Dosimetric comparisons of different hypofractionated stereotactic radiotherapy techniques in treating intracranial tumors &gt; 3 cm in longest diameter

Cao, Hongyan; Xiao, Zhiyan; Yin, Zhinan; Kwong, Tiffany C.; Danish, Shabbar F.; Weiner, Joseph; Wang, Xiao; Yue, Ning J.; Dai, Zhitao; Kuang, Yu; Bai, Yongrui; Nie, Ke

doi:10.3171/2018.12.jns181578

Cited by 29 publications

(32 citation statements)

References 35 publications

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“…After an international meta-analysis of Lehrer et al in 2018, 17 studies across 15 institutes in 3 countries have been analyzed and shown that concurrent administration of immune checkpoint inhibitors and SRS does not appear to be associated with untoward rates of radionecrosis with a possible survival advantage observed. Additionally, enhanced regional brain control within the brain with excellent rates of 1-year LC may be associated with concurrent therapy [57,58]. This argues for non-invasive treatment of brain metastases even in advanced and extra-cranially spread disease to prevent progression and subsequent neurological deterioration, while treating the underlying disease effectively.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

et al. 2021

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Introduction Malignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity. Methods We evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast‐enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up. Results The median age was 61 years (range 27–80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7–14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7–11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant. Conclusion The present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.

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Section: Discussionmentioning

confidence: 99%

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

et al. 2021

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“…They were observed in the GI and V 3 Gy –V 24 Gy of normal brain tissue. Cao et al had compared dose metrics for six different plans. They found that the V 12 Gy of CK and GK plan was smaller than coplanar and non‐coplanar VMAT plans.…”

Section: Discussionmentioning

confidence: 99%

“…Beside conventional C‐arm based linear accelerator, there are some distinctive technologies, such as Gamma Knife (GK) and CyberKnife (CK). Due to non‐coplanar beams and the non isocentric nature of CK, the advantage of CK is quick dose falloff and better protection of normal brain tissue . CK contains a high‐resolution image‐guided tracking system to adjust the angle of beams during treatment to ensure the accuracy of the treatment.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

Zhang

Yang

Wang

2019

J Applied Clin Med Phys

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The incidence of brain metastases is increasing and various treatment modalities exist for brain metastases. The aim of this study was to investigate the dosimetric quality and delivery efficiency of robotic radiosurgery (CyberKnife) for multiple brain metastases compared with C-arm linear accelerator (linac) based plans. C-arm linac based plans included intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and non-coplanar VMAT with 1, 3 and 5 non-coplanar arcs, respectively (NC1, NC3 and NC5). For 20 patients, six plans with a prescription dose of 30 Gy in three fractions were generated. The gradient index (GI), conformity index (CI), maximum dose (D max ) of organs at risk (OARs), normal brain tissue volume (V 3 Gy -V 24 Gy ), monitor units (MUs) and beam on time (BT) were evaluated. The GI of CyberKnife plans (3.60 ± 0.70) was lower than IMRT (6.21 ± 2.26, P < 0.05), VMAT (6.04 ± 1.93, P < 0.05), NC1 (5.16 ± 1.71, P < 0.05), NC3 (5.02 ± 1.59, P < 0.05) and NC5 (5.03 ± 1.72, P < 0.05). The CI of the VMAT plans (both coplanar and non-coplanar) was larger than IMRT and CK plans. The D max for most OARs of the CyberKnife plan was lower than the C-arm linac based plans, although some differences were not statistically significant. The normal brain tissue volume of CyberKnife plan was lower than the C-arm linac based plans, and the normal brain tissue volume of non-coplanar VMAT plans was lower than IMRT and VMAT plans at high-moderate dose level. However, the MUs and BT of CyberKnife plans was more than C-arm linac based plans. CyberKnife plan was better than C-arm linac based plans in protecting normal brain tissue and OARs for patients with multiple brain metastases. C-arm linac based plan with non-coplanar arc provided better protection of normal brain tissue than coplanar plan. However, the BT of CyberKnife plan was longer than C-arm linac based plans. K E Y W O R D SCyberKnife, dosimetry, IMRT, multiple brain metastases,

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“…This variability may be especially pertinent when dealing with lesions near critical structures such as the brainstem or optic chiasm [5]. Such targets are usually best treated with a fractionated approach, which is now possible using MB GK SRS [21].…”

Section: Comparisons To Current Literaturementioning

confidence: 99%

“…As it currently stands, there is a gap in the literature comparing patient perspectives between SRS with a frame and SRS with a mask. The development of the Elekta Gamma Knife Icon in 2015 provided a unique opportunity to compare FB and MB SRS because the 2 can occur on the same treatment platform while maintaining the sharpest dose falloff gradient compared with other SRS treatment modalities [6,21]. The present study aims to analyze patient experiences of FB and MB SRS with respect to the comfort, pain, and perception of the procedure.…”

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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Dosimetric comparisons of different hypofractionated stereotactic radiotherapy techniques in treating intracranial tumors > 3 cm in longest diameter

Cited by 29 publications

References 35 publications

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA

Dosimetric quality and delivery efficiency of robotic radiosurgery for brain metastases: Comparison with C‐arm linear accelerator based plans

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

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