Therapeutic Effect of Linac-based Stereotactic Radiotherapy with a Micro-multileaf Collimator for the Treatment of Patients with Brain Metastases from Lung Cancer

Saitoh, Jun‐ichi; Saito, Yoshihiro; Kazumoto, Tomoko; Kudo, Shigehiro; Ichikawa, Akihiro; Hayase, Nobuaki; Kazumoto, Kiyoshi; Shibuya, Kazuhiko

doi:10.1093/jjco/hyp128

Cited by 29 publications

(21 citation statements)

References 14 publications

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“…The development of new technologies for performing frameless radiosurgery has enabled the treatment of large lesions using multisession treatments or hypofractionation [17–19]. However, the incidence of radiation necrosis is not insignificant for the treatment of large metastases, even when hypofractionation is used [16, 18, 20]. Grade 5 adverse effects may easily appear in patients with large metastases due to a brain hernia resulting from extensive brain edema after treatment [7].…”

Section: Discussionmentioning

confidence: 99%

Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis

Inoué¹,

Sato²,

Seto³

et al. 2013

Journal of Radiation Research

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The efficacy and toxicity of five-fraction CyberKnife radiotherapy were evaluated in patients with large brain metastases in critical areas. A total of 85 metastases in 78 patients, including tumors >30 cm3 (4 cm in diameter) were treated with five-fraction CyberKnife radiotherapy with a median marginal dose of 31 Gy at a median prescribed isodose of 58%. Changes in the neurological manifestations, local tumor control, and adverse effects were investigated after treatment. The surrounding brain volumes circumscribed with 28.8 Gy (single dose equivalent to 14 Gy: V14) were measured to evaluate the risk of radiation necrosis. Neurological manifestations, such as motor weakness, visual disturbances and aphasia improved in 28 of 55 patients (50.9%). Local tumor control was obtained in 79 of 85 metastases (92.9%) during a median follow-up of eight months. Symptomatic edema occurred in 10 patients, and two of them (2.6%) required surgical resection because of radiation necrosis. The V14 of these patients was 3.0–19.7 cm3. There were 16 lesions with a V14 of ≥7.0 cm3, and two of these lesions developed extensive brain edema due to radiation necrosis. None of the patients with a V14 of <7.0 cm3 exhibited edema requiring surgical intervention. We therefore conclude that a high rate of local tumor control and low rates of complications can be obtained after five-fraction CyberKnife radiotherapy for large metastases in critical areas. The V14 of the surrounding brain is therefore a useful indicator for the risk of radiation necrosis in patients with large metastases.

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Section: Discussionmentioning

confidence: 99%

Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis

Inoué¹,

Sato²,

Seto³

et al. 2013

Journal of Radiation Research

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show abstract

“…The development of new technologies for performing frameless radiosurgery has enabled the treatment of larger lesions using multisession treatments or hypofractionation [15–17]. However, the incidence of radiation necrosis is not insignificant for the treatment of large metastases, even when hypofractionation is used [14, 16, 18]. Surgical management after radiosurgery may thus be required in some patients.…”

Section: Discussionmentioning

confidence: 99%

Three-fraction CyberKnife radiotherapy for brain metastases in critical areas: referring to the risk evaluating radiation necrosis and the surrounding brain volumes circumscribed with a single dose equivalence of 14 Gy (V14)

Inoué¹,

Seto²,

Nozaki³

et al. 2013

Journal of Radiation Research

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The efficacy and toxicity of three-fraction CyberKnife radiotherapy were evaluated in patients with brain metastases in critical areas. One hundred and fifty-nine metastases in 145 patients including tumors >10 cm3 were treated with three-fraction CyberKnife radiotherapy with a median marginal dose of 27 Gy at a median prescribed isodose of 60%. Changes in the neurological manifestations, local tumor control and adverse effects were investigated after treatment. The surrounding brain volumes circumscribed with 23.1 Gy (single dose equivalence of 14 Gy: V14) were measured to evaluate the risk of adverse effects. Neurological manifestations, such as motor weakness, visual disturbances and aphasia improved in 26 of 97 patients (26.8%). Local tumor control was obtained in 137 of 143 metastases (95.8%) during a median follow-up of 7 months. Nine patients had symptomatic edema and three of them (2.1%) required surgical resection because of radiation necrosis. The V14 of these patients was 4.6–31.5 cm3. There were 35 lesions with a V14 of 7 cm3 or more and three of them developed extensive brain edema due to radiation necrosis. None of the patients with a V14 of <7 cm3 exhibited edema requiring an operation. We therefore conclude that a high rate of local tumor control and low rates of complications are obtained after three-fraction CyberKnife radiotherapy for metastases in critical areas. The V14 of the surrounding brain therefore seems to be a useful indicator for the risk evaluation of radiation necrosis in patients with larger metastases.

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“…This results in a burden to nations and alarming for effective treatment approaches [1][2][3]. Despite considerable improvement of local control of tumors due to recent advances in radiation therapy, the survival of patients with metastatic brain tumors remains relatively low with a median survival of 6-12 months, although better local control improves quality of life in some cases [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Double Dose Contrast-enhanced Magnetic Resonance Imaging for Clear Delineation of Gross Tumor Volume in Stereotactic Radiotherapy Treatment Planning of Metastatic Brain Tumors: A Dose Comparison Study

Subedi

2013

Practical Radiation Oncology

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The purpose of this study was to compare the size and clearness of gross tumor volumes (GTVs) of metastatic brain tumors on T1-weighted magnetic resonance images between a single dose contrast administration protocol and a double dose contrast administration protocol to determine the optimum dose of contrastenhancement for clear delineation of GTV in stereotactic radiotherapy (SRT). A total of 28 small metastatic brain tumors were evaluated in 13 patients by intra-individual comparison of GTV measurements using single dose and double dose contrast-enhanced thin-slice (1-mm) magnetic resonance imaging (MRI). All patients had confirmed histological types of primary tumors and had undergone hypo-fractionated SRT for metastatic brain tumors. The mean tumor diameter with single dose and double dose contrast-enhancement was 12.0 ± 1.1 mm and 13.2 ± 1.1 mm respectively (P < 0.001). The mean incremental ratio (MIR) obtained by comparing mean tumor diameters was 11.2 ± 0.02 %. The mean volume of GTV-1 (single dose contrastenhancement) and GTV-2 (double dose contrast-enhancement) was 1.38 ± 0.41 ml and 1.59 ± 0.45 ml respectively (P < 0.01). The MIR by comparing mean tumor volumes was 32.3 ± 0.4 %. The MIR of GTV-1 with < 1ml volume and GTV-1 with > 1ml volume was 41.8 ± 0.05 % and 12.4 ± 0.03 % respectively (P < 0.001). We conclude that double dose contrast-enhanced thin-slice MRI is a more useful technique than single dose contrast-enhanced thin-slice MRI, especially for clear delineation of GTVs of small metastatic brain tumors in treatment planning of highly precise SRT.

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Therapeutic Effect of Linac-based Stereotactic Radiotherapy with a Micro-multileaf Collimator for the Treatment of Patients with Brain Metastases from Lung Cancer

Abstract: Hypofactionated stereotactic radiotherapy with mMLC is considered to be an effective and safe modality for the treatment of brain metastases in lung cancer patients.

Cited by 29 publications

References 14 publications

Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis

Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis

Three-fraction CyberKnife radiotherapy for brain metastases in critical areas: referring to the risk evaluating radiation necrosis and the surrounding brain volumes circumscribed with a single dose equivalence of 14 Gy (V14)

Usefulness of Double Dose Contrast-enhanced Magnetic Resonance Imaging for Clear Delineation of Gross Tumor Volume in Stereotactic Radiotherapy Treatment Planning of Metastatic Brain Tumors: A Dose Comparison Study

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