Simultaneous stereotactic radiosurgery of multiple brain metastases using single-isocenter dynamic conformal arc therapy: a prospective monocentric registry trial

Bodensohn, Raphael; Kaempfel, Anna-Lena; Fleischmann, Daniel; Hadi, Ibnu; Hofmaier, Jan; Garny, Sylvia; Reiner, M. J.; Forbrig, Robert; Corradini, Stefanie; Thon, Niklas; Belka, Claus; Niyazi, Maximilian

doi:10.1007/s00066-021-01773-6

Cited by 15 publications

(16 citation statements)

References 47 publications

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“…Bodensohn, et. al reported on the feasibility and safety of single isocenter treatments for patients with multiple brain metastases [ 7 ]. In the view of the newly proposed legislation by the Centers for Medicare & Medicaid Services (CMS) on an Alternative Payment Model (APM) affecting Radiation Oncology, the single isocenter treatment technique is a timely and relevant treatment method considering the upcoming bundled reimbursement rates [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience

et al. 2021

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Purpose/objective(s) To communicate our institutional experience with single isocenter radiosurgery treatments for multiple brain metastases, including challenges with determining planning target volume (PTV) margins and resulting consequences, image-guidance translational and rotational tolerances, intra-fraction patient motion, and prescription considerations with larger PTV margins. Materials/methods Eight patient treatments with 51 targets were planned with various margins using Elements Multiple Brain Mets SRS treatment planning software (Brainlab, Munich, Germany). Forty-eight plans with 0 mm, 1 mm and 2 mm margins were created, including plans with variable margins, where targets more than 6 cm away from the isocenter were planned with larger margins. The dosimetric impact of the margins were analyzed with V5Gy, V8Gy, V10Gy, V12Gy values. Additionally, 12 patient motion data were analyzed to determine both the impact of the repositioning threshold and the distributions of the patient translational and rotational movements. Results The V5Gy, V8Gy, V10Gy, V12Gy volumes approximately doubled when margins change from 0 to 1 mm and tripled when change from 0 to 2 mm. With variable margins, the aggregated results are similar to results from plans using the lower of two margins, since only 12.2% of the targets were more than 6 cm away from the isocenter. With 0.5 mm re-positioning threshold, 57.4% of the time the patients are repositioned. Reducing the threshold to 0.25 mm results in 91.7% repositioning rate, due to limitations of the fusion algorithm and actual patient motion. The 90th percentile of translational movements in all directions is 0.7 mm, while the 90th percentile of rotational movements in all directions is 0.6 degrees. Median translations and rotations are 0.2 mm and 0.2 degrees, respectively. Conclusions Based on the data presented, we have switched our modus operandi from 2 to 1 mm PTV margins, with an eventual goal of using 0.5 and 1.0 mm variable margins when an automated margin assignment method becomes available. The 0.5 mm and 0.5 degrees repositioning thresholds are clinically appropriate with small residual patient movements.

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Section: Introductionmentioning

confidence: 99%

Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience

et al. 2021

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“…For the platforms that treat MIM with a single isocentre, poor isocentre placement can lead to compromised coverage during treatment, particularly without the use of 6 dof corrections and intrafraction monitoring systems. 67,91,92 Gamma Knife and linac-based CC platforms are immune to this issue as the isocentre is individually placed inside each target and CyberKnife treatments are non-isocentric. For these platforms, large numbers of mets can take considerable time to deliver (CyberKnife utilises about 10 times more MU than Elements DCA to deliver the same prescription).…”

Section: Discussion Of Clinical Cases and Clinical Evaluation Of Mim Treatment Platforms And Tpsmentioning

confidence: 99%

“…While this approach may not be ideal for complex targets, the geometric simplicity of intracranial metastases makes this solution quite attractive. 67 The low degree of MLC modulation lends itself to simpler dosimetry, faster delivery and monitor unit economy. The use of the linac’s primary and secondary collimators for SRS increases the field size and therefore target size that can be treated, allowing for the first time the simultaneous treatment of multiple targets via the same arc.…”

Section: Mim Platforms and Treatment Planning Systems Utilized In This Studymentioning

confidence: 99%

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Skourou¹,

Hickey²,

Rock³

et al. 2021

BJR|Open

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The use of stereotactic radiosurgery to treat multiple intracranial metastases, frequently concurrently, has become increasingly common. The ability to accurately and safely deliver stereotactic radiosurgery treatment to multiple intracranial metastases (MIM) relies heavily on the technology available for targeting, planning, and delivering the dose. A number of platforms are currently marketed for such applications, each with intrinsic capabilities and limitations. These can be broadly categorised as cobalt-based, linac-based, and robotic. This review describes the most common representative technologies for each type along with their advantages and current limitations as they pertain to the treatment of multiple intracranial metastases. Each technology was used to plan five clinical cases selected to represent the clinical breadth of multiple metastases cases. The reviewers discuss the different strengths and limitations attributed to each technology in the case of MIM as well as the impact of disease-specific characteristics (such as total number of intracranial metastases, their size and relative proximity) on plan and treatment quality.

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“…Whole brain radiation therapy (WBRT) is the most widely used treatment for patients with disseminated brain metastases and bulky meningeal disease [7,8]. Bodensohn et al demonstrated that a simultaneous stereotactic radiosurgery using a single-isocenter dynamic conformal arc (SIDCA) seems to be a feasible and safe treatment for patients with multiple brain metastases [9]. However, WBRT is the conventional treatment for patients with LM and provides attenuation of prevalent neurological signs and symptoms [10].…”

Section: Introductionmentioning

confidence: 99%

Whole brain radiotherapy combined with intrathecal liposomal cytarabine for leptomeningeal metastasis—a safety analysis and validation of the EANO-ESMO classification

et al. 2022

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Background Although there is no proven standard therapy for leptomeningeal metastases (LM), treatment often includes intrathecal chemotherapy combined with whole brain radiation therapy (WBRT). Little is known about the toxicity of such combination therapies. We performed a retrospective safety analysis for the combination of intrathecal liposomal cytarabine with WBRT in patients with LM and validated the EANO-ESMO (European Association of Neuro-oncology—European Society for Medical Oncology) classification in this unique cohort. Methods Treatment toxicities in patients diagnosed with LM between 2004 and 2014 were retrospectively analyzed according to RTOG (Radiation Therapy Oncology Group) toxicity criteria and NCI CTCAE V5.0 (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0). Diagnostic criteria and treatment response as assessed by EANO-ESMO classification were correlated with survival by Kaplan–Meier analysis and Breslow test. Results In all, 40 patients with LM who were treated with combined WBRT and intrathecal cytarabine, were identified. Ten patients (25%) experienced adverse events ≥grade 3 according to RTOG toxicity criteria; in 22 patients (55%) NCI CTCAE ≥grade 3 were detected. Median overall survival was 124 days. Median time to neurological progression was 52 days. Patients with positive cerebrospinal fluid (CSF) cytology (n = 26) showed worse prognosis compared to patients with negative CSF cytology (n = 14; mOS (median overall survival) 84 days versus 198 days, p = 0.006, respectively). The EANO-ESMO response assessment was significantly associated with survival: “stable” (n = 7) mOS 233 days, “response” (n = 10) mOS 206 days, “progression” (n = 17) mOS 45 days, “suspicion of progression” (n = 6) mOS 133 days; overall, p < 0.001. Conclusions In this retrospective analysis, combined treatment of WBRT and intrathecal liposomal cytarabine shows an acceptable safety profile and may indicate a trend towards improved efficacy. The EANO-ESMO classification for diagnosis and treatment response predicts survival.

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Simultaneous stereotactic radiosurgery of multiple brain metastases using single-isocenter dynamic conformal arc therapy: a prospective monocentric registry trial

Cited by 15 publications

References 47 publications

Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience

Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience

Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies

Whole brain radiotherapy combined with intrathecal liposomal cytarabine for leptomeningeal metastasis—a safety analysis and validation of the EANO-ESMO classification

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