A comparison of clinical and radiologic outcomes between frame-based and frameless stereotactic radiosurgery for brain metastases

Bennion, N.R.; Malouff, Timothy D.; Verma, Vivek; Denniston, Kyle A.; Bhirud, A.R.; Zhen, Weining; Wahl, Andrew O.; Lin, Chi

doi:10.1016/j.prro.2016.05.001

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…To overcome the obstacles of frame-based SRS, frameless SRS, in which the head ring is removed and replaced by a thermoplastic mask and a back of the head mold, has seen expanded clinical implementation (Bennion et al, 2016). Here, significant effort is required in order to ensure effective mask immobilization and, in certain cases, even with the mask, large systematic drifts of up to several millimeters from initial setup have been reported (Amelio et al, 2013; Fuss et al, 2004; Murphy, 2009).…”

Section: Introductionmentioning

confidence: 99%

Towards frameless maskless SRS through real-time 6DoF robotic motion compensation

Belcher¹,

Liu²,

Chmura³

et al. 2017

Phys. Med. Biol.

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Purpose Stereotactic radiosurgery (SRS) uses precise dose placement to treat conditions of the CNS. Frame-based SRS uses a metal head ring fixed to the patient’s skull to provide high treatment accuracy, but patient comfort and clinical workflow may suffer. Frameless SRS, while potentially more convenient, may increase uncertainty of treatment accuracy and be physiologically confining to some patients. By incorporating highly precise robotics and advanced software algorithms into frameless treatments, we present a novel frameless and maskless SRS system where a robot provides real-time 6DOF head motion stabilization allowing positional accuracies to match or exceed those of traditional frame-based SRS. Methods A 6DOF parallel kinematics robot was developed and integrated with a real-time infrared camera in a closed loop configuration. A novel compensation algorithm was developed based on an iterative closest-path correction approach. The robotic SRS system was tested on six volunteers, whose motion was monitored and compensated for in real-time over 15-minute simulated treatments. The system’s effectiveness in maintaining the target’s 6DOF position within preset thresholds was determined by comparing volunteer head motion with and without compensation. Results Comparing corrected and uncorrected motion, the 6DOF robotic system showed an overall improvement factor of 21 in terms of maintaining target position within 0.5 mm and 0.5 degree thresholds. Although the system’s effectiveness varied among the volunteers examined, for all volunteers tested the target position remained within the preset tolerances 99.0% of the time when robotic stabilization was used, compared to 4.7% without robotic stabilization. Conclusion The pre-clinical robotic SRS compensation system was found to be effective at responding to sub-millimeter and sub-degree cranial motions for all volunteers examined. The system’s success with volunteers has demonstrated its capability for implementation with frameless and maskless SRS treatments, potentially able to achieve the same or better treatment accuracies compared to traditional frame-based approaches.

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Section: Introductionmentioning

confidence: 99%

Towards frameless maskless SRS through real-time 6DoF robotic motion compensation

Belcher¹,

Liu²,

Chmura³

et al. 2017

Phys. Med. Biol.

View full text Add to dashboard Cite

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“…This strategy may increase radiation necrosis. However, in one small series, 13 increased radiation necrosis or local failure was not seen in reality. However, a study comparing framebased with frameless techniques that did not use PTV also revealed no impact on the quality of the clinical outcome after treatment.…”

Section: Discussionmentioning

confidence: 89%

Large In-mask Motion during Frameless Radiosurgery of a Brain Metastasis

Harat¹,

Furtak

2018

J Neurol Surg A Cent Eur Neurosurg

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Frameless radiosurgery is now a common alternative to traditional in-frame treatment. Several dosimetric studies have reported small in-mask positioning inaccuracies during frameless radiosurgery. We present a case of an uncommonly large deviation in in-mask motion detected offline in a patient undergoing linear accelerator-based frameless radiosurgery. Our case illustrates how the use of a thermoplastic mask can lead to unacceptable setup errors for passive image-guided radiosurgery. The case underlines the need for correct patient preparation, adequate time between mask molding and computed tomography, and routine intrafraction imaging. Image-guided positioning is recommended to achieve clinically acceptable setup accuracy (< 1 mm) for stereotactic radiosurgery.

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“…In 2018, Grimm et al [8] compared the clinical outcomes of FB and MB SRS in patients with brain metastases and found no significant difference in overall survival and progression free survival. Bennion et al [9] compared the 2 techniques using local failure and radiation necrosis as variables. They found no significant difference with respect to both variables between the 2 fixation techniques [9].…”

Section: Comparisons To Current Literaturementioning

confidence: 99%

“…Both procedures are extensively validated and comparisons between the 2 in terms of clinical outcomes are cited in the current literature [8,9]. One advantage of FB SRS, certainly from a neurosurgical perspective, is that the workflow has little variance and has been the mainstay of SRS for over 50 years [6,10].…”

Section: Introductionmentioning

confidence: 99%

Frame-Based and Mask-Based Stereotactic Radiosurgery: The Patient Experience, Compared

Pavlica

Dawley

Goenka

et al. 2021

Stereotact Funct Neurosurg

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Introduction: Noninvasive frameless modalities have become increasingly utilized for stereotactic radiosurgery (SRS) for benign and malignant pathologies. There is minimal comparison in the literature of frame-based (FB) and mask-based (MB) SRS. With the dual capabilities of the Elekta Gamma Knife® Icon™, we sought to compare patient perceptions of FB and MB SRS with respect to comfort and pain and to examine effects of lesion type on the patient experience of SRS. Methods: Over a 1-year period, patients who underwent single fraction, fractionated or hypofractionated FB or MB Gamma Knife SRS at our institution were given an 8-question survey about their experience with the procedure immediately after treatment was completed. Descriptive statistics were applied. Results: A total of 117 patients completed the survey with 65 FB and 52 MB SRS treatments. Mean pain for FB SRS (5.64 ± 2.55) was significantly greater than mean pain for MB SRS (0.92 ± 2.24; t114 = 10.46, p < 0.001). Patient comfort during the procedure was also higher for those having MB SRS (p < 0.001). Mixed results were obtained when investigating if benign versus malignant diagnosis affected patient experience of SRS. For the purposes of this study, malignant diagnoses were almost entirely metastatic lesions. Diagnosis played no role on pain levels when all patients were analyzed together. The treatment technique had no effect on patient comfort in patients with benign diagnoses, while patients with malignant diagnoses treated with MB SRS were more likely to be comfortable (p < 0.001). Among patient’s receiving FB treatments, diagnosis played no role on patient comfort. When only MB treatments were analyzed, patients were more likely to be comfortable if they had a malignant lesion (p < 0.01). Conclusions: Patients treated with MB SRS experience the procedure as more comfortable and less painful compared to those treated using a FB modality. Overall, this difference was not affected by a benign versus a malignant diagnosis and the treatment type is more indicative of the patient experience during SRS. A more homogenous sample between modalities and diagnoses and further follow-up with the patient’s input on their experience would be beneficial.

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A comparison of clinical and radiologic outcomes between frame-based and frameless stereotactic radiosurgery for brain metastases

Cited by 15 publications

References 20 publications

Towards frameless maskless SRS through real-time 6DoF robotic motion compensation

Towards frameless maskless SRS through real-time 6DoF robotic motion compensation

Large In-mask Motion during Frameless Radiosurgery of a Brain Metastasis

Frame-Based and Mask-Based Stereotactic Radiosurgery: The Patient Experience, Compared

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