Linac-based radiosurgery for multiple brain metastases: Comparison between two mono-isocenter techniques with multiple non-coplanar arcs

Ruggieri, R.; Naccarato, S.; Mazzola, Rosario; Ricchetti, F.; Corradini, Stefanie; Fiorentino, Alba; Alongi, Filippo

doi:10.1016/j.radonc.2018.11.014

Cited by 42 publications

(38 citation statements)

References 35 publications

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“…Besides, the risk of RN also increases with the increasing tumor volume and with the consequently rising PTV, V10 and V12 volume [28,29]. The latest study reported that multiple brain metastases (up to 10 metastases and maximum diameter of 2.5 cm) could be treated in single fraction SRS, which offered an option not just to defer WBRT but also to start TT/IT expeditiously in patients with metastatic melanoma [35,36]. The limitation of our study is its retrospective characters with small numbers of patients including a heterogeneous patient population.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

et al. 2020

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Background: There is limited data on the use of targeted or immunotherapy (TT/IT) in combination with single fraction stereotactic radiosurgery (SRS) in patients with melanoma brain metastasis (MBM). Therefore, we analyzed the outcome and toxicity of SRS alone compared to SRS in combination with TT/IT. Methods: Patients with MBM treated with single session SRS at our department between 2014 and 2017 with a minimum follow-up of 3 months after first SRS were included. The primary endpoint of this study was local control (LC). Secondary endpoints were distant intracranial control, radiation necrosis-free survival (RNFS), and overall survival (OS). The local/ distant intracranial control rates, RNFS and OS were analyzed using the Kaplan-Meier method. The log-rank test was used to test differences between groups. Cox proportional hazard model was performed for univariate continuous variables and multivariate analyses. Results: Twenty-eight patients (17 male and 11 female) with 52 SRS-lesions were included. The median follow-up was 19 months (range 14-24 months) after first SRS. Thirty-six lesions (69.2%) were treated with TT/IT simultaneously (4 weeks before and 4 weeks after SRS), while 16 lesions (30.8%) were treated with SRS alone or with sequential TT/ IT. The 1-year local control rate was 100 and 83.3% for SRS with TT/IT and SRS alone (p = 0.023), respectively. The estimated 1-year RNFS was 90.0 and 82.1% for SRS in combination with TT/IT and SRS alone (p = 0.935). The distant intracranial control rate after 1 year was 47.7 and 50% for SRS in combination with TT/IT and SRS alone (p = 0.933). On univariate analysis, the diagnosis-specific Graded Prognostic Assessment including the BRAF status (Melanoma-molGPA) was associated with a significantly improved LC. Neither gender nor SRS-PTV margin had a prognostic impact on LC. V10 and V12 were significantly associated with RNFS (p < 0.001 and p = 0.004). Conclusion: SRS with simultaneous TT/IT significantly improved LC with no significant difference in radiation necrosis rate. The therapy combination appears to be effective and safe. However, prospective studies on SRS with simultaneous TT/IT are necessary and ongoing. Trial registration: The institutional review board approved this analysis on 10th of February 2015 and all patients signed informed consent (UE nr. 128-14).

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Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

et al. 2020

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“…Different treatment planning system (TPS) may result in different plan quality and delivery efficiency. Ruggieri et al compared the plan quality and efficiency of two different TPS, Eclipse and MultipleBrainMets (Brainlab AG, Germany) for the treatment of multiple brain metastases. They found that the two TPS were comparable in GI, V 12 Gy and MUs.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

Zhang

Yang

Wang

2019

J Applied Clin Med Phys

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The incidence of brain metastases is increasing and various treatment modalities exist for brain metastases. The aim of this study was to investigate the dosimetric quality and delivery efficiency of robotic radiosurgery (CyberKnife) for multiple brain metastases compared with C-arm linear accelerator (linac) based plans. C-arm linac based plans included intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and non-coplanar VMAT with 1, 3 and 5 non-coplanar arcs, respectively (NC1, NC3 and NC5). For 20 patients, six plans with a prescription dose of 30 Gy in three fractions were generated. The gradient index (GI), conformity index (CI), maximum dose (D max ) of organs at risk (OARs), normal brain tissue volume (V 3 Gy -V 24 Gy ), monitor units (MUs) and beam on time (BT) were evaluated. The GI of CyberKnife plans (3.60 ± 0.70) was lower than IMRT (6.21 ± 2.26, P < 0.05), VMAT (6.04 ± 1.93, P < 0.05), NC1 (5.16 ± 1.71, P < 0.05), NC3 (5.02 ± 1.59, P < 0.05) and NC5 (5.03 ± 1.72, P < 0.05). The CI of the VMAT plans (both coplanar and non-coplanar) was larger than IMRT and CK plans. The D max for most OARs of the CyberKnife plan was lower than the C-arm linac based plans, although some differences were not statistically significant. The normal brain tissue volume of CyberKnife plan was lower than the C-arm linac based plans, and the normal brain tissue volume of non-coplanar VMAT plans was lower than IMRT and VMAT plans at high-moderate dose level. However, the MUs and BT of CyberKnife plans was more than C-arm linac based plans. CyberKnife plan was better than C-arm linac based plans in protecting normal brain tissue and OARs for patients with multiple brain metastases. C-arm linac based plan with non-coplanar arc provided better protection of normal brain tissue than coplanar plan. However, the BT of CyberKnife plan was longer than C-arm linac based plans. K E Y W O R D SCyberKnife, dosimetry, IMRT, multiple brain metastases,

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“…With modern dedicated SRS platforms such as Gamma Knife and Cyberknife it is possible to routinely treat multiple metastases in a single session (see figure 2). [102,103]. HyperArc TM has been shown to be capable of delivering a higher Conformity Index, Gradient Index and reduced treatment times compared to conventional multiple isocentre VMAT SRS [102].…”

Section: Radiosurgery Technical Developmentsmentioning

confidence: 99%

“…[102,103]. HyperArc TM has been shown to be capable of delivering a higher Conformity Index, Gradient Index and reduced treatment times compared to conventional multiple isocentre VMAT SRS [102]. At treatment planning level this single isocentre VMAT technique can achieve similar dose metrics to Gamma Knife and cyberknife for multiple metastases [103,104].…”

Section: Radiosurgery Technical Developmentsmentioning

confidence: 99%

The Expanding Role of Radiosurgery for Brain Metastases

O’Beirn

Benghiat

Meade

et al. 2018

Preprint

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Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole brain radiotherapy (WBRT) improved local control rates versus WBRT alone. Concerns with WBRT associated neurocognitive toxicity have contributed to greater use of SRS alone, including for patients with multiple metastases and following surgical resection. Molecular information, targeted agents and immunotherapy have also altered the landscape for the management of brain metastases. This review summarises current and emerging data on the role of SRS in the management of brain metastases.

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Linac-based radiosurgery for multiple brain metastases: Comparison between two mono-isocenter techniques with multiple non-coplanar arcs

Cited by 42 publications

References 35 publications

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

Stereotactic radiosurgery combined with targeted/ immunotherapy in patients with melanoma brain metastasis

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

The Expanding Role of Radiosurgery for Brain Metastases

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