Comparison between stereotactic radiosurgery and whole‑brain radiotherapy for 10‑20 brain metastases from non‑small cell lung cancer

Grantham

et al. 2020

Strahlenther Onkol

Background/Purpose Frameless stereotactic radiosurgery (SRS) requires dedicated systems to monitor patient motion in order to avoid inaccurate radiation delivery due to involuntary shifts. The purpose of this study is to assess the accuracy and sensitivity of two distinct motion monitoring systems used for frameless SRS. Methods A surface image-guided system known as optical surface monitoring system (OSMS), and a fiducial marker-based system known as high definition motion management (HDMM) as part of the latest Gamma Knife Icon® were compared. A 3D printer-based cranial motion phantom was developed to evaluate the accuracy and sensitivity of these two systems in terms of: (1) the capability to recognize predefined shifts up to 3 cm, and (2) the capability to recognize predefined speeds up to 3 cm/s. The performance of OSMS, in terms of different reference surfaces, was also evaluated. Results Translational motion could be accurately detected by both systems, with an accuracy of 0.3 mm for displacement up to 1 cm, and 0.5 mm for larger displacements. The reference surface selection had an impact on OSMS performance, with flat surface resulting in less accuracy. HDMM was in general more sensitive when compared with OSMS in capturing the motion, due to its faster frame rate, but a delay in response was observed with faster speeds. Both systems were less sensitive in detection of superior-inferior motion when compared to lateral or vertical displacement directions. Conclusion Translational motion can be accurately and sensitively detected by OSMS and HDMM real-time monitoring systems. However, performance variations were observed along different motion directions, as well as amongst the selection of reference images. Caution is needed when using real-time monitoring systems for frameless SRS treatment.

Section: Discussionmentioning

confidence: 99%

Performance assessment of two motion management systems for frameless stereotactic radiosurgery

Grantham

et al. 2020

Strahlenther Onkol

“…Radiotherapy is an effective treatment for brain metastasis, especially for multiple brain metastases patients. Currently, radiotherapy for multiple brain metastases is a WRBTbased radiation mode (4)(5)(6). Studies have reported that stereotactic radiotherapy or hypofractionated radiation therapy has better efficacy and less adverse reactions, and tends to be chosen over WBRT (7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

Clinical study on different doses and fractionated radiotherapies for multiple brain metastases of non-EGFR mutant lung adenocarcinoma

Liu

et al. 2020

Ann Palliat Med

Background: To study the effects and adverse reactions of different doses and fractionated radiotherapies on non-epidermal growth factor receptor (EGFR) mutant lung adenocarcinoma patients with multiple brain metastases.Methods: In total, 80 patients eligible for inclusion were randomly divided into 4 groups. Group A included whole brain radiotherapy (WBRT) alone 300 cGy/fraction ×10 fractions, at a total dose of 3,000 cGy.Group B included WBRT alone 180 cGy/fraction ×22 fractions, at a total dose of 3,960 cGy. Group C included intracranial metastases radiotherapy alone 250 cGy/fraction ×22 fractions at a total dose of 5,500 cGy.Group D included the whole brain + intracranial metastases group (SIB group) whole brain 180 cGy/fraction ×22 fractions intracranial metastases 250 cGy/fraction ×22 fractions, at a total dose 3,960 cGy, 5,500 cGy, respectively. Results:The median survival time of intracranial disease-free survival (IPFS) in group A, group B, group C, and group D was 6, 9, 8, and 13 months, respectively (P=0.000). The median overall survival (OS) time was 16, 24.5, 24, and 30 months, respectively (P=0.150). There was a significant difference in IPFS between different doses and fractionated radiotherapies, but there was no difference in OS. Multivariate analysis showed that the radiotherapy dose of intracranial metastases was positively correlated with IPFS and OS.

Section: Discussionmentioning

confidence: 99%

Performance Assessment of Two Motion Management Systems for Frameless Stereotactic Radiosurgery

Zhou

Grantham

et al. 2020

Preprint

Background/PurposeFrameless stereotactic radiosurgery (SRS) requires dedicated systems to monitor patient motion in order to avoid inaccurate radiation delivery due to involuntary shifts. The purpose of this study is to assess the accuracy and sensitivity of two distinct motion monitoring systems used for frameless SRS.MethodsA surface image-guided system known as Optical Surface Monitoring System (OSMS), and a fiducial marker-based system known as High Definition Motion Management (HDMM) as part of the latest Gamma Knife Icon® were compared with each other. A 3D printer-based cranial motion phantom was developed to evaluate the accuracy and sensitivity of these two systems in terms of: (1) the capability to recognize predefined shifts up to 3 cm, and (2) the capability to recognize predefined speeds up to 3 cm/s. The performance of OSMS, in terms of different reference surfaces, was also evaluated.ResultsTranslational motion could be accurately detected by both systems, with an accuracy of 0.3 mm for displacement up to 1 cm, and 0.5 mm for larger displacements. The reference surface selection had an impact OSMS performance, with flat surface resulting in less accuracy. HDMM was in general more sensitive when compared with OSMS in capturing the motion, due to its faster frame rate, but a delay in response was observed with faster speeds. Both systems were less sensitive in detection of superior-inferior motion when compared to lateral or vertical displacement directions.ConclusionTranslational motion can be accurately and sensitively detected by OSMS and HDMM real-time monitoring systems. However, performance variations were observed along different motion directions, as well as amongst the selection of reference images. Caution is needed when using real-time monitoring systems for frameless SRS treatment.