Hypofractionated stereotactic radiotherapy for large brain metastases: Optimizing the dosimetric parameters

Brun, L.; Dupic, G.; Chassin, V.; Chautard, Emmanuel; Moreau, J.; Dedieu, V.; Khalil, T.; Verrelle, Pierre; Lapeyre, M.; Biau, J.

doi:10.1016/j.canrad.2020.04.011

Cited by 6 publications

(19 citation statements)

References 37 publications

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“…With respect to the average dose gradients outside the PTV, the SIB plans were even superior. Admittedly, this might be partly due to the higher number of DCA plans in the SIB concept (7 vs. 3), as also suggested by the findings of Brun et al in a similar plan comparison [ 17 ]. Also, the beam quality (6MV flattened versus unflattened) could have had an influence on the dose gradients.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of a simultaneously integrated boost concept for hypofractionated stereotactic radiotherapy of unresected brain metastases

Kornhuber,

Ensminger,

Hübsch

et al. 2023

Radiat Oncol

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Background In stereotactic radiotherapy, dose is prescribed to an isodose surrounding the planning target volume (PTV). However, the desired dose inhomogeneity inside the PTV leaves the specific dose distribution to the gross tumor volume (GTV) unspecified. A simultaneously integrated boost (SIB) to the GTV could solve this shortcoming. In a retrospective planning study with 20 unresected brain metastases, a SIB approach was tested against the classical prescription. Methods For all metastases, the GTV was isotropically enlarged by 3 mm to a PTV. Two plans were generated, one according to the classical 80% concept with 5 times 7 Gy prescribed (on D2%) to the 80% PTV surrounding isodose (with D98%(PTV) ≥ 35 Gy), and the other one following a SIB concept with 5 times 8.5 Gy average GTV dose and with D98%(PTV) ≥ 35 Gy as additional requirement. Plan pairs were compared in terms of homogeneity inside GTV, high dose in PTV rim around GTV, and dose conformity and gradients around PTV using Wilcoxon matched pairs signed rank test. Results The SIB concept was superior to the classical 80% concept concerning dose homogeneity inside GTV: Heterogeneity index of GTV was in the SIB concept (median 0.0513, range 0.0397–0.0757) significantly (p = 0.001) lower than in the 80% concept (median 0.0894, range 0.0447–0.1872). Dose gradients around PTV were not inferior. The other examined measures were comparable. Conclusion Our stereotactic SIB concept better defines the dose distribution inside PTV and can be considered for clinical use.

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Section: Discussionmentioning

confidence: 99%

Feasibility of a simultaneously integrated boost concept for hypofractionated stereotactic radiotherapy of unresected brain metastases

Kornhuber,

Ensminger,

Hübsch

et al. 2023

Radiat Oncol

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“…Regardless of the SRT technique used, our study found no significant differences in acute and late toxicities, LR or CR, and overall survival. To the best of our knowledge, the studies comparing VMAT and DCAT to date, have been in silico studies, therefore, no clinical data is available to correlate dosimetric differences with potential clinical outcome differences [24] , [25] , [26] , [27] .…”

Section: Discussionmentioning

confidence: 99%

“…DCAT uses direct planning, whereas VMAT uses inverse planning. The latter is better in terms of CI and time-consuming as volume increases and becomes complex [25] , [26] . Since 2014, when the VMAT was deployed in our RT department, the teams have prioritized its use for high-volume treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of dynamic conformal arc therapy and volumetric modulated arc therapy for treating single brain metastases: A retrospective analysis of dosimetric and clinical outcomes

Chambrelant,

Jarnet,

Le Fèvre

et al. 2024

Physics and Imaging in Radiation Oncology

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“…However, there is no evidence shown that CRT can enhance anlotinib cross the BBB, and the detailed mechanism of anlotinib action in lung cancer patients with BM requires further study. 13 Additionally, further clinical studies are required to determine whether the combination of anlotinib and CRT is better than CRT alone for patients with BM from lung cancer who failed to respond to multi-line chemotherapy or without EGFR/ALK/ROS1-TKIs indication.…”

Section: Discussionmentioning

confidence: 99%

“… 12 However, for NSCLC patients with no specific gene mutation or EGFR/ALK/ROS1-TKIs resistance, cranial radiotherapy (CRT) is still considered the standard treatment regime, as this treatment can quickly relieve central nervous system symptoms and improve the survival time of patients. 13 CRT can increase the permeability of the blood–brain barrier (BBB), 14 which may increase anlotinib content in brain tissue, so the curative effect of CRT combined with anlotinib may be better than that of CRT alone for NSCLC patients with no specific gene mutation or EGFR/ALK/ROS1-TKIs resistance. In this study, we retrospectively analyzed the treatment effects of CRT combined with anlotinib compared with CRT alone for patients with lung cancer BM and multi-line chemotherapy failure or patients with EGFR/ALK/ROS1-TKIs resistance or patients with non-EGFR/ALK/ROS1 mutations or intolerable chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Anlotinib Combined with Cranial Radiotherapy for Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospectively, Control Study

He¹,

Liu²,

Ma³

et al. 2021

CMAR

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Introduction Cranial radiotherapy (CRT) is the main treatment for non-small cell lung cancer (NSCLC) with brain metastasis (BM) and non-EGFR/ALK/ROS1-TKIs indication, and anlotinib can improve overall prognosis. However, the clinical effects of CRT combined with anlotinib for the treatment of NSCLC with BM remain unclear. Methods We retrospectively analyzed the clinical effects of anlotinib + CRT versus CRT alone in NSCLC patients with BM and non-EGFR/ALK/ROS1-TKIs indication from September 2016 to June 2020. The progression-free survival (PFS) and overall survival (OS) of anlotinib + CRT versus CRT alone were analyzed. After evaluation of the clinical characteristics to generate a baseline, the independent prognostic factors for intracranial PFS (iPFS) and OS were subjected to univariate and multivariate analysis. Finally, subgroup analysis for iPFS and OS was performed to assess treatment effects using randomized stratification factors and stratified Cox proportional hazards models. Results This study included data for 73 patients with BM at baseline. Of the 73 patients, 45 patients received CRT alone, and 28 patients received CRT + anlotinib. There was no significant difference in clinical features between the two groups ( P > 0.05). Compared with the CRT group, the combined group had longer iPFS (median iPFS [miPFS]: 3.0 months vs 11.0 months, P = 0.048). However, there were no significant differences in OS, extracranial PFS, and systemic PFS. For clinical features, univariate and multivariate analysis showed that the plus anlotinib treatment was an independent advantage predictor of iPFS (hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.27–0.95; P = 0.04), and age ≥57 years (HR 1.04, 95% CI 1.01–1.08, P = 0.014) and KPS score ≤80 (HR 1.04, 95% CI 1.01–1.08, P = 0.014) were independent disadvantage predictors of OS ( P < 0.05). In addition, although this difference was not statistically significant ( p > 0.05), the patients with the anlotinib + local CRT (LCRT) treatment had the longest iPFS (miPFS: 27.0 months) and OS (median OS [mOS]: 36 months). The miPFS and mOS values for the LCRT group were 11 months and 18 months, respectively, with shorter values for whole-brain RT (WBRT) + anlotinib group, WBRT + LCRT + anlotinib group, WBRT, and WBRT + LCRT. Conclusion Anlotinib can improve the intracranial lesion control and survival prognosis of NSCLC patients with CRT.

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Hypofractionated stereotactic radiotherapy for large brain metastases: Optimizing the dosimetric parameters

Cited by 6 publications

References 37 publications

Feasibility of a simultaneously integrated boost concept for hypofractionated stereotactic radiotherapy of unresected brain metastases

Feasibility of a simultaneously integrated boost concept for hypofractionated stereotactic radiotherapy of unresected brain metastases

Comparative study of dynamic conformal arc therapy and volumetric modulated arc therapy for treating single brain metastases: A retrospective analysis of dosimetric and clinical outcomes

Anlotinib Combined with Cranial Radiotherapy for Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospectively, Control Study

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