Radiotherapy management of brain metastases using conventional linear accelerator

Abstract

Background and Aims. As treatments for primary cancers continue to improve life expectancy, unfortunately, brain metastases also appear to be constantly increasing and life expectancy for patients with brain metastases is low. Longer survival and improved quality of life may be achieved using localised radiological and surgical approaches in addition to low dose corticosteroids. Stereotactic brain radiotherapy is one rapidly evolving localized radiation treatment. This article describes our experience with stereotactic radiotherapy using a linear accelerator. Methods. We reviewed patients treated with stereotactic radiotherapy, from the time of its introduction into daily practice in our Department of Oncology in 2014. We collected the data on patient treatment and predicted survival based on prognostic indices and actual patient outcome. Results. A total of 10 patients were treated by stereotactic radiotherapy, in one case in combination with whole brain radiotherapy and hippocampal sparing. There was no significant treatment related toxicity during the treatment or follow-up and due to the small number of fractions, the overall tolerance of the treatment was excellent. The patient intrafractional movement in all cases was under 1 mm suggesting that 1 mm margin around the CTV to create the PTV is sufficient and also that patient immobilization using the thermoplastic mask compared with invasive techniques, is feasible. We also found that prognostic indices such as the Graded Prognostic Assessment provide accurate predictions of patient survival. Conclusions. Based on our current evidence, patients with brain metastases fit enough, should be considered for stereotactic radiotherapy treatment.

Left hippocampus sparing whole brain radiotherapy (WBRT): A planning study

“…The inherent limitation may be the fundamental question whether there is a role for WBRT in up-to-date treatment of brain metastases and with higher availability of systems for stereotactic radiosurgery [24][25][26] . From one perspective, the best technique for sparing the hippocampus is avoidance of WBRT itself and proceeding with stereotactic radiotherapy.…”

Stereotactic radiotherapy in the treatment of local recurrences of esophageal cancer

“…SBRT utilizing conventional linear accelerators is a rapidly evolving technique that, due to low toxicity and a short overall treatment time, may be considered an ideal therapeutic option for patients with a poor prognosis, such as those with recurrent EC in whom the balance between quality of life and treatment toxicity should be carefully weighed. The utilization of SBRT has been widely reported in patients with primary lung cancer, primary liver cancer and metastatic disease, and in individuals with recurrences of gynecological tumors and brain metastases, with SBRT quickly becoming a standard institutional treatment worldwide (21)(22)(23). However, there are few studies describing the use of SBRT in locally recurrent EC patients without distant metastases, and further studies are required to clarify the optimal treatment approach in this group of patients (24,25).…”

Dosimetria gel polimérica usando imagem de ressonância magnética para aplicação em radioterapia

“…Tabela 1: Profundidades de máxima dose (zmax) para os feixes de fótons e elétrons mostrados nas figuras 2(a) e (b). Atualmente, os aparelhos mais utilizados em tratamentos de radioterapia são os aceleradores lineares, uma vez que possuem uma variedade maior de energia, tanto de feixe de elétrons bem como de feixe de fótons, tornando possível o tratamento em diversas profundidades (MERNA et al, 2016;MATZENAUER et al, 2016;YAHYA et al, 2017;GIGLIOTTI et al, 2018;WEN et al, 2018).…”