Radiosurgery With or Without A 2-mm Margin for 93 Single Brain Metastases

Nataf, F.; Schlienger, M.; Liu, Zhihua; Foulquier, Jean Noel; Grès, B. Du; Orthuon, A.; Vannetzel, J.M.; Escudier, Bernard; Méder, J.F.; Roux, F. X.; Touboul, E.

doi:10.1016/j.ijrobp.2007.11.002

Cited by 83 publications

(32 citation statements)

References 21 publications

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“…Several studies have assessed SRS target margins for intact metastases 16, 17. Kirkpatrick et al performed a single-institutional, randomized trial that showed no difference in local control using 1-mm compared with 3-mm margins with a trend for increased toxicity with larger margins 16 .…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Rava

Rosenberg

Jamorabo

et al. 2016

Advances in Radiation Oncology

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ObjectiveOur objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases.MethodsEighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses.ResultsThe median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P < .020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P < .001) and central nervous system failure (P < .030).ConclusionsExcellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Rava

Rosenberg

Jamorabo

et al. 2016

Advances in Radiation Oncology

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“…Finally, most of the dogs in this series were imaged in sternal recumbency but treated while in dorsal recumbency, and one study of humans has shown that such a change in positioning can introduce additional error into lesion targeting . The main drawback of PTV expansion is the inclusion of normal brain tissue within the treatment field and the associated increased risk of radionecrosis, which has been demonstrated in human patients . Thus, the benefits of such a strategy must be balanced with this increased risk of late effects, particularly as the volume of the prescribed treatment increases …”

Section: Discussionmentioning

confidence: 99%

Frameless stereotactic radiosurgery for the treatment of primary intracranial tumours in dogs

Mariani

Schubert

House

et al. 2013

Vet Comparative Oncology

104

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Stereotactic radiosurgery (SRS) is a procedure that delivers a single large radiation dose to a well-defined target. Here, we describe a frameless SRS technique suitable for intracranial targets in canines. Medical records of dogs diagnosed with a primary intracranial tumour by imaging or histopathology that underwent SRS were retrospectively reviewed. Frameless SRS was used successfully to treat tumours in 51 dogs with a variety of head sizes and shapes. Tumours diagnosed included 38 meningiomas, 4 pituitary tumours, 4 trigeminal nerve tumours, 3 gliomas, 1 histiocytic sarcoma and 1 choroid plexus tumour. Median survival time was 399 days for all tumours and for dogs with meningiomas; cause-specific survival was 493 days for both cohorts. Acute grade III central nervous system toxicity (altered mentation) occurred in two dogs. Frameless SRS resulted in survival times comparable to conventional radiation therapy, but with fewer acute adverse effects and only a single anaesthetic episode required for therapy.

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“…In a multi-fraction study [43], the total systematic (and random) deviations reached 1.6 mm (0.9 mm), 1.7 mm (1.1 mm), and 1.1 mm (0.8 mm) for brain cancer patients in the medial-lateral, cranial-caudal, and anterior-posterior directions, respectively. Therefore, a 2 mm isotropic margin was used in principle for CTV for planning target volume (PTV) expansion in the present study, although the use of 2 mm margins is controversial [44]. The dose was 28 Gy at 80% isodose in 4 fractions delivered on consecutive weekdays.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Single or Multiple Brain Metastases by Hypofractionated Stereotactic Radiotherapy Using Helical Tomotherapy

Nagai

Shibamoto

Yoshida

et al. 2014

IJMS

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This study investigated the clinical outcomes of a 4-fraction stereotactic radiotherapy (SRT) study using helical tomotherapy for brain metastases. Between August 2009 and June 2013, 54 patients with a total of 128 brain metastases underwent SRT using tomotherapy. A total dose of 28 or 28.8 Gy at 80% isodose was administered in 4 fractions for all tumors. The mean gross tumor volume (GTV) was 1.9 cc. Local control (LC) rates at 6, 12, and 18 months were 96%, 91%, and 88%, respectively. The 12-month LC rates for tumors with GTV ≤0.25, >0.25 and ≤1, and >1 cc were 98%, 82%, and 93%, respectively; the rates were 92% for tumors >3 cc and 100% for >10 cc. The 6-month rates for freedom from distant brain failure were 57%, 71%, and 55% for patients with 1, 2, and ≥3 brain metastases, respectively. No differences were significant. No major complications were observed. The 4-fraction SRT protocol provided excellent tumor control with minimal toxicity. Distant brain failure was not so frequent, even in patients with multiple tumors. The results of the current study warrant a prospective randomized study comparing single-fraction stereotactic radiosurgery (SRS) with SRT in this patient population.

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Radiosurgery With or Without A 2-mm Margin for 93 Single Brain Metastases

Cited by 83 publications

References 21 publications

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Frameless stereotactic radiosurgery for the treatment of primary intracranial tumours in dogs

Treatment of Single or Multiple Brain Metastases by Hypofractionated Stereotactic Radiotherapy Using Helical Tomotherapy

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