number(s): 87.56.B‐, 87.59.B‐

show abstract

“…[9][10][11][12][13][14][15] The outcomes of frameless SRS have been reported only in limited series, with 1-year local control of 79% to 95%. 5,[16][17][18] Patient selection and tailor-made management are indeed challenging. Several scoring systems have been modelled to predict survival of patients with brain metastases, including the Radiation Therapy Oncology Group Recursive Partitioning Analysis (RTOG RPA), 19 Basic Score for Brain Metastases (BSBM), 20 the Score Index for Radiosurgery in Brain Metastases (SIR), 21 Graded Prognostic Assessment (GPA), 22 and Disease-Specific Graded Prognostic Assessment (DS-GPA).…”

Section: New Knowledge Added By This Studymentioning

confidence: 99%

Frameless stereotactic radiosurgery for brain metastases: a review of outcomes and prognostic scores evaluation

et al. 2017

View full text Add to dashboard Cite

Introduction: Stereotactic brain radiosurgery provides good local control in patients with limited brain metastases. A newly developed frameless system allows pain-free treatment. We reviewed the effectiveness of this frameless stereotactic brain radiosurgery and identified prognostic factors that may aid better patient selection. Methods:Medical records of patients with brain metastases treated with linear accelerator-based frameless stereotactic brain radiosurgery between January 2010 and July 2015 in a university affiliated hospital in Hong Kong were reviewed. Outcomes including local and distant brain control rate, progression-free survival, and overall survival were analysed. Prognostic factors were identified by univariable and multivariable analyses. Association of outcomes with four common prognostic scores was performed.Results: In this study, 64 patients with 94 lesions were treated with a median dose of 18 Gy (range, 12-22 Gy) in a single fraction. The median follow-up was 11.5 months. One-year actuarial local and distant brain control rates were 72% and 71%, respectively. The median overall survival was 13.0 months. On multivariable analysis, Karnofsky performance status score (>50 vs ≤50) and number of lesions (1-2 vs ≥3) were found to associate significantly with distinct brain progression-free survival (P=0.022, hazard ratio=0.20, 95% confidence interval 0.05-0.80 and P=0.003, hazard ratio=0.31, 95% confidence interval 0.14-0.68, respectively). Overall survival was

show abstract

Frameless Image-Guided Intracranial Stereotactic Radiosurgery: Clinical Outcomes for Brain Metastases

Cited by 61 publications

References 23 publications

kV Cone-Beam CT-Based IGRT

kV Cone-Beam CT-Based IGRT

Quantitative evaluation of patient setup uncertainty of stereotactic radiotherapy with the frameless 6D ExacTrac system using statistical modeling

Frameless stereotactic radiosurgery for brain metastases: a review of outcomes and prognostic scores evaluation

Contact Info

Product

Resources

About