Intensity modulated radiosurgery of brain metastases with flattening filter-free beams

Stieler, Florian; Fleckenstein, Jens; Simeonova, A.; Wenz, Frederik; Lohr, Frank

doi:10.1016/j.radonc.2013.10.017

Cited by 52 publications

(62 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The dosimetric characteristics of VMAR with or without FFF mode for multiple brain metastases are comparable, although FFF mode provides even greater reductions in treatment time. 19, 27 Taken together, the dosimetric profile of single-isocenter VMAR compares favorably to both conventional frame-based SRS techniques and static beam IMRS. In the present study, dosimetric characteristics of VMAR were generally within accepted standards in concordance with prior feasibility studies.…”

Section: Discussionmentioning

confidence: 98%

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Lau¹,

Zakeri²,

Zhao³

et al. 2015

Neurosurgery

View full text Add to dashboard Cite

Background Stereotactic radiosurgery is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. Objective To report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases. Methods We performed a retrospective analysis of 15 patients undergoing frameless VMAR for multiple intracranial metastases using a single, centrally-located isocenter between 2009 and 2011. Among these, 3 patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median 3 per patient, range 2-13) were treated to a median dose of 20 Gy (range, 15-30 Gy). 3 patients were treated with fractionated SRS. Follow-up including clinical examination and magnetic resonance imaging (MRI) occurred every 3 months. Results Median follow-up for all patients was 7.1 months (range, 1.1-24.3), with 11 patients (73.3%) followed until death. For the remaining 4 patients alive at the time of analysis, median follow-up was 19.6 months (range, 9.2-24.3). Local control at 6 and 12 months was 91.7 (95% Confidence Interval [C.I.], 84.6-100.0%) and 81.5 (95% C.I., 67.9-100.0%), respectively. Regional failure was observed in 9 patients (60.0%), and 7 patients (46.7%) received salvage therapy. Overall survival at 6 months was 60.0% (95% C.I., 40.3-88.2%). Grade 3 or greater treatment-related toxicity was not observed. Median total treatment time was 7.2 minutes (range, 2.8-13.2 minutes). Conclusion Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared to conventional radiosurgery.

show abstract

Section: Discussionmentioning

confidence: 98%

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Lau¹,

Zakeri²,

Zhao³

et al. 2015

Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Compensation of the forward-peak bremsstrahlung by a flattening-filter decreases the maximal dose output of a linac, increasing the treatment time (17). By removing the flattening filter (so called flattening-filter-free), it is possible to increase the dose rate and dramatically shorten the treatment time.…”

Section: Introductionmentioning

confidence: 99%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

View full text Add to dashboard Cite

Abstract. The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.

show abstract

“…According to a prior study with FFF beams on radiation doses in brain metastases, increased MUs were observed with FFF treatment plans, but depended on the plan complexity and degree of modulation. 16 Another recent study investigated the potential capabilities in achieving flat dose profiles from FFF beams, which would be highly beneficial for treatments that require large fields, and showed these beams to combine dosimetric advantages of conventional flattened beams and FFF beams, potentially offering more efficient treatment with less scatter, less radiation leakage and fewer MUs required to deliver the dose. 17 Regardless of the greater MUs in the RA-FFF plans, the treatment delivery times for RA-FFF are slightly faster than for RA, which may also be beneficial in the case of stereotactic radiotherapy for patients with rNPC.…”

Section: Discussionmentioning

confidence: 99%

“…16 However, the treatment of rNPC is more difficult owing to its special anatomical site, compared with many other types of head and neck cancer. The more radioresistant clones of rNPC may necessitate larger fractional dosing.…”

mentioning

confidence: 99%

Reirradiation of nasopharyngeal carcinoma focusing on volumetric modulated arcs with flattening filter-free beams

Zhuang

Huang

Zhu

et al. 2015

BJR

View full text Add to dashboard Cite

Intensity modulated radiosurgery of brain metastases with flattening filter-free beams

Cited by 52 publications

References 18 publications

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Reirradiation of nasopharyngeal carcinoma focusing on volumetric modulated arcs with flattening filter-free beams

Contact Info

Product

Resources

About