Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study

Yamamoto, Masaaki; Serizawa, Toru; Shuto, Takashi; Akabane, Atsuya; Higuchi, Yoshinori; Kawagishi, Jun; Yamanaka, Kazuhiro; Sato, Yasunori; Jokura, Hidefumi; Yomo, Shoji; Nagano, Osamu; Kenai, Hiroyuki; Moriki, Akihito; Suzuki, Satoshi; Kida, Yoshihisa; Iwai, Yoshiyasu; Hayashi, Motohiro; Onishi, Hiroaki; Gondo, Masazumi; Sato, Mitsuya; Akimitsu, Tomohide; Kubo, Kenji; Kikuchi, Yasuhiro; Shibasaki, Toru; Goto, Takehiko; Takanashi, Masami; Mori, Yoshimasa; Takakura, Kintomo; Saeki, Naokatsu; Kunieda, Etsuo; Aoyama, Hidefumi; Momoshima, Suketaka; Tsuchiya, Kunihiko

doi:10.1016/s1470-2045(14)70061-0

Cited by 1,223 publications

(895 citation statements)

References 31 publications

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“…A recent publication by Yamamoto et al demonstrated that survival in patients with 5 to 10 brain metastases is noninferior to that of patients with 2 to 4 brain metastases and may be a reasonable treatment option for patients with up to 10 metastases with an otherwise good performance status. 5 Although SRS is thought to deliver radiation with minimal normal tissue toxicities, patients receiving this treatment for 1 to 3 metastases will also experience neurocognitive decline. 6 These patients may benefit from decreased hippocampal doses.…”

Section: Introductionmentioning

confidence: 99%

Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

Zhang

Antone

et al. 2017

Practical Radiation Oncology

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Section: Introductionmentioning

confidence: 99%

Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

Zhang

Antone

et al. 2017

Practical Radiation Oncology

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“…It was demonstrated that even with multiple metastases the SRS treatment could provide reasonable local control,4, 5 and a multi‐institutional observational study suggested that clinical outcomes for patients with 5–10 individual metastases treated by SRS alone may be non‐inferior to those with 2–4 targets 6, 7. While conceptually straightforward in principle, multi‐target SRS poses logistical challenges.…”

Section: Introductionmentioning

confidence: 99%

A hybrid volumetric dose verification method for single‐isocenter multiple‐target cranial SRS

Ahmed

Kapatoes

Zhang

et al. 2018

J Applied Clin Med Phys

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A commercial semi‐empirical volumetric dose verification system (PerFraction [PF], Sun Nuclear Corp.) extracts multi‐leaf collimator positions from the electronic portal imaging device movies collected during a pre‐treatment run, while the rest of the delivered control point information is harvested from the accelerator log files. This combination is used to reconstruct dose on a patient CT dataset with a fast superposition/convolution algorithm. The method was validated for single‐isocenter multi‐target SRS VMAT treatments against absolute radiochromic film measurements in a cylindrical phantom. The targets ranged in size from 0.8 to 3.6 cm and in number from 3 to 10 per plan. A total of 17 films rotated at different angles around the cylinder axis were analyzed. Each of 27 total targets was intercepted by at least one film, and 2–4 different films were analyzed per plan. Film dose was always scaled to the ion chamber measurement in a high‐dose, low‐gradient area deliberately created at the isocenter. The planar dose agreement between PF and film using 3%(Global dose‐difference normalization)/1 mm gamma analysis was on average 99.2 ± 1.1%. The point dose difference in the low‐gradient area in the middle of every target was below 3%, while PF‐reconstructed and film dose centroids for individual targets showed submillimeter agreement when measured on a well aligned accelerator. Volumetrically, all voxels in all plans agreed between PF and the primary treatment planning system at the 3%/1 mm level. With proper understanding of its advantages and shortcomings, the tool can be applied to patient‐specific QA in routine radiosurgical clinical practice.

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“…In the present work, we hypothesized that the AG system could lead to lower integral dose to the healthy brain tissue than an older system with 4-mm leaves called the Beam Modulator (BM) 8 owing to the AG's decreased leakage, increased leaf speed and perpendicular diaphragm. As the number of patients being treated with multiple brain metastases is increasing, 9 including the number of retreatments, increasing evidence is needed to support new technologies such as AG in order to minimize brain dose. The focus of the present article was on cases involving multiple brain metastases that were considered challenging to plan.…”

Section: Introductionmentioning

confidence: 99%

Investigation of two linear accelerator head designs for treating brain metastases with hypofractionated volumetric-modulated arc radiotherapy

Ruschin

Sahgal

Iradji

et al. 2016

BJR

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Objective: To investigate brain radiation dose in complex cases arising from two stereotactic linear accelerator designs and to present a method for comparing brain dose to published data. Methods: Two head designs were considered: Beam Modulator (BM) and Agility (AG). 12 patients treated on BM were replanned with AG. Planning objectives were: minimize brain dose and satisfy target coverage and organs at risk dose constraints. Each of the 36 targets was analyzed for conformality index (CI Paddick), gradient index (GI) and homogeneity index (HI). Total volume of tissue receiving 80% (V80) of the prescription dose down to 25% (V25) was evaluated. Similarly the volume of brain minus planning target volume receiving 80% (BMP80) down to 25% (BMP25) was evaluated. The mean brain dose and BMP dose were also evaluated. System differences were statistically evaluated using Wilcoxon signed-rank test. Powerlaw models for total volume (V) and brain minus planning target volumes (BMP) were generated based on BM data.Results: The median CI Paddick was 0.74 and 0.76 for BM and AG, respectively (p 5 0.04). The median GI was 5.5 and 6.1 (p , 0.01) and the median HI was 1.17 and 1.16 for BM and AG, respectively (p , 0.01). Neither V or BMP receiving doses of 80% down to 40% exhibited statistically significant difference between the two systems, whereas the volume of brain minus PTV receiving 25% (BMP25) was weakly different (p 5 0.02). AG exhibited a lower mean BMP dose (4.1 Gy) than BM (4.6 Gy) (p , 0.01). Power-law models for V/BMP showed excellent (R 2 . 0.80) agreement for the dose levels studied and comparable results with published data. Conclusion: Treatment plans of equivalent quality were attained with AG compared with BM. Advances in knowledge: The AG system involves a novel collimation design. The present article demonstrates equivalent or improved brain dose for complex, multitarget cases using AG vs an older stereotactic system. INTRODUCTIONThe use of intensity-modulated radiotherapy or volumetricmodulated arc radiotherapy (VMAT) using multileaf collimators (MLCs) for stereotactic radiosurgery and radiotherapy is becoming increasingly popular, as this technique affords efficient delivery with a high degree of target conformality. [1][2][3] In particular, for multiple targets, the use of VMAT has been implicated in yielding shorter treatment times while providing comparable plan quality to intensity-modulated radiotherapy and three-dimensional conformal treatments. 1 Initial experiences with VMAT were with multi-isocentre plans, 4,5 followed by a series of studies investigating the feasibility of a singleisocentre approach. 2,6

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Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study

Cited by 1,223 publications

References 31 publications

Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

Hippocampal-sparing and target volume coverage in treating 3 to 10 brain metastases: A comparison of Gamma Knife, single-isocenter VMAT, CyberKnife, and TomoTherapy stereotactic radiosurgery

A hybrid volumetric dose verification method for single‐isocenter multiple‐target cranial SRS

Investigation of two linear accelerator head designs for treating brain metastases with hypofractionated volumetric-modulated arc radiotherapy

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