Alan Nichol1, Roy Ma2, Fred Hsu3, Lovedeep Gondara4, Hannah Carolan2, Robert Olson5, Devin Schellenberg6, François Germain7, Arthur Cheung6, Michael Peacock2, Alanah Bergman8, Emily Vollans9, Rosemin Vellani10, Michael McKenzie2. 1. Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: anichol@bccancer.bc.ca. 2. Department of Radiation Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada. 3. University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Oncology, BC Cancer Agency, Abbotsford Centre, Abbotsford, British Columbia, Canada. 4. Department of Surveillance and Outcomes, BC Cancer Agency, Vancouver, British Columbia, Canada. 5. University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Oncology, BC Cancer Agency, Centre for the North, Prince George, British Columbia, Canada. 6. University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Oncology, BC Cancer Agency, Fraser Valley Centre, Surrey, British Columbia, Canada. 7. University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Oncology, BC Cancer Agency, Sindi Ahluwalia Centre for the Southern Interior, Kelowna, British Columbia, Canada. 8. University of British Columbia, Vancouver, British Columbia, Canada; Department of Medical Physics, BC Cancer Agency, Vancouver, British Columbia, Canada. 9. Department of Medical Physics, BC Cancer Agency, Vancouver, British Columbia, Canada. 10. Department of Radiation Therapy, BC Cancer Agency, Vancouver, British Columbia, Canada.
Abstract
PURPOSE: Interest is growing in treating multiple brain metastases with radiosurgery. We report on the effectiveness and tolerability of volumetric radiosurgery (VRS). METHODS AND MATERIALS: We enrolled patients with a ≥6-month estimated life expectancy and 1 to 10 brain metastases with a diameter of ≤3 cm at 5 cancer centers. Volumetric radiosurgery was delivered in 5 fractions with 98% target coverage, prescribed as 95% of 50 Gy (47.5 Gy in 5 fractions) to the metastases with no margin and 95% of 40 Gy (38 Gy in 5 fractions) to their 2-mm planning target volumes, concurrent with 20 Gy to the whole brain planning target volume. The treatment was delivered with daily image guidance using conventional linear accelerators and volumetric modulated arc therapy. A magnetic resonance imaging scan was obtained every 3 months. The primary endpoint was the 3-month objective response in the brain according to the Response Evaluation Criteria in Solid Tumors, version 1.1. The principal secondary endpoint was 1-year actuarial control of treated metastases. Toxicities were graded using the Common Terminology Criteria for Adverse Events, version 4.0. The present study is registered with ClinicalTrials.gov (clinicaltrials.gov identifier NCT01046123). RESULTS: From July 2010 to May 2013, 60 patients underwent VRS with 47.5 Gy in 5 fractions for 12 metastases in the thalamus and basal ganglia (deep metastases) and 207 non-deep metastases. The median follow-up period was 30.5 months, and the median survival was 10.1 months. For the 43 patients assessable at 3 months, the objective response in the brain was 56%. The treated metastases were controlled in 88% of patients at 1 year and 84% at 3 years. Overall survival did not differ for patients with 4 to 10 versus 1 to 3 metastases (hazard ratio 1.18, P=.6). The crude incidence of severe radionecrosis (grade 3-5) was 25% (3 of 12) per deep metastasis, 1.9% (4 of 219) per non-deep metastasis, and 10% (6 of 60) per patient. CONCLUSIONS: For non-deep brain metastases, 47.5 Gy in 5 fractions was tolerable. Volumetric radiosurgery was effective for long-term control of treated brain metastases.
PURPOSE: Interest is growing in treating multiple brain metastases with radiosurgery. We report on the effectiveness and tolerability of volumetric radiosurgery (VRS). METHODS AND MATERIALS: We enrolled patients with a ≥6-month estimated life expectancy and 1 to 10 brain metastases with a diameter of ≤3 cm at 5 cancer centers. Volumetric radiosurgery was delivered in 5 fractions with 98% target coverage, prescribed as 95% of 50 Gy (47.5 Gy in 5 fractions) to the metastases with no margin and 95% of 40 Gy (38 Gy in 5 fractions) to their 2-mm planning target volumes, concurrent with 20 Gy to the whole brain planning target volume. The treatment was delivered with daily image guidance using conventional linear accelerators and volumetric modulated arc therapy. A magnetic resonance imaging scan was obtained every 3 months. The primary endpoint was the 3-month objective response in the brain according to the Response Evaluation Criteria in Solid Tumors, version 1.1. The principal secondary endpoint was 1-year actuarial control of treated metastases. Toxicities were graded using the Common Terminology Criteria for Adverse Events, version 4.0. The present study is registered with ClinicalTrials.gov (clinicaltrials.gov identifier NCT01046123). RESULTS: From July 2010 to May 2013, 60 patients underwent VRS with 47.5 Gy in 5 fractions for 12 metastases in the thalamus and basal ganglia (deep metastases) and 207 non-deep metastases. The median follow-up period was 30.5 months, and the median survival was 10.1 months. For the 43 patients assessable at 3 months, the objective response in the brain was 56%. The treated metastases were controlled in 88% of patients at 1 year and 84% at 3 years. Overall survival did not differ for patients with 4 to 10 versus 1 to 3 metastases (hazard ratio 1.18, P=.6). The crude incidence of severe radionecrosis (grade 3-5) was 25% (3 of 12) per deep metastasis, 1.9% (4 of 219) per non-deep metastasis, and 10% (6 of 60) per patient. CONCLUSIONS: For non-deep brain metastases, 47.5 Gy in 5 fractions was tolerable. Volumetric radiosurgery was effective for long-term control of treated brain metastases.
Authors: F Alongi; L Nicosia; V Figlia; N Giaj-Levra; F Cuccia; R Mazzola; F Ricchetti; M Rigo; C Vitale; A De Simone; S Naccarato; G Sicignano; D Gurrera; S Corradini; R Ruggeri Journal: Clin Transl Oncol Date: 2021-02-11 Impact factor: 3.405
Authors: Carmine Antonio Donofrio; Andrea Cavalli; Marco Gemma; Lucia Riccio; Alessandra Donofrio; Pietro Panni; Camillo Ferrari da Passano; Antonella Del Vecchio; Angelo Bolognesi; Riccardo Soffietti; Pietro Mortini Journal: Clin Exp Metastasis Date: 2020-05-19 Impact factor: 5.150
Authors: Matthew Chan; David Ferguson; Elaine Ni Mhurchu; Ren Yuan; Lovedeep Gondara; Michael McKenzie; Robert Olson; Brian Thiessen; Nafisha Lalani; Roy Ma; Alan Nichol Journal: Radiat Oncol Date: 2020-11-25 Impact factor: 3.481
Authors: Michael T Milano; Jimm Grimm; Andrzej Niemierko; Scott G Soltys; Vitali Moiseenko; Kristin J Redmond; Ellen Yorke; Arjun Sahgal; Jinyu Xue; Anand Mahadevan; Alexander Muacevic; Lawrence B Marks; Lawrence R Kleinberg Journal: Int J Radiat Oncol Biol Phys Date: 2020-09-11 Impact factor: 8.013