Radiosurgery for Patients with More Than Ten Brain Metastases

Abstract

In this article, we report on Gamma Knife radiosurgery performed on patients with more than 10 brain metastases. Although the standard treatment for multiple brain metastases is currently believed to be whole-brain irradiation, many patients are averse to it due to the potential for serious complications such as cognitive impairment. Cases and Methods Here, 70 cases of Gamma Knife radiosurgery for metastatic foci originating from various primary cancer are reviewed. Several different treatment protocols were selected: (1) single session, (2) two or three consecutive sessions, (3) fractionated irradiation for large tumor and stereotactic radiosurgery (SRS) for small ones, and (4) salvage treatment for recurrent tumors after whole-brain irradiation. Results Despite the long beam-on-time (BOT) necessary for Gamma Knife radiosurgery and unavoidable spillage irradiation to the entire brain, all the treatments were completed without any major difficulties. Conclusion SRS or radiotherapy might be a treatment choice for patients with more than 10 brain metastases. However, the very long treatment time and big spillage irradiation to the entire brain warrants that large metastatic foci should be removed before or after radiosurgery.

Spatiotemporal fractionation schemes for stereotactic radiosurgery of multiple brain metastases

“…[9][10][11] Major concerns are the prolonged treatment duration and the large integral dose delivered to the healthy brain associated with the concurrent treatment of multiple lesions. 12,13 While recent advances in dose delivery techniques have enabled the efficient treatment of multiple targets using SRS, 14 it would be highly desirable to limit the radiation-induced damage to the brain in order to expand the indications for SRS to include selected patients with multiple brain metastases. The volume of brain exposed to high doses is widely considered the most relevant dosimetric parameter.…”

The Potential for Using Extended Reality Technology in Interdisciplinary Case Discussions and Case Planning in Stereotactic Radiosurgery: Proof-of-Concept Usability Study

“…Patients with multiple intracranial metastases, previously treated with whole brain irradiation, now commonly undergo SRS [20][21][22][23]. Furthermore, radiosurgical treatment for many brain metastases is now feasible [22,24,25]. The main visual challenge in planning cases with several metastases is understanding the topography or spread of the many lesions intracranially.…”