Mean Brain Dose Remains Uninfluenced by the Lesion Number for Gamma Knife Stereotactic Radiosurgery for 10+ Metastases

Sita, Timothy L.; Gopalakrishnan, Mahesh; Rooney, Michael K.; Ho, Alexander; Savoor, Rohan; Sonabend, Adam M.; Tate, Matthew C.; Chandler, James P.; Lesniak, Maciej S.; Kruser, Tim J.; Kalapurakal, John A.; Sachdev, Sean

doi:10.1016/j.wneu.2022.06.057

Cited by 2 publications

(3 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sita et al recently published data from 30 patients treated with single fraction SRS for ten or more metastasis from different solid tumor primary sites evaluating clinical and dosimetric outcomes based on GK treatment (median of 13 lesions ranging from 10 to 26). In their study, the mean dose to the brain was not related to the number of lesions (Pearson r = 0.23, p = 0.21), but was closely associated with total tumor volume (Pearson r = 0.95, p < 0.0001) [32]. Given that this is well below the threshold for significant mean brain dose, this is likely the reason no correlation was established in their study.…”

Section: Discussionmentioning

confidence: 85%

Dosimetric Impact of Lesion Number, Size, and Volume on Mean Brain Dose with Stereotactic Radiosurgery for Multiple Brain Metastases

Rosa

Wieczorek

Tolakanahalli

et al. 2023

Cancers

View full text Add to dashboard Cite

We evaluated the effect of lesion number and volume for brain metastasis treated with SRS using GammaKnife® ICON™ (GK) and CyberKnife® M6™ (CK). Four sets of lesion sizes (<5 mm, 5–10 mm, >10–15 mm, and >15 mm) were contoured and prescribed a dose of 20 Gy/1 fraction. The number of lesions was increased until a threshold mean brain dose of 8 Gy was reached; then individually optimized to achieve maximum conformity. Across GK plans, mean brain dose was linearly proportional to the number of lesions and total GTV for all sizes. The numbers of lesions needed to reach this threshold for GK were 177, 57, 29, and 10 for each size group, respectively; corresponding total GTVs were 3.62 cc, 20.37 cc, 30.25 cc, and 57.96 cc, respectively. For CK, the threshold numbers of lesions were 135, 35, 18, and 8, with corresponding total GTVs of 2.32 cc, 12.09 cc, 18.24 cc, and 41.52 cc respectively. Mean brain dose increased linearly with number of lesions and total GTV while V8 Gy, V10 Gy, and V12 Gy showed quadratic correlations to the number of lesions and total GTV. Modern dedicated intracranial SRS systems allow for treatment of numerous brain metastases especially for ≤10 mm; clinical evidence to support this practice is critical to expansion in the clinic.

show abstract

Section: Discussionmentioning

confidence: 85%

Dosimetric Impact of Lesion Number, Size, and Volume on Mean Brain Dose with Stereotactic Radiosurgery for Multiple Brain Metastases

Rosa

Wieczorek

Tolakanahalli

et al. 2023

Cancers

View full text Add to dashboard Cite

show abstract

“…Unlike the regular partner in ALK fusions, LOC399815 is classified as an lncRNA with 2112nt bases of 7 exons located on human chromosome 10q26. 13. Previous study has reported that the expression of LOC399815 is significantly related to the clinical characteristics of patients with lung squamous cell carcinoma, including factors such as gender and lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies support that stereotactic radiosurgery alone may be used to treat >10 brain metastases without affecting the decline of neurocognitive function. [13] With the patient receiving a combination of Alectinib and CyberKnife, a reduction of in both the volume and number of brain metastatic lesions, accompanied with an improvement in neurocognitive function. Therefore, liquid biopsy-based gene detection successfully determines rare gene fusion in clinical assistant diagnoses, such as LOC399815-ALK fusion, which guide efficient and accurate treatment and thereby improving the quality of life for NSCLC patients.…”

Section: Discussionmentioning

confidence: 99%

Lung adenocarcinoma with brain metastasis detected dual fusion of LOC399815-ALK and ALK-EML4 in combined treatment of Alectinib and CyberKnife: A case report

Li,

Lu,

Yao

et al. 2024

Medicine

View full text Add to dashboard Cite

Introduction: The anaplastic lymphoma kinase (ALK) gene fusion occurs in approximately 3% to 7% of nonsmall cell lung cancer (NSCLC), in which occurs approximately 23% to 31% of brain metastasis patients in poor prognosis. ALK tyrosine kinase inhibitors have shown efficacy in treating ALK-positive (ALK+) NSCLC. More than 90 distinct subtypes of ALK fusions have been identified through sequencing technique and would lead to significant differences in clinical efficacy, it is necessary to guide clinical treatment effectively by gene detection. Patient concerns: A 56-year-old nonsmoking female admitted to hospital due to cough, expectoration, and chest pain. Chest computed tomography revealed a space-occupying lesion in the upper left lobe (5.0 cm × 2.4 cm × 2.9 cm), multiple enlarged lymph nodes in mediastinum 3A and 5 (largest size 1.5 cm × 1.4 cm), and evidence of thoracic vertebral metastasis, brain magnetic resonance imaging also showed brain metastasis. Diagnoses: Lung adenocarcinoma with brain metastasis. Interventions: The patient initially received conventional first-line chemotherapy, which led to a deteriorated condition. Blood-base liquid biopsy by next-generation sequencing resulted in double ALK fusions, in which with a neo-partner of lncRNA (LOC399815-ALK). Following subsequent treatment with Alectinib and stereotactic radiotherapy (CyberKnife) was subsequently employed to manage the brain metastatic lesions, resulting in a substantial decreased in both the number and size of tumor lesions. Outcomes: The patient’s response to therapy efficacy resulted in a substantial decreased in both the number and size of tumor lesions that assessed comprehensively evaluated through computed tomography imaging and ctDNA sequencing. Patient’s condition has been under control for over 29 months. Conclusion: Liquid biopsy may reveal the rare fusion forms of ALK, precisely guiding personalized treatment, and providing a reference method for longitudinal monitoring and efficacy evaluation of ALK-tyrosine kinase inhibitors in NSCLC patients.

show abstract

Mean Brain Dose Remains Uninfluenced by the Lesion Number for Gamma Knife Stereotactic Radiosurgery for 10+ Metastases

Cited by 2 publications

References 28 publications

Dosimetric Impact of Lesion Number, Size, and Volume on Mean Brain Dose with Stereotactic Radiosurgery for Multiple Brain Metastases

Dosimetric Impact of Lesion Number, Size, and Volume on Mean Brain Dose with Stereotactic Radiosurgery for Multiple Brain Metastases

Lung adenocarcinoma with brain metastasis detected dual fusion of LOC399815-ALK and ALK-EML4 in combined treatment of Alectinib and CyberKnife: A case report

Contact Info

Product

Resources

About