&lt;p&gt;Whole-brain helical tomotherapy with integrated boost for brain metastases in patients with malignant melanoma – final results of the BRAIN-RT trial&lt;/p&gt;

Hauswald, Henrik; Bernhardt, Denise; Krug, David; Katayama, Sonja; Habl, Gregor; Bermejo, Justo Lorenzo; Debus, Jürgen; Sterzing, Florian

doi:10.2147/cmar.s204729

Cited by 7 publications

(6 citation statements)

References 37 publications

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“…Of the three RCTs, none reported how their randomisation sequence was generated but all reported complete outcome data and clinically-relevant outcomes. Two of the three trials 28 , 29 were closed early due to poor accrual and had sample sizes of 7 and 18, greatly limiting the reliability of their results. Baseline characteristics for the different treatment arms were reported and similar for the trial of 18 patients 29 but were not reported for the trial of 7 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Baseline characteristics for the different treatment arms were reported and similar for the trial of 18 patients 29 but were not reported for the trial of 7 patients. 28 The largest trial 30 had 215 patients, and while not stratifying for previous treatments, randomisation was effective as previous treatments were well balanced between the two study arms, as were baseline characteristics. This trial provided the most reliable data for identifying the effects of adjuvant WBRT in conjunction with surgery and/or SRS for patients with 1–3 brain metastases.…”

Section: Resultsmentioning

confidence: 99%

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Radiation therapy for melanoma brain metastases: a systematic review

Thompson

Williams

Hong

2022

Radiology and Oncology

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Background Radiation therapy (RT) for melanoma brain metastases, delivered either as whole brain radiation therapy (WBRT) or as stereotactic radiosurgery (SRS), is an established component of treatment for this condition. However, evidence allowing comparison of the outcomes, advantages and disadvantages of the two RT modalities is scant, with very few randomised controlled trials having been conducted. This has led to considerable uncertainty and inconsistent guideline recommendations. The present systematic review identified 112 studies reporting outcomes for patients with melanoma brain metastases treated with RT. Three were randomised controlled trials but only one was of sufficient size to be considered informative. Most of the evidence was from non-randomised studies, either specific treatment series or disease cohorts. Criteria for determining treatment choice were reported in only 32 studies and the quality of these studies was variable. From the time of diagnosis of brain metastasis, the median survival after WBRT alone was 3.5 months (IQR 2.4–4.0 months) and for SRS alone it was 7.5 months (IQR 6.7–9.0 months). Overall patient survival increased over time (pre-1989 to 2015) but this was not apparent within specific treatment groups. Conclusions These survival estimates provide a baseline for determining the incremental benefits of recently introduced systemic treatments using targeted therapy or immunotherapy for melanoma brain metastases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Radiation therapy for melanoma brain metastases: a systematic review

Thompson

Williams

Hong

2022

Radiology and Oncology

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“…Three RCTs compared hippocampal avoidance-WBRT with conventional WBRT. [22][23][24] The studies could not be combined because they did not report the same outcomes; 2 of the studies were determined to be highrisk, one low risk of bias. The low risk of bias NRG CC001 trial found no significant difference in overall or intracranial-progression free survival and no significant differences in quality of life.…”

Section: Wbrt With Neuroprotectionmentioning

confidence: 99%

“…However, comparing patients treated with hippocampal avoidance WBRT with memantine versus those treated with WBRT with memantine, hippocampal avoidance WBRT was associated with a lower risk of cognitive failure, with less deterioration of executive function and learning and memory. 24 A trial reported by Hauswald et al 22 was stopped early, and quality of life data were not analyzable. Yang et al concluded that hippocampal-avoidance WBRT has better preservation of late verbal memory, but not in verbal fluency or executive function.…”

Section: Wbrt With Neuroprotectionmentioning

confidence: 99%

Radiation Therapy for Brain Metastases: A Systematic Review

Garsa

Jang

Baxi

et al. 2021

Practical Radiation Oncology

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This evidence report synthesizes the available evidence on radiation therapy for brain metastases. Methods and Materials: The literature search included PubMed, EMBASE, Web of Science, Scopus, CINAHL, clinicaltrials.gov, and published guidelines in July 2020; independently submitted data, expert consultation, and contacting authors. Included studies were randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. Results: Ninety-seven studies reported in 189 publications were identified, but the number of analyses was limited owing to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied, and 25 trials were terminated early, predominantly owing to poor accrual. The combination of SRS plus WBRT compared with SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.69%-1.73%; 4 RCTs) or death owing to brain metastases (relative risk [RR], 0.93; 95% CI, 0.48%-1.81%; 3 RCTs). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; 95% CI, 0.76%-1.26%; 5 RCTs). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or postsurgery interventions. We did not find systematic differences across interventions in serious adverse events, number of adverse events, radiation necrosis, fatigue, or seizures. WBRT plus systemic therapy (RR 1.44; 95% CI, 1.03%-2.00%; 14 studies) was associated with increased risks for vomiting compared with WBRT alone. Conclusions: Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.

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“…The target volume is irradiated using a fan beam with rotating linac continuously moving the treatment couch. With this special helical design, HT can achieve comparable or better plan quality than conventional VMAT, which is used for a limited number of brain metastases [ 26 ]. Several studies compared HT and VMAT for different sites, and mixed results were reported [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases

Men

et al. 2022

Radiat Oncol

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Purpose This study implemented a piecewise volumetric modulated arc therapy (P-VMAT) for realizing whole-brain radiation therapy (WBRT) with simultaneous integrated boost (SIB) for multiple brain metastases (> 40 metastases) with a conventional C-arm linear accelerator. Materials and methods This study retrospectively analyzed 10 patients with multiple brain metastases (40–120 metastases, median 76), who underwent WBRT and SIB using helical tomotherapy (HT). The prescribed doses were 40 Gy/20 f and 60 Gy/20 f for WBRT and SIB, respectively. Corresponding new HT plans were designed with P-VMAT using 7 arcs. For each arc, the collimator was rotated to 45°, and the field width was limited to 2.5 cm with 0.5 cm overlap with adjacent arcs. Thus, each arc covered only one section of the brain target volume. A conventional dual arc VMAT (DA-VMAT) plan was also designed. HT, P-VMAT, and DA-VMAT plans were compared using dose distribution reviews and dosimetric parameters. ArcCHECK phantom measurements were performed for verification of P-VMAT plans. Results No significant differences in the mean coverage of the whole-brain target and metastases were observed between HT and P-VMAT (p > 0.05). The conformity index for the whole-brain target improved with P-VMAT compared with HT (p < 0.05). Furthermore, the volume of 44 Gy V44 (110% of prescribed dose for WBRT) received for whole-brain significantly reduced with P-VMAT from 38.2 ± 12.9% to 23.3 ± 9.4% (p < 0.05), and the maximum dose for organs at risks such as the hippocampus, optical nerve, optical chiasm, and spinal cord declined with P-VMAT (p < 0.05). Unlike HT and P-VMAT, DA-VMAT was clinically unacceptable because V44 in the whole-brain was too high (54.7 ± 8.2%). The mean absolute dose gamma passing rate for P-VMAT plans was 97.6 ± 1.1% (3%/3 mm criterion, 10%). Conclusions P-VMAT is favorable for WBRT and SIB for multiple brain metastases. It provides comparable coverage of whole-brain target and SIB, with better conformity, lower V44, and better dose sparing of organs at risk compared with HT. Furthermore, results show that DA-VMAT fails clinical practice even for a relatively large number of brain metastases with a high degree of plan complexity. The patient specific verification demonstrates the feasibility of P-VMAT for clinical application.

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<p>Whole-brain helical tomotherapy with integrated boost for brain metastases in patients with malignant melanoma – final results of the BRAIN-RT trial</p>

Cited by 7 publications

References 37 publications

Radiation therapy for melanoma brain metastases: a systematic review

Radiation therapy for melanoma brain metastases: a systematic review

Radiation Therapy for Brain Metastases: A Systematic Review

Application of piecewise VMAT technique to whole-brain radiotherapy with simultaneous integrated boost for multiple metastases

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