Value of Whole Brain Re-irradiation for Brain Metastases — Single Centre Experience

Sadikov, Evgeny; Bezjak, Andrea; Yi, Q-L.; Wells, Woodrow; Dawson, Laura A.; Millar, Barbara‐Ann; Laperrière, Normand

doi:10.1016/j.clon.2007.06.001

Cited by 77 publications

(62 citation statements)

References 26 publications

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“…Repeat WBRT or even partial brain radiotherapy is possible, but may be inappropriate for low volume disease and the dose that can be delivered is limited [8].…”

Section: Discussionmentioning

confidence: 99%

Fractionated Helical Tomotherapy as an alternative to radiosurgery in patients unwilling to undergo additional radiosurgery for recurrent brain metastases

Sanghera

Lightstone²,

Hyde³

et al. 2010

BJR

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ABSTRACT. Our clinic routinely treats brain metastases with stereotactic radiosurgery using a 6 megavoltage (MV) linear accelerator, cones, and a surgically attached head frame. Four patients declined repeat radiosurgery for new lesions due to their previous discomfort and a fifth patient could not complete radiosurgery because of uncontrolled nausea. Instead patients were treated with Helical Tomotherapy (HT). This report discusses the spatial dose distribution of HT as measured in a head phantom and the clinical course of these five patients. The planning target volume (PTV) was a 3 mm geometric expansion of the gross tumour volume (GTV). The prescribed dose to the PTV was 27 Gy in five daily fractions with the distribution optimised to deliver 30 Gy to the GTV. Patients were immobilised with a mask and the lesions were targeted by MV computerised tomography, an inherent feature of the system. One patient died six weeks later from systemic disease; the remaining patients survived eight to 16 months. No patient experienced an exacerbation of neurological symptoms following Helical Tomotherapy. These results suggest that fractionated Helical Tomotherapy for brain metastases may be a viable alternative to radiosurgery in patients unable or unwilling to undergo that procedure.

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“…Repeat WBRT or even partial brain radiotherapy is possible, but may be inappropriate for low volume disease and the dose that can be delivered is limited [8].…”

Section: Discussionmentioning

confidence: 99%

Fractionated Helical Tomotherapy as an alternative to radiosurgery in patients unwilling to undergo additional radiosurgery for recurrent brain metastases

Sanghera

Lightstone²,

Hyde³

et al. 2010

BJR

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“…The application of this novel technique for the treatment of the whole brain is exciting and may carry promise for further evaluation. Unlike upfront management of brain metastases patients, the literature is relatively limited for guiding treatment of patients with intracranial relapse after WBRT [6][7][8][9][10][11][12][13], despite its occurrence in 47-86% of patients [5]. Furthermore, recommendations are often conflicting, and the existing series span decades over which patient survival and RT delivery techniques have changed significantly [6][7][8][9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Potential interventions after WBRT include surgical resection, chemotherapy, SRS, or repeat WBRT. The radiation dose given at the time of repeat WBRT generally is reduced secondary to toxicity concerns and ranges from 20 to 30 Gy [6][7][8][9][10][11][12][13]. This only provides limited biologic effect on gross disease, yet still carries a substantial risk for neurocognitive delay to the patient.…”

Section: Introductionmentioning

confidence: 99%

Repeat Whole Brain Radiation Therapy with a Simultaneous Infield Boost: A Novel Technique for Reirradiation

Hall

Prabhu

Crocker

et al. 2014

Journal of Radiotherapy

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The treatment of patients who experience intracranial progression after whole brain radiation therapy (WBRT) is a clinical challenge. Novel radiation therapy delivery technologies are being applied with the objective of improving tumor and symptom control in these patients. The purpose of this study is to describe the clinical outcomes of the application of a novel technology to deliver repeat WBRT with volume modulated arc therapy (VMAT) and a simultaneous infield boost (WB-SIB) to gross disease. A total of 16 patients were initially treated with WBRT between 2000 and 2008 and then experienced intracranial progression, were treated using repeat WB-SIB, and were analyzed. The median dose for the first course of WBRT was 35 Gy (range: 30-50.4 Gy). Median time between the initial course of WBRT and repeat WB-SIB was 11.3 months. The median dose at reirradiation was 20 Gy to the whole brain with a median boost dose of 30 Gy to gross disease. A total of 2 patients demonstrated radiographic disease progression after treatment. The median overall survival (OS) time from initial diagnosis of brain metastases was 18.9 months (range: 7.1-66.6 (95% CI: 0.8-36.9)). The median OS time after initiation of reirradiation for all patients was 2.7 months (range: 0.46-14.46 (95% CI: 1.3-8.7)). Only 3 patients experienced CTCAE grade 3 fatigue. No other patients experienced any ≥ CTCAE grade 3 toxicity. This analysis reports the result of a novel RT delivery technique for the treatment of patients with recurrent brain metastases. Side effects were manageable and comparable to other conventional repeat WBRT series. Repeat WB-SIB using the VMAT RT delivery technology is feasible and appears to have acceptable short-term acute toxicity. These results may provide a foundation for further exploration of the WB-SIB technique for repeat WBRT in future prospective clinical trials.

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“…Table 2 summarizes retrospective series of patients treated with repeat WBRT after initial WBRT for brain metastases. Approximately two thirds of the patients had stable or improved clinical symptoms following reirradiation [24]. The median survival following a second course of WBRT ranged between 4 and 5 months.…”

Section: Whole Brain Reirradiationmentioning

confidence: 99%

“…Based on these findings, there have been recent studies investigating methods to deliver whole brain radiotherapy Mintz (1996) [24] 30 Gy/10 vs. surgery+30 Gy/10 84 6.4 months 5.6 months (ns)…”

Section: Advances In Radiotherapy Deliverymentioning

confidence: 99%

Conventional radiation therapy for brain metastases

2012

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Conventional radiotherapy in the form of whole brain radiation treatment has been a longstanding treatment for brain metastases, and it continues to provide effective palliation as monotherapy and in combination with local and systemic treatments. Advances in systemic therapy have improved survival with metastatic disease, and in those patients with better prognostic factors, more aggressive local therapeutic approaches for brain metastases appear to benefit their survival and intracranial tumor control. Increased treatment intensity and longer survival following treatment of brain metastases have raised concerns about persistent treatmentrelated neurocognitive toxicities and the resulting impact on quality of life. Technological advances in conventional radiotherapy planning and delivery have led to novel approaches that may increase intracranial tumor control while minimizing the treatment-related toxicities of therapy. These innovative approaches include intensitymodulated radiotherapy, new image-guidance techniques, and volumetric modulated arc therapy, which allow for the delivery of whole brain radiotherapy with integrated boost treatment to the visible disease while sparing the hippocampal regions or delivery of hypofractionated radiotherapy to larger metastatic targets that may not be amenable to radiosurgery boost or salvage treatment.

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Value of Whole Brain Re-irradiation for Brain Metastases — Single Centre Experience

Cited by 77 publications

References 26 publications

Fractionated Helical Tomotherapy as an alternative to radiosurgery in patients unwilling to undergo additional radiosurgery for recurrent brain metastases

Fractionated Helical Tomotherapy as an alternative to radiosurgery in patients unwilling to undergo additional radiosurgery for recurrent brain metastases

Repeat Whole Brain Radiation Therapy with a Simultaneous Infield Boost: A Novel Technique for Reirradiation

Conventional radiation therapy for brain metastases

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