Jinyu Xue1, Tamara LaCouture1, Jimm Grimm2, H Warren Goldman3, Geoffrey S Ibbott4, Ellen Yorke5, Gregory J Kubicek1. 1. Department of Radiation Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ 08103, USA. 2. Holy Redeemer Hospital, Meadowbrook, PA, 19046, USA. 3. Department of Neurological Surgery, Cooper University Hospital, Camden, NJ 08103, USA. 4. Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX 77030, USA. 5. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Abstract
PURPOSE: Treatment option of stereotactic radiosurgery versus whole brain radiotherapy for multiple brain metastases (>10) is an ongoing debate. Detailed dosimetric and biological information are presented in this study to investigate the possible clinical outcomes.Materials and Methods: Nine patients with multiple brain metastases (11-25) underwent stereotactic radiosurgery. Whole brain radiotherapy plans are retrospectively designed with the same MR image set and the same structure set for each patient using the standard opposing lateral beams and fractionation (3 Gy × 10).Physical doses and biologically effective doses are calculated for each lesion target and the CNS normal tissues and they are compared between whole brain radiotherapy and stereotactic radiosurgery in the context of clinical efficacy and published toxicities. RESULTS: Tumor biologically effective dose is higher in radiosurgery than in whole brain radiotherapy by factors of 3.2-5.3 in maximum dose and of 2.4-3.1 in mean dose. Biologically effective mean dose in radiosurgery is 1.3-34.3% for normal brain, 0.7-31.6% for brainstem, 0.5-5.7% for chiasm, 0.2-5.7% for optic nerves and 0.6-18.1% for hippocampus of that in whole brain radiotherapy over nine cases presented here. We also presented the dose-volume relationship for normal brain to address the dosimetric concerns in radiosurgery. CONCLUSIONS: Dose-volume metrics presented in this study are essential to understanding the safety and efficacy of whole brain radiotherapy and/or radiosurgery for multiple brain metastases. Whole brain radiotherapy has resulted in higher incidence of radiation-related toxicities than radiosurgery. Even for patients with more than 10 brain metastases, the CNS normal tissues receive significantly lower doses in radiosurgery. Mean normal brain dose in SRS is found to correlate with the total volume of lesions rather than the number of lesions treated.
PURPOSE: Treatment option of stereotactic radiosurgery versus whole brain radiotherapy for multiple brain metastases (>10) is an ongoing debate. Detailed dosimetric and biological information are presented in this study to investigate the possible clinical outcomes.Materials and Methods: Nine patients with multiple brain metastases (11-25) underwent stereotactic radiosurgery. Whole brain radiotherapy plans are retrospectively designed with the same MR image set and the same structure set for each patient using the standard opposing lateral beams and fractionation (3 Gy × 10).Physical doses and biologically effective doses are calculated for each lesion target and the CNS normal tissues and they are compared between whole brain radiotherapy and stereotactic radiosurgery in the context of clinical efficacy and published toxicities. RESULTS: Tumor biologically effective dose is higher in radiosurgery than in whole brain radiotherapy by factors of 3.2-5.3 in maximum dose and of 2.4-3.1 in mean dose. Biologically effective mean dose in radiosurgery is 1.3-34.3% for normal brain, 0.7-31.6% for brainstem, 0.5-5.7% for chiasm, 0.2-5.7% for optic nerves and 0.6-18.1% for hippocampus of that in whole brain radiotherapy over nine cases presented here. We also presented the dose-volume relationship for normal brain to address the dosimetric concerns in radiosurgery. CONCLUSIONS: Dose-volume metrics presented in this study are essential to understanding the safety and efficacy of whole brain radiotherapy and/or radiosurgery for multiple brain metastases. Whole brain radiotherapy has resulted in higher incidence of radiation-related toxicities than radiosurgery. Even for patients with more than 10 brain metastases, the CNS normal tissues receive significantly lower doses in radiosurgery. Mean normal brain dose in SRS is found to correlate with the total volume of lesions rather than the number of lesions treated.
Authors: M K Martel; H M Sandler; W T Cornblath; L H Marsh; M B Hazuka; W H Roa; B A Fraass; A S Lichter Journal: Int J Radiat Oncol Biol Phys Date: 1997-05-01 Impact factor: 7.038
Authors: E Shaw; C Scott; L Souhami; R Dinapoli; R Kline; J Loeffler; N Farnan Journal: Int J Radiat Oncol Biol Phys Date: 2000-05-01 Impact factor: 7.038
Authors: Ramesh Grandhi; Douglas Kondziolka; David Panczykowski; Edward A Monaco; Hideyuki Kano; Ajay Niranjan; John C Flickinger; L Dade Lunsford Journal: J Neurosurg Date: 2012-05-25 Impact factor: 5.115
Authors: Timothy Korytko; Tomas Radivoyevitch; Valdir Colussi; Barry W Wessels; Kunjan Pillai; Robert J Maciunas; Douglas B Einstein Journal: Int J Radiat Oncol Biol Phys Date: 2005-10-14 Impact factor: 7.038
Authors: David W Andrews; Charles B Scott; Paul W Sperduto; Adam E Flanders; Laurie E Gaspar; Michael C Schell; Maria Werner-Wasik; William Demas; Janice Ryu; Jean-Paul Bahary; Luis Souhami; Marvin Rotman; Minesh P Mehta; Walter J Curran Journal: Lancet Date: 2004-05-22 Impact factor: 79.321
Authors: Eric L Chang; Jeffrey S Wefel; Kenneth R Hess; Pamela K Allen; Frederick F Lang; David G Kornguth; Rebecca B Arbuckle; J Michael Swint; Almon S Shiu; Moshe H Maor; Christina A Meyers Journal: Lancet Oncol Date: 2009-10-02 Impact factor: 41.316
Authors: Peter van Luijk; Hette Faber; Jacobus M Schippers; Sytze Brandenburg; Johannes A Langendijk; Harm Meertens; Robert P Coppes Journal: Int J Radiat Oncol Biol Phys Date: 2009-07-15 Impact factor: 7.038
Authors: Hendrik P Bijl; Peter van Luijk; Rob P Coppes; Jacobus M Schippers; Antonius W T Konings; Albert J van der Kogel Journal: Int J Radiat Oncol Biol Phys Date: 2003-09-01 Impact factor: 7.038