John P Kirkpatrick1, Zhiheng Wang2, John H Sampson3, Frances McSherry4, James E Herndon4, Karen J Allen2, Eileen Duffy2, Jenny K Hoang5, Zheng Chang2, David S Yoo2, Chris R Kelsey2, Fang-Fang Yin2. 1. Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Surgery, Duke University, Durham, North Carolina. Electronic address: john.kirkpatrick@dm.duke.edu. 2. Department of Radiation Oncology, Duke University, Durham, North Carolina. 3. Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Surgery, Duke University, Durham, North Carolina. 4. Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina. 5. Department of Radiology, Duke University, Durham, North Carolina.
Abstract
PURPOSE: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. METHODS AND MATERIALS: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). RESULTS:Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed. CONCLUSIONS: SRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.
RCT Entities:
PURPOSE: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. METHODS AND MATERIALS: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). RESULTS: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed. CONCLUSIONS: SRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.
Authors: Jaymin Jhaveri; Mudit Chowdhary; Xinyan Zhang; Robert H Press; Jeffrey M Switchenko; Matthew J Ferris; Tiffany M Morgan; Justin Roper; Anees Dhabaan; Eric Elder; Bree R Eaton; Jeffrey J Olson; Walter J Curran; Hui-Kuo G Shu; Ian R Crocker; Kirtesh R Patel Journal: J Neurosurg Date: 2018-04-20 Impact factor: 5.115
Authors: John P Kirkpatrick; Scott G Soltys; Simon S Lo; Kathryn Beal; Dennis C Shrieve; Paul D Brown Journal: Neuro Oncol Date: 2017-04-01 Impact factor: 12.300
Authors: A Serna; P P Escolar; V Puchades; F Mata; D Ramos; M A Gómez; A Iglesias; J Salinas; M Alcaraz Journal: Clin Transl Oncol Date: 2015-03-17 Impact factor: 3.405
Authors: Brahma D Natarajan; Christel N Rushing; Michael A Cummings; Jessica Ms Jutzy; Kingshuk R Choudhury; Michael J Moravan; Peter E Fecci; Justus Adamson; Steven J Chmura; Michael T Milano; John P Kirkpatrick; Joseph K Salama Journal: J Radiosurg SBRT Date: 2019
Authors: Adam C Olson; Samantha Thomas; Rosie Qin; Bhavana Singh; Joseph K Salama; John Kirkpatrick; April Ks Salama Journal: Melanoma Manag Date: 2016-08-22
Authors: Jessica L Narloch; S Harrison Farber; Sarah Sammons; Frances McSherry; James E Herndon; Jenny K Hoang; Fang-Fang Yin; John H Sampson; Peter E Fecci; Kimberly L Blackwell; John P Kirkpatrick; Grace J Kim Journal: Neuro Oncol Date: 2017-10-01 Impact factor: 12.300