Treatment of Single or Multiple Brain Metastases by Hypofractionated Stereotactic Radiotherapy Using  Helical Tomotherapy

Nagai, Aiko; Shibamoto, Yuta; Yoshida, Masanori; Wakamatsu, Koichi; Kikuchi, Yuzo

doi:10.3390/ijms15046910

Cited by 29 publications

(22 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of up to 51 beam angles for treatment planning allows for highly conformal dose distributions with improved sparing of normal tissues compared to more conventional 3D plans [7]. HT-based SBRT is often utilized for treating brain [8] or spine lesions [9]; however, its role in treating intrahepatic tumors has not been explored. HT is effective in treating multiple targets simultaneously, and we have previously shown its adequacy for multiple metastatic tumors [10].…”

Section: Introductionmentioning

confidence: 99%

Phase I dose-escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma

et al. 2016

View full text Add to dashboard Cite

BackgroundPhase I trial was conducted to determine feasibility and toxicity of helical intensity-modulated radiotherapy (IMRT)-based stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC).ResultsEighteen patients (22 lesions) were enrolled. With no DLT at 52 Gy (13 Gy/fraction), protocol was amended for further escalation to 60 Gy (15 Gy/fraction). Radiologic complete response rate was 88.9%. Two outfield intrahepatic, 2 distant, 4 concurrent local and outfield, and 1 concurrent local, outfield and distant failures (no local failure at dose levels 3–4) occurred. The worst toxicity was grade 3 hematologic in five patients, with no gastrointestinal toxicity > grade 1. At median follow-up of 28 months for living patients, 2-year local control, progression-free (PFS), and overall survival rates were 71.3%, 49.4% and 69.3%, respectively. Multi-segmental recurrences prior to SBRT was independent prognostic factor for PFS (p = 0.033).Materials and MethodsEligible patients had Child-Pugh's class A or B, unresectable HCC, ≤ 3 lesions, and cumulative tumor diameter ≤ 6 cm. Starting at 36 Gy in four fractions, dose was escalated with 2 Gy/fraction per dose-level. CTCAE v 3.0 ≥ grade 3 gastrointestinal toxicity and radiation induced liver disease defined dose-limiting toxicity (DLT).ConclusionsHelical IMRT-based SBRT was tolerable and showed encouraging results. Confirmatory phase II trial is underway.

show abstract

Section: Introductionmentioning

confidence: 99%

Phase I dose-escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma

et al. 2016

View full text Add to dashboard Cite

show abstract

“…15 These advantages of fractionation can be fully utilized in the treatment of large BM. Nagai et al 9 reported fractionated SRT (28 Gy/4 fr) outcomes of 122 BM. The LC rate at 12 months was 91%, while no severe radiation necrosis was observed.…”

Section: Discussionmentioning

confidence: 99%

“…3–7 SRT for BM can be delivered with helical tomotherapy in the clinical setting. 8,9 However, the optimal dose and fractionation schedules have not been established yet. Our previous dose escalation study showed that fractionated SRT (30 Gy/3 fr or 35 Gy/5 fr) was acceptable against large BM (≥10 cc) in the cyberknife radiosurgery system.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system

Murai¹,

Hayashi²,

Manabe³

et al. 2016

BJR

Self Cite

View full text Add to dashboard Cite

Objective:Dynamic jaws (DJ) are expected to be useful in stereotactic radiotherapy (SRT) for brain metastases (BM). The efficacy and optimal dose fractionation were investigated.Methods:In a planning study, 63 treatment plans were generated for the following 3 conditions: 1.0-cm fixed jaws (FJ), 2.5-cm FJ and 2.5-cm DJ. In a clinical study, 30 Gy/3 fr, 35 Gy/5 fr or 37.5 Gy/5 fr were prescribed depending on tumour size. Clinical results of groups treated with 2.5-cm DJ plans and 1.0-cm FJ were compared.Results:In the planning study, the treatment times in 2.5-cm DJ and FJ plans were less than that in 1.0-cm FJ plans (p < 0.001). The brain doses in 1.0-cm FJ plans and 2.5-cm DJ plans were smaller than those in 2.5-cm FJ plans (p < 0.05). In the clinical study, 34 patients with 68 BM were treated with SRT. Of those, 15 patients with 34 BM were treated with 2.5-cm DJ plans and 19 patients with 34 BM were treated with 1.0-cm FJ plans. The overall survival and local tumour control (LC) rates were 52 and 93% at 12 months, respectively. The DJ system achieved favourable LC and 29% shorter treatment time compared with the FJ system (p < 0.001). Grade 2 or 3 necrosis occurred more frequently in patients with 15 cc or larger tumour volumes (p = 0.05).Conclusion:DJ technology enables treatment time to be reduced without worsening the dose distribution and clinical efficacy. The prescribed doses in this study may be acceptable for patients with small tumour volumes.Advances in knowledge:DJ technology enables treatment time to be reduced without worsening the dose.

show abstract

“…For purposes of sample size calculation, the baseline risk of DBF in patients with 1 to 4 brain metastases was estimated to be approximately 60% at 1 year as calculated by the Kaplan-Meier method 11 . Enrollment of 28 patients would have an 80% power to detect a reduction in the 1-year risk of DBF from 60% to 30%.…”

Section: Methodsmentioning

confidence: 99%

A phase 2 study of radiosurgery and temozolomide for patients with 1 to 4 brain metastases

Fiveash

Arafat

Naoum³

et al. 2016

Advances in Radiation Oncology

View full text Add to dashboard Cite

PurposeTo determine if temozolomide reduces the risk of distant brain failure (DBF, metachronous brain metastases) in patients with 1 to 4 brain metastases treated with radiosurgery without whole-brain radiation therapy (WBRT).Methods and materialsTwenty-five patients with newly diagnosed brain metastases were enrolled in a single institution phase 2 trial of radiosurgery (15-24 Gy) and adjuvant temozolomide. Temozolomide was continued for a total of 12 cycles unless the patient developed DBF, unacceptable toxicity, or systemic progression requiring other therapy.ResultsTwenty-five patients were enrolled between 2002 and 2005; 3 were not evaluable for determining DBF. Of the remaining 22 patients, tumor types included non-small cell lung cancer (n = 8), melanoma (n = 7), and other (n = 7). Extracranial disease was present in 10 (45%) patients. The median number of tumors at the time of radiosurgery was 3 (range, 1-6). The median overall survival was 31 weeks. The median radiographic follow-up for patients who did not develop DBF was 33 weeks. Six patients developed DBF. The 1-year actuarial risk of DBF was 37%.ConclusionsIn this study, there was a relatively low risk of distant brain failure observed in the nonmelanoma subgroup receiving temozolamide. However, patient selection factors rather than chemotherapy treatment efficacy are more likely the reason for the relatively low risk of distant brain failure observed in this study. Future trial design should account for these risk factors.

show abstract

Treatment of Single or Multiple Brain Metastases by Hypofractionated Stereotactic Radiotherapy Using Helical Tomotherapy

Cited by 29 publications

References 44 publications

Phase I dose-escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma

Phase I dose-escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma

Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system

A phase 2 study of radiosurgery and temozolomide for patients with 1 to 4 brain metastases

Contact Info

Product

Resources

About