Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Cho, Young Hyun; Lee, Jung Min; Lee, Doheui; Park, Jae Hong; Yoon, Kwan Han; Kim, Seon‐Ok; Kwon, Do Hoon; Kim, Jeong Hoon; Kim, Chang‐Jin; Roh, Sung Woo

doi:10.1007/s00701-015-2585-3

Cited by 19 publications

(11 citation statements)

References 30 publications

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“…These “reference” schedules ranged between 6-7 Gy × 5 and 7-10Gyx3. [ 4 13 18 19 20 36 43 44 46 ] Prescription doses to tumor margins were set at lower isodose lines (usually at the 35%-40% lines) to (i) match local target conformity aspects, (ii) increase the average dose inside the tumor, and (iii) optimize 10 Gy-volume increment at each GKRS. Taking into account the possible limitations of the LQ-formalism, isoeffective conversions[ 1 26 41 42 ] were used to (i) identify bearable/minimally toxic biologically effective dose distributions outside tumor margins using an alpha/beta ratio of 2-2.5 for normal brain tissue and (ii) set a customized Baseline Ablative Isodose Line (BAIL) adjusted to the tumor's potential alpha/beta ratio.…”

Section: Discussionmentioning

confidence: 99%

The concept of rapid rescue radiosurgery in the acute management of critically located brain metastases: A retrospective short-term outcome analysis

Sinclair¹,

Benmakhlouf²,

Brigui³

et al. 2018

Surg Neurol Int

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Background:Adaptive hypofractionated gamma knife radiosurgery has been used to treat brain metastases in the eloquent regions while limiting the risk of adverse radiation effect (ARE). Ablative responses might be achieved within days to weeks with the goal to preserve the neurological function. The application of this treatment modality in selected acute/subacute settings has been termed Rapid Rescue Radiosurgery (RRR) in our department. We report the expeditious effects of RRR during treatment and 4 weeks after treatment completion.Methods:In all, 34 patients with 40 brain metastases, each treated over a period of 7 days in three separate gamma knife radiosurgery sessions (GKRS 1-3) between November 2013 and August 2017, were retrospectively analyzed in terms of tumor volume reduction, salvage of organs at risk (OAR), and radiation induced toxicity under the period of treatment (GKRS 1-3 = one week) and at first follow-up magnetic resonance imaging (MRI) (4 weeks after GKRS 3).Results:Mean tumor volume at GKRS 1 was 12.8 cm3. Mean peripheral doses at GKRS 1, GKRS 2, and GKRS 3 were 7.7 Gy, 8.1 Gy, and 8.4 Gy (range: 6.0-9.5 Gy) at the 35% to 50% isodose lines. In the surviving group at first follow-up (n = 28), mean tumor volume reduction was − 10% at GKRS 3 (1 week) and − 48% four weeks after GKRS 3. There was no further clinical deterioration between GKRS 3 and first follow-up in 21 patients. Six patients died prior to first follow-up due to extracranial disease. No ARE was noticed/reported.Conclusions:In this study, RRR proved effective in terms of rapid tumor volume reduction, debulking, and preservation/rescue of neurological function.

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Section: Discussionmentioning

confidence: 99%

The concept of rapid rescue radiosurgery in the acute management of critically located brain metastases: A retrospective short-term outcome analysis

Sinclair¹,

Benmakhlouf²,

Brigui³

et al. 2018

Surg Neurol Int

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“…Lehrer et al made an international meta‐analysis of trials and found that HFSRT offered a relative reduction of radionecrosis while maintaining or improving 1‐year local control rate when compared to SRS. Therefore, HFSRT is effective to treat brain metastases, associates with better local control and reduces risk of radionecrosis as compared with SRS …”

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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“…The technical characteristics of Leksell Gamma Knife ® (Schell et al 1995) and CyberKnife ® (Dieterich et al 2011), covering both these aspects, make them elective modalities for that purpose. On the other side, due to the improvement of image guided delivery techniques, linac based protocols are also quite widespread (Wowra et al 2009, Treuer et al 2014, Cho et al 2015, Frakes et al 2015, Park et al 2016. In this framework the dose delivery method that characterizes helical TomoTherapy ® (HT) (Langen et al 2010) systems could potentially provide an efficient and accurate alternative to the previously mentioned techniques.…”

Section: Introductionmentioning

confidence: 99%

TomoTherapy treatments of multiple brain lesions: an in-phantom accuracy evaluation

Zani¹,

Marrazzo²,

Calusi³

et al. 2019

Phys. Med. Biol.

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Aim of the present study was to evaluate the accuracy which can be obtained with helical TomoTherapy ® (HT, Accuray) systems in the case of multiple intracranial targets treatments. Setup accuracy was measured, for different registration options and MegaVoltage CT (MVCT) slice thickness, by applying known misalignments to an ad-hoc developed phantom. End-to-end (E2E) tests were performed to assess the delivery accuracy in phantoms containing multiple targets by using radiochromic films: measured dose distribution centroids were compared with physical and calculated target positions on axial and coronal planes. A Gamma index analysis was carried out on planned and measured planar dose maps. The bone and tissue algorithm with the fine MVCT reconstruction grid gave the best results among the automatic options. The most accurate registration modality resulted to be the manual one with a sub-voxel accuracy shifts and a capability in the detection of rotations within 0.3°. For the E2E along the coronal plane (six targets), a mean deviation between measured dose distribution centroids and physical barycenters of 0.6 mm (range 0.1 mm-1.3 mm) was observed. Along the axial plane (five targets), a mean deviation of 1.2 mm (range 0.7 mm-2.1 mm) was found for the centroids shifts. Gamma index (5%, 1 mm, local) passing rates higher than 87.5% between planned and delivered dose distributions were measured. These results demonstrate that multiple brain lesion HT treatments are feasible with an accuracy at least comparable to frameless linac-based delivery, when a setup capable to assure angular corrections and a reliable patient immobilization is employed.

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Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Cited by 19 publications

References 30 publications

The concept of rapid rescue radiosurgery in the acute management of critically located brain metastases: A retrospective short-term outcome analysis

The concept of rapid rescue radiosurgery in the acute management of critically located brain metastases: A retrospective short-term outcome analysis

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

TomoTherapy treatments of multiple brain lesions: an in-phantom accuracy evaluation

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