Repeated Courses of Radiosurgery for New Brain Metastases to Defer Whole Brain Radiotherapy: Feasibility and Outcome With Validation of the New Prognostic Metric Brain Metastasis Velocity

Fritz, Corinna; Borsky, Kim; Stark, L. S.; Tanadini‐Lang, Stephanie; Kroeze, S.G.C.; Krayenbühl, J.; Gückenberger, Matthias; Andratschke, Nicolaus

doi:10.3389/fonc.2018.00551

Cited by 37 publications

(23 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ogawa et al [ 7 ] analyzed 31 patients with in-field local tumor relapses of NSCLC or lung metastasis and reported that repeat stereotactic body radiotherapy (SBRT) constitutes a viable therapeutic regimen. Further Fritz et al [ 8 ] assessed the feasibility of repeat stereotactic radiosurgery (SRS) in 42 patients harboring 197 brain metastases with 16 patients having undergone minimum three courses of SRS. The authors concluded that repeat SRS constitutes a reasonable treatment option in selected patients to delay rescue whole-brain radiation therapy [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Further Fritz et al [ 8 ] assessed the feasibility of repeat stereotactic radiosurgery (SRS) in 42 patients harboring 197 brain metastases with 16 patients having undergone minimum three courses of SRS. The authors concluded that repeat SRS constitutes a reasonable treatment option in selected patients to delay rescue whole-brain radiation therapy [ 8 ]. Barton et al [ 9 ] conducted an epidemiological calculus in more than 60,000 patients to assess the retreatment rate in different radio-oncological facilities, and found that it was fairly similar.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term cancer survivors treated with multiple courses of repeat radiation therapy

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-term cancer survivors treated with multiple courses of repeat radiation therapy

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The prognostic value of BMV has since been validated in several other international patient populations. 58 , 59 …”

Section: Radiotherapymentioning

confidence: 99%

Multidisciplinary patient-centered management of brain metastases and future directions

Palmer

Trifiletti

Gondi

et al. 2020

Neuro-Oncology Advances

View full text Add to dashboard Cite

The incidence of brain metastasis is increasing as improvements in systemic therapy lead to increased survival. This provides new and challenging clinical decisions for patients who are trying to balance the risk of recurrence or progression with treatment-related side effects, and it requires appropriate management strategies from multidisciplinary teams. Improvements in prognostic assessment and systemic therapy with increasing activity in the brain allow for individualized care to better guide the use of local therapies and/or systemic therapy. Here, we review the current landscape of brain-directed therapy for the treatment of brain metastasis in the context of recent improved systemic treatment options. We also discuss emerging treatment strategies including targeted therapies for patients with actionable mutations, immunotherapy, modern whole-brain radiation therapy, radiosurgery, surgery, and clinical trials.

show abstract

“…From common primary cancer sites such as lung, breast, and melanoma, brain metastasis occurs in 15% to 40% of the cancer patients 2,3 . The treatment of metastatic brain tumors depends on the number of metastatic tumors, extracranial tumor status, and performance status 4–6 . Currently, whole‐brain radiation therapy (WBRT) is considered a well‐established treatment for patients with multiple brain metastases.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The treatment of metastatic brain tumors depends on the number of metastatic tumors, extracranial tumor status, and performance status. [4][5][6] Currently, whole-brain radiation therapy (WBRT) is considered a well-established treatment for patients with multiple brain metastases.…”

mentioning

confidence: 99%

Feasibility of automated planning for whole‐brain radiation therapy using deep learning

Goh

Song

et al. 2020

J Applied Clin Med Phys

View full text Add to dashboard Cite

Purpose: The purpose of this study was to develop automated planning for wholebrain radiation therapy (WBRT) using a U-net-based deep-learning model for predicting the multileaf collimator (MLC) shape bypassing the contouring processes. Methods: A dataset of 55 cases, including 40 training sets, five validation sets, and 10 test sets, was used to predict the static MLC shape. The digitally reconstructed radiograph (DRR) reconstructed from planning CT images as an input layer and the MLC shape as an output layer are connected one-to-one via the U-net modeling. The Dice similarity coefficient (DSC) was used as the loss function in the training and ninefold cross-validation. Dose-volume-histogram (DVH) curves were constructed for assessing the automatic MLC shaping performance. Deep-learning (DL) and manually optimized (MO) approaches were compared based on the DVH curves and dose distributions.Results: The ninefold cross-validation ensemble test results were consistent with DSC values of 94.6 ± 0.4 and 94.7 ± 0.9 in training and validation learnings, respectively. The dose coverages of 95% target volume were (98.0 ± 0.7)% and (98.3 ± 0.8)%, and the maximum doses for the lens as critical organ-at-risk were 2.9 Gy and 3.9 Gy for DL and MO, respectively. The DL technique shows the consistent results in terms of the DVH parameter except for MLC shaping prediction for dose saving of small organs such as lens.Conclusions: Comparable with the MO plan result, the WBRT plan quality obtained using the DL approach is clinically acceptable. Moreover, the DL approach enables WBRT auto-planning without the time-consuming manual MLC shaping and target contouring.whole-brain radiation therapy, deep learning, automatic planning | INTRODUCTIONMetastatic brain cancer is the most common type of intracranial tumor. 1 From common primary cancer sites such as lung, breast, and melanoma, brain metastasis occurs in 15% to 40% of the cancer patients. 2,3 The treatment of metastatic brain tumors depends on the number of metastatic tumors, extracranial tumor status, and performance status. [4][5][6] Currently, whole-brain radiation therapy (WBRT) is considered a well-established treatment for patients with multiple brain metastases.

show abstract

Repeated Courses of Radiosurgery for New Brain Metastases to Defer Whole Brain Radiotherapy: Feasibility and Outcome With Validation of the New Prognostic Metric Brain Metastasis Velocity

Cited by 37 publications

References 43 publications

Long-term cancer survivors treated with multiple courses of repeat radiation therapy

Long-term cancer survivors treated with multiple courses of repeat radiation therapy

Multidisciplinary patient-centered management of brain metastases and future directions

Feasibility of automated planning for whole‐brain radiation therapy using deep learning

Contact Info

Product

Resources

About