Stereotactic radiosurgery for treatment of brain metastases

Köcher, Martin; Wittig, Andrea; Piroth, Marc D.; Treuer, Harald; Seegenschmiedt, Heinrich; Ruge, Maximilian I.; Grosu, Anca‐Ligia; Gückenberger, Matthias

doi:10.1007/s00066-014-0648-7

Cited by 188 publications

(84 citation statements)

References 116 publications

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“…Since the literature on external beam radiation boost following WBRT for the management of brain metastases is sparse, we compared our results to outcome after stereotactic radiosurgery boost following WBRT. According to a report of the DEGRO (Deutsche Gesellschaft für Radioonkologie) on stereotactic radiotherapy [29] and the literature referred to in the report [6,30], adding stereotactic radiosurgery as boost to WBRT was recommended for several subgroups of patients with brain metastases. In the RTOG 9508 study [6], patients with a single brain metastasis treated with adjuvant stereotactic radiosurgery boost following WBRT had significantly better survival than those without boost treatment.…”

Section: Discussionmentioning

confidence: 99%

Whole Brain Radiotherapy-Based Combined Modality Treatment of Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis of Prognostic Factors

Xiang

Zhang²,

Shen³

et al. 2015

Oncol Res Treat

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Background: The prognostic factors for patients with brain metastases from non-small cell lung cancer treated with whole brain radiotherapy (WBRT)-based combined modality therapy were investigated. Materials and Methods: Out of 135 patients treated with WBRT, 47 (34.8%) received a radiation boost, 84 (62.2%) underwent systemic chemotherapy, and 39 (28.9%) were given epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Results: The mean survival time was 9.3 months, and the 1-year and 2-year survival rates were 46.3 and 16.1%, respectively. In univariate analysis, improved survival was associated with age < 60 years, no extracranial metastasis, Karnofsky performance score ≥ 70, ≥ 3 cycles of chemotherapy after diagnosis of brain metastases, combined treatment with EGFR-TKIs, and no metastases in the cerebellum. In multivariate analysis, the above prognostic factors maintained significance with the exception of age. In an additional analysis of the 58 patients with 1-3 brain metastases, combination of WBRT with radiation boost was associated with better survival. Conclusion: We confirm previously described prognostic factors. Moreover, we found the absence of cerebellar metastases to be an independent prognostic factor for favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Whole Brain Radiotherapy-Based Combined Modality Treatment of Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis of Prognostic Factors

Xiang

Zhang²,

Shen³

et al. 2015

Oncol Res Treat

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“…Radiosurgery is an increasingly common therapeutic strategy, especially for small metastases, as it demonstrates benefits in local tumor control, functional autonomy, and survival [2]. In patients with 1-4 brain metastases with a diameter <3-3.5 cm, stereotactic radiosurgery may be preferred [3][4][5]. Radiosurgery has recently widened in scope and demonstrates good local tumor control without compromising survival, even in patients with up to ten brain metastatic lesions [6,7].…”

Section: Inclusion Criteriamentioning

confidence: 99%

The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis

et al. 2016

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This study aimed to compare the detectability of brain metastases using contrast-enhanced spin-echo (SE) and gradient-echo (GRE) T1-weighted images. The Ovid-MEDLINE and EMBASE databases were searched for studies on the detectability of brain metastases using contrast-enhanced SE or GRE images. The pooled proportions for the detectability of brain metastases were assessed using random-effects modeling. Heterogeneity among studies was determined using χ (2) statistics for the pooled estimates and the inconsistency index, I (2) . To overcome heterogeneity, subgroup analyses according to slice thickness and lesion size were performed. A total of eight eligible studies, which included a sample size of 252 patients and 1413 brain metastases, were included. The detectability of brain metastases using SE images (89.2 %) was higher than using GRE images (81.6 %; adjusted 84.0 %), but this difference was not statistically significant (p = 0.2385). In subgroup analysis of studies with 1-mm-thick slices and small metastases (<5 mm in diameter), 3-dimensional (3D) SE images demonstrated a higher detectability in comparison to 3D GRE images (93.7 % vs 73.1 % in 1-mm-thick slices; 89.5 % vs 59.4 % for small metastases) (p < 0.0001). Although both SE or GRE images are acceptable for detecting brain metastases, contrast-enhanced 3D SE images using 1-mm-thick slices are preferred for detecting brain metastases, especially small lesions (<5 mm in diameter).

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“…SRS provides an alternative to surgery, and whole brain radiotherapy (WBRT), or can accompany these treatments to ensure residual tumor cells are eliminated. Due to the high dose, sharp dose gradients, and small margins utilized in SRS, accurate patient positioning is vital to reduction in dose to normal tissue, as well as tumor control 1. To achieve the required levels of setup accuracy, image guidance and a thermoplastic mask attached to the treatment couch are used in place of an invasive head frame.…”

Section: Introductionmentioning

confidence: 99%

Monitoring frequency of intra‐fraction patient motion using the ExacTrac system for LINAC‐based SRS treatments

Lewis

Snyder

Kim

et al. 2018

J Applied Clin Med Phys

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PurposeThe aim of this study was to investigate the intra‐fractional patient motion using the ExacTrac system in LINAC‐based stereotactic radiosurgery (SRS).MethodA retrospective analysis of 104 SRS patients with kilovoltage image‐guided setup (Brainlab ExacTrac) data was performed. Each patient was imaged pre‐treatment, and at two time points during treatment (1st and 2nd mid‐treatment), and bony anatomy of the skull was used to establish setup error at each time point. The datasets included the translational and rotational setup error, as well as the time period between image acquisitions. After each image acquisition, the patient was repositioned using the calculated shift to correct the setup error. Only translational errors were corrected due to the absence of a 6D treatment table. Setup time and directional shift values were analyzed to determine correlation between shift magnitudes as well as time between acquisitions.ResultsThe average magnitude translation was 0.64 ± 0.59 mm, 0.79 ± 0.45 mm, and 0.65 ± 0.35 mm for the pre‐treatment, 1st mid‐treatment, and 2nd mid‐treatment imaging time points. The average time from pre‐treatment image acquisition to 1st mid‐treatment image acquisition was 7.98 ± 0.45 min, from 1st to 2nd mid‐treatment image was 4.87 ± 1.96 min. The greatest translation was 3.64 mm, occurring in the pre‐treatment image. No patient had a 1st or 2nd mid‐treatment image with greater than 2 mm magnitude shifts.ConclusionThere was no correlation between patient motion over time, in direction or magnitude, and duration of treatment. The imaging frequency could be reduced to decrease imaging dose and treatment time without significant changes in patient position.

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Stereotactic radiosurgery for treatment of brain metastases

Cited by 188 publications

References 116 publications

Whole Brain Radiotherapy-Based Combined Modality Treatment of Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis of Prognostic Factors

Whole Brain Radiotherapy-Based Combined Modality Treatment of Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis of Prognostic Factors

The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis

Monitoring frequency of intra‐fraction patient motion using the ExacTrac system for LINAC‐based SRS treatments

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