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

Skourou, Christina; Hickey, Darina; Rock, Luke; Houston, P.; Sturt, P.; Sullivan, Siobhra O'; Faul, C.; Paddick, Ian

doi:10.1259/bjro.20210035

Cited by 5 publications

(6 citation statements)

References 76 publications

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“…A clinician blinded to treatment technique did not find any significant difference in quality between plans generated with SI-VMAT (Hyperarc, Varian) and with RayStation for Cyberknife ( 16 ), reinforcing the notion that radiosurgery is platform independent as long as a high quality is achieved. Reviews of the technical aspects of SRS for MBM are available ( 55 , 56 ) and guidelines for SRS for MBM with a linac ( 57 ) and with gamma knife ( 58 ) were published in 2019.…”

Section: Discussionmentioning

confidence: 99%

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

et al. 2022

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PurposeStereotactic radiosurgery (SRS) is now mainstream for patients with 1-4 brain metastases however the management of patients with 5 or more brain metastases remains controversial. Our aim was to evaluate the clinical outcomes of patients with 5 or more brain metastases and to compare with published series as a benchmarking exercise.MethodsPatients with 5 or more brain metastases treated with a single isocentre dynamic conformal arc technique on a radiosurgery linac were identified from the institutional database. Endpoints were local control, distant brain failure, leptomeningeal disease and overall survival. Dosimetric data were extracted from the radiosurgery plans. Series reporting outcomes following SRS for multiple brain metastases were identified by a literature search.Results36 patients, of whom 35 could be evaluated, received SRS for 5 or more brain metastases between February 2015 and October 2021. 25 patients had 5-9 brain metastases (group 1) and 10 patients had 10-15 brain metastases (group 2). The mean number of brain metastases in group 1 was 6.3 (5-9) and 12.3 (10-15) in group 2. The median cumulative irradiated volume was 4.6 cm3 (1.25-11.01) in group 1 and 7.2 cm3 (2.6-11.1) in group 2. Median follow-up was 12 months. At last follow-up, local control rates per BM were 100% and 99.8% as compared with a median of 87% at 1 year in published series. Distant brain failure was 36% and 50% at a median interval of 5.2 months and 7.4 months after SRS in groups 1 and 2 respectively and brain metastasis velocity at 1 year was similar in both groups (9.7 and 11). 8/25 patients received further SRS and 7/35 patients received whole brain radiotherapy. Median overall survival was 10 months in group 1 and 15.7 months in group 2, which compares well with the 7.5 months derived from the literature. There was one neurological death in group 2, leptomeningeal disease was rare (2/35) and there were no cases of radionecrosis.ConclusionWith careful patient selection, overall survival following SRS for multiple brain metastases is determined by the course of the extracranial disease. SRS is an efficacious and safe modality that can achieve intracranial disease control and should be offered to patients with 5 or more brain metastases and a constellation of good prognostic factors.

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Section: Discussionmentioning

confidence: 99%

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

et al. 2022

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“…This fractionated approach allows for the delivery of effective doses to the multiple-target while minimizing damage to surrounding healthy brain tissue [ 5 , 6 ]. Various techniques, including the use of conventional linear accelerator (LINAC), Gamma Knife (Elekta AB, Stockholm, Sweden), and CyberKnife (Accuray, Sunnyvale, CA), have been employed for SRS/fSRS [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among these techniques, LINAC-based SRS/fSRS offers several advantages [ 10 ]. Firstly, it is widely accessible, making it a practical option for many healthcare facilities.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery with more than 20 targets: comparing MME, HyperArc, and RapidArc

Jung,

Yoon,

Dona Lemus

et al. 2024

Radiat Oncol

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Background To compare the dosimetric quality of three widely used techniques for LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery (fSRS) with more than 20 targets: dynamic conformal arc (DCA) in BrainLAB Multiple Metastases Elements (MME) module and volumetric modulated arc therapy (VMAT) using RapidArc (RA) and HyperArc (HA) in Varian Eclipse. Methods Ten patients who received single-isocenter fSRS with 20–37 targets were retrospectively replanned using MME, RA, and HA. Various dosimetric parameters, such as conformity index (CI), Paddick CI, gradient index (GI), normal brain dose exposures, maximum organ-at-risk (OAR) doses, and beam-on times were extracted and compared among the three techniques. Wilcoxon signed-rank test was used for statistical analysis. Results All plans achieved the prescribed dose coverage goal of at least 95% of the planning target volume (PTV). HA plans showed superior conformity compared to RA and MME plans. MME plans showed superior GI compared to RA and HA plans. RA plans resulted in significantly higher low and intermediate dose exposure to normal brain compared to HA and MME plans, especially for lower doses of ≥ 8Gy and ≥ 5Gy. No significant differences were observed in the maximum dose to OARs among the three techniques. The beam-on time of MME plans was about two times longer than RA and HA plans. Conclusions HA plans achieved the best conformity, while MME plans achieved the best dose fall-off for LINAC-based single-isocenter multi-target multi-fraction SRS with more than 20 targets. The choice of the optimal technique should consider the trade-offs between dosimetric quality, beam-on time, and planning effort.

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“…Their incidence has risen over time due to the advances in systemic therapy and improvements in extracranial disease control (Kushnirsky et al 2016). Recently, stereotactic radiosurgery (SRS) has become one of the most popular treatments for BM and is typically planned on the contrast-enhanced T1-weighted magnetic resonance imaging (T1c-MRI), which can be performed a few days prior to treatment (Skourou et al 2021). Unlike resection surgery, SRS is a non-invasive (using thermoplastic mask) or minimally-invasive (using stereotactic frame) procedure.…”

Section: Introductionmentioning

confidence: 99%

DeSeg: auto detector-based segmentation for brain metastases

Zhang

Xia

et al. 2023

Phys. Med. Biol.

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Delineation of brain metastases (BMs) is a paramount step in stereotactic radiosurgery (SRS) treatment. Clinical practice has specific expectation on BM auto-delineation that the method is supposed to avoid missing of small lesions and yield accurate contours for large lesions. In this study, we propose a novel coarse-to-fine framework, named detector-based segmentation (DeSeg), to incorporate object-level detection into pixel-wise segmentation so as to meet the clinical demand. DeSeg consists of three components: a center-point-guided single-shot detector (CPG-SSD) to localize the potential lesion regions, a multi-head U-Net segmentation model to refine contours, and a data cascade unit to connect both tasks smoothly. Performance on tiny lesions is measured by the object-based sensitivity and positive predictive value (PPV), while that on large lesions is quantified by dice similarity coefficient (DSC), average symmetric surface distance (ASSD) and 95% Hausdorff distance (HD95). Besides, computational complexity is also considered to study the potential of method in real-time processing. This study retrospectively collected 240 BM patients with Gadolinium injected contrast-enhanced T1-weighted magnetic resonance imaging (T1c-MRI), which were randomly split into training, validating and testing datasets (192, 24 and 24 scans, respectively). The lesions in the testing dataset were further divided into two groups based on the volume size (small S:≤1.5 cc, N=88; large L: >1.5 cc, N=15). On average, DeSeg yielded a sensitivity of 0.91 and a PPV of 0.77 on S group, and a DSC of 0.86, an ASSD 0f 0.76 mm and a HD95 of 2.31 mm on L group. The results indicated that DeSeg achieved leading sensitivity and PPV for tiny lesions as well as segmentation metrics for large ones. After our clinical validation, DeSeg showed competitive segmentation performance while kept faster processing speed comparing with existing 3D models.

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

Cited by 5 publications

References 76 publications

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

Dosimetric evaluation of LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery with more than 20 targets: comparing MME, HyperArc, and RapidArc

DeSeg: auto detector-based segmentation for brain metastases

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