Fractionated Stereotactic Radiotherapy using CyberKnife for the Treatment of Large Brain Metastases: A Dose Escalation Study

Murai, Taro; Ogino, Hiroyuki; Manabe, Yoshihiko; Iwabuchi, M.; Okumura, Takuro; Matsushita, Yasuhiro; Tsuji, Yoshihiko; Suzuki, Hirochika; Shibamoto, Yuta

doi:10.1016/j.clon.2013.11.027

Cited by 65 publications

(50 citation statements)

References 29 publications

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“…Fractionated administration of radiation dose potentially decreases toxicity to late-responding normal tissues compared to a single acute dose of radiation for a given level of tumor damage [23], and reoxygenation and redistribution of the cell cycle between fractions render hypoxic tumor cells and cells in a lessresponding cell cycle more radiosensitive [9,16]. As expected from this concept, recently published studies on fractionated SRS for large BMs have demonstrated high LTC rates ranging from 63 to 100 % at 1 year with acceptable risks of toxicity [4,5,8,10,11,13,14,21,22]. Along with these, in the present study, the LTC rate was 87.0 % at 1 year and the median OS was 16 months in patients with large BMs treated with fractionated CK, which also compares well with the outcomes of single-fraction SRS for small BMs [6,17,26].…”

Section: Discussionmentioning

confidence: 87%

“…Recently, the concept of fractionated SRS has been emerging and is reportedly effective and safe in treating BMs, especially large ones [4,5,8,10,11,13,14,21,22]. The Cyberknife (CK) (Accuray, Sunnyvale, CA, USA) features a more flexible fractionation delivery of SRS compared with GK, as it relies on the frameless, image-guided technology for tracking the target both in space and time.…”

Section: Introductionmentioning

confidence: 99%

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

Cho

Lee

et al. 2015

Acta Neurochir

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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

Cho

Lee

et al. 2015

Acta Neurochir

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“…The maximum doses to the brain stem, optic nerve and optic chiasm were limited to <25 Gy/5 fr or 18 Gy/3 fr, as described previously. 10 The maximum dose to the lens was lowered to <7 Gy/3 fr or 10 Gy/5 fr. 10 To satisfy these limitations, dose-painting technique was applied.…”

Section: Methodsmentioning

confidence: 99%

“…10 The maximum dose to the lens was lowered to <7 Gy/3 fr or 10 Gy/5 fr. 10 To satisfy these limitations, dose-painting technique was applied.…”

Section: Methodsmentioning

confidence: 99%

“…Our previous dose escalation study showed that fractionated SRT (30 Gy/3 fr or 35 Gy/5 fr) was acceptable against large BM (≥10 cc) in the cyberknife radiosurgery system. 10 According to that study, similar dose fractionation regimens have been used in tomotherapy treatment in our institution. Thus, the first hypothesis of this study is that those suggested regimens for SRT can be used with tomotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system

Murai¹,

Hayashi²,

Manabe³

et al. 2016

BJR

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Objective:Dynamic jaws (DJ) are expected to be useful in stereotactic radiotherapy (SRT) for brain metastases (BM). The efficacy and optimal dose fractionation were investigated.Methods:In a planning study, 63 treatment plans were generated for the following 3 conditions: 1.0-cm fixed jaws (FJ), 2.5-cm FJ and 2.5-cm DJ. In a clinical study, 30 Gy/3 fr, 35 Gy/5 fr or 37.5 Gy/5 fr were prescribed depending on tumour size. Clinical results of groups treated with 2.5-cm DJ plans and 1.0-cm FJ were compared.Results:In the planning study, the treatment times in 2.5-cm DJ and FJ plans were less than that in 1.0-cm FJ plans (p < 0.001). The brain doses in 1.0-cm FJ plans and 2.5-cm DJ plans were smaller than those in 2.5-cm FJ plans (p < 0.05). In the clinical study, 34 patients with 68 BM were treated with SRT. Of those, 15 patients with 34 BM were treated with 2.5-cm DJ plans and 19 patients with 34 BM were treated with 1.0-cm FJ plans. The overall survival and local tumour control (LC) rates were 52 and 93% at 12 months, respectively. The DJ system achieved favourable LC and 29% shorter treatment time compared with the FJ system (p < 0.001). Grade 2 or 3 necrosis occurred more frequently in patients with 15 cc or larger tumour volumes (p = 0.05).Conclusion:DJ technology enables treatment time to be reduced without worsening the dose distribution and clinical efficacy. The prescribed doses in this study may be acceptable for patients with small tumour volumes.Advances in knowledge:DJ technology enables treatment time to be reduced without worsening the dose.

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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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Fractionated Stereotactic Radiotherapy using CyberKnife for the Treatment of Large Brain Metastases: A Dose Escalation Study

Cited by 65 publications

References 29 publications

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

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

Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system

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

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