Single-Dose Versus Fractionated Stereotactic Radiotherapy for Brain Metastases

Kim, Yeon-Joo; Cho, Kwan Ho; Kim, Joo-Young; Lim, Young Kyung; Min, Hye Sook; Lee, Sang Hyun; Kim, Ho Jin; Gwak, Ho Shin; Yoo, Heon; Lee, Jun Young

doi:10.1016/j.ijrobp.2010.05.033

Cited by 144 publications

(101 citation statements)

References 19 publications

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“…Fractionated administration of radiation dose potentially decreases toxicity to late-responding normal tissues compared to a single acute dose of radiation for a given level of tumor damage [23], and reoxygenation and redistribution of the cell cycle between fractions render hypoxic tumor cells and cells in a lessresponding cell cycle more radiosensitive [9,16]. As expected from this concept, recently published studies on fractionated SRS for large BMs have demonstrated high LTC rates ranging from 63 to 100 % at 1 year with acceptable risks of toxicity [4,5,8,10,11,13,14,21,22]. Along with these, in the present study, the LTC rate was 87.0 % at 1 year and the median OS was 16 months in patients with large BMs treated with fractionated CK, which also compares well with the outcomes of single-fraction SRS for small BMs [6,17,26].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the concept of fractionated SRS has been emerging and is reportedly effective and safe in treating BMs, especially large ones [4,5,8,10,11,13,14,21,22]. The Cyberknife (CK) (Accuray, Sunnyvale, CA, USA) features a more flexible fractionation delivery of SRS compared with GK, as it relies on the frameless, image-guided technology for tracking the target both in space and time.…”

Section: Introductionmentioning

confidence: 99%

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Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Cho

Lee

et al. 2015

Acta Neurochir

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Cho

Lee

et al. 2015

Acta Neurochir

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“…A recent study concluded that fractionated stereotactic radiotherapy (FSRT) was a more effective and safe treatment compared to single dose radiosurgery. 11 In this small retrospective study, we report imaging and clinical outcomes of patients who underwent both WBRT and FSRT with CyberKnife ® (Accuray Incorporated, Sunnyvale, CA) for metastatic brain tumors in or adjacent (≤5 mm) to brainstem.…”

Section: -10mentioning

confidence: 99%

Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Güney¹,

Ozseker²,

İnan³

et al. 2013

Turkiye Klinikleri J Med Sci

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“…The main difference between SRS and SRT is in the number of fractions delivered. SRS utilizes only 1 fraction (1 day) for delivery of the whole ablative dose of radiotherapy, which imitates the surgical techniques of treating a patient in one day; whereas, SRT uses 3-6 fractions for treatment dose delivery (4,5). Several prognostic indexes were created to assess the expected patient survival to help clinicians to decide about proper treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing

et al. 2016

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Abstract.Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm 3 , with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience. IntroductionRenal cell cancer (RCC) with brain metastases is a disease with poor prognosis (1). The treatment strategy generally depends on the patient performance status, tumor burden and patient preference. The departmental facility device equipment often plays a significant role in the decision making process. Targeted therapy is the mainstay of the systemic treatment at present (2). There are a few viable treatment options with respect to the number of brain lesions, their location and patient overall fitness: Surgical resection, hypofractionated stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT) and symptomatic treatment with steroids (best supportive care (BSC) (3). The main difference between SRS and SRT is in the number of fractions delivered. SRS utilizes only 1 fraction (1 day) for delivery of the whole ablative dose of radiotherapy, which imitates the surgical techniques of treating a patient in one day; whereas, SRT uses 3-6 fractions for treatment dose delivery (4,5). Several prognostic indexes were created to assess the expected patient survival to help clinicians to decide about proper treatment strategy. The recursive partitioning analysis (RPA) index combines the patient's performance status, age and disease burden. One of the greatest disadv...

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Single-Dose Versus Fractionated Stereotactic Radiotherapy for Brain Metastases

Cited by 144 publications

References 19 publications

Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Experiences on two different stereotactic radiosurgery modalities of Gamma Knife and Cyberknife in treating brain metastases

Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing

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