Raphael Bodensohn1, Anna-Lena Kaempfel1, Daniel Felix Fleischmann1,2,3, Indrawati Hadi1, Jan Hofmaier1, Sylvia Garny1, Michael Reiner1, Robert Forbrig4, Stefanie Corradini1, Niklas Thon5, Claus Belka1,2, Maximilian Niyazi6,7. 1. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. 2. German Cancer Consortium (DKTK), Munich, Germany. 3. German Cancer Research Center (DKFZ), Heidelberg, Germany. 4. Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. 5. Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. 6. Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. Maximilian.Niyazi@med.uni-muenchen.de. 7. German Cancer Consortium (DKTK), Munich, Germany. Maximilian.Niyazi@med.uni-muenchen.de.
Abstract
BACKGROUND: Single-isocenter dynamic conformal arc (SIDCA) therapy is a technically efficient way of delivering stereotactic radiosurgery (SRS) to multiple metastases simultaneously. This study reports on the safety and feasibility of linear accelerator (LINAC) based SRS with SIDCA for patients with multiple brain metastases. METHODS: All patients who received SRS with this technique between November 2017 and June 2019 within a prospective registry trial were included. The patients were irradiated with a dedicated planning tool for multiple brain metastases using a LINAC with a 5 mm multileaf collimator. Follow-up was performed every 3 months, including clinical and radiological examination with cranial magnetic resonance imaging (MRI). These early data were analyzed using descriptive statistics and the Kaplan-Meier method. RESULTS: A total of 65 patients with 254 lesions (range 2-12) were included in this analysis. Median beam-on time was 23 min. The median follow-up at the time of analysis was 13 months (95% CI 11.1-14.9). Median overall survival and median intracranial progression-free survival was 15 months (95% CI 7.7-22.3) and 7 months (95% CI 3.9-10.0), respectively. Intracranial and local control after 1 year was 64.6 and 97.5%, respectively. During follow-up, CTCAE grade I adverse effects (AE) were experienced by 29 patients (44.6%; 18 of them therapy related, 27.7%), CTCAE grade II AEs by four patients (6.2%; one of them therapy related, 1.5%), and CTCAE grade III by three patients (4.6%; none of them therapy related). Two lesions (0.8%) in two patients (3.1%) were histopathologically proven to be radiation necrosis. CONCLUSION: Simultaneous SRS using SIDCA seems to be a feasible and safe treatment for patients with multiple brain metastases.
BACKGROUND: Single-isocenter dynamic conformal arc (SIDCA) therapy is a technically efficient way of delivering stereotactic radiosurgery (SRS) to multiple metastases simultaneously. This study reports on the safety and feasibility of linear accelerator (LINAC) based SRS with SIDCA for patients with multiple brain metastases. METHODS: All patients who received SRS with this technique between November 2017 and June 2019 within a prospective registry trial were included. The patients were irradiated with a dedicated planning tool for multiple brain metastases using a LINAC with a 5 mm multileaf collimator. Follow-up was performed every 3 months, including clinical and radiological examination with cranial magnetic resonance imaging (MRI). These early data were analyzed using descriptive statistics and the Kaplan-Meier method. RESULTS: A total of 65 patients with 254 lesions (range 2-12) were included in this analysis. Median beam-on time was 23 min. The median follow-up at the time of analysis was 13 months (95% CI 11.1-14.9). Median overall survival and median intracranial progression-free survival was 15 months (95% CI 7.7-22.3) and 7 months (95% CI 3.9-10.0), respectively. Intracranial and local control after 1 year was 64.6 and 97.5%, respectively. During follow-up, CTCAE grade I adverse effects (AE) were experienced by 29 patients (44.6%; 18 of them therapy related, 27.7%), CTCAE grade II AEs by four patients (6.2%; one of them therapy related, 1.5%), and CTCAE grade III by three patients (4.6%; none of them therapy related). Two lesions (0.8%) in two patients (3.1%) were histopathologically proven to be radiation necrosis. CONCLUSION: Simultaneous SRS using SIDCA seems to be a feasible and safe treatment for patients with multiple brain metastases.
Entities:
Keywords:
Elements Multiple Brain Mets®; Linear accelerator; Local ablative therapy; Oligometastases; Radiotherapy
Authors: Vinai Gondi; Stephanie L Pugh; Wolfgang A Tome; Chip Caine; Ben Corn; Andrew Kanner; Howard Rowley; Vijayananda Kundapur; Albert DeNittis; Jeffrey N Greenspoon; Andre A Konski; Glenn S Bauman; Sunjay Shah; Wenyin Shi; Merideth Wendland; Lisa Kachnic; Minesh P Mehta Journal: J Clin Oncol Date: 2014-10-27 Impact factor: 44.544
Authors: Paul D Brown; Stephanie Pugh; Nadia N Laack; Jeffrey S Wefel; Deepak Khuntia; Christina Meyers; Ali Choucair; Sherry Fox; John H Suh; David Roberge; Vivek Kavadi; Soren M Bentzen; Minesh P Mehta; Deborah Watkins-Bruner Journal: Neuro Oncol Date: 2013-08-16 Impact factor: 12.300
Authors: Martin Kocher; Andrea Wittig; Marc Dieter Piroth; Harald Treuer; Heinrich Seegenschmiedt; Maximilian Ruge; Anca-Ligia Grosu; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2014-04-09 Impact factor: 3.621
Authors: Paul D Brown; Karla V Ballman; Jane H Cerhan; S Keith Anderson; Xiomara W Carrero; Anthony C Whitton; Jeffrey Greenspoon; Ian F Parney; Nadia N I Laack; Jonathan B Ashman; Jean-Paul Bahary; Costas G Hadjipanayis; James J Urbanic; Fred G Barker; Elana Farace; Deepak Khuntia; Caterina Giannini; Jan C Buckner; Evanthia Galanis; David Roberge Journal: Lancet Oncol Date: 2017-07-04 Impact factor: 41.316
Authors: Riccardo Soffietti; Martin Kocher; Ufuk M Abacioglu; Salvador Villa; François Fauchon; Brigitta G Baumert; Laura Fariselli; Tzahala Tzuk-Shina; Rolf-Dieter Kortmann; Christian Carrie; Mohamed Ben Hassel; Mauri Kouri; Egils Valeinis; Dirk van den Berge; Rolf-Peter Mueller; Gloria Tridello; Laurence Collette; Andrew Bottomley Journal: J Clin Oncol Date: 2012-12-03 Impact factor: 44.544
Authors: Anita Mahajan; Salmaan Ahmed; Mary Frances McAleer; Jeffrey S Weinberg; Jing Li; Paul Brown; Stephen Settle; Sujit S Prabhu; Frederick F Lang; Nicholas Levine; Susan McGovern; Erik Sulman; Ian E McCutcheon; Syed Azeem; Daniel Cahill; Claudio Tatsui; Amy B Heimberger; Sherise Ferguson; Amol Ghia; Franco Demonte; Shaan Raza; Nandita Guha-Thakurta; James Yang; Raymond Sawaya; Kenneth R Hess; Ganesh Rao Journal: Lancet Oncol Date: 2017-07-04 Impact factor: 41.316
Authors: Paula Mulvenna; Matthew Nankivell; Rachael Barton; Corinne Faivre-Finn; Paula Wilson; Elaine McColl; Barbara Moore; Iona Brisbane; David Ardron; Tanya Holt; Sally Morgan; Caroline Lee; Kathryn Waite; Neil Bayman; Cheryl Pugh; Benjamin Sydes; Richard Stephens; Mahesh K Parmar; Ruth E Langley Journal: Lancet Date: 2016-09-04 Impact factor: 79.321
Authors: Tugce Kutuk; Ranjini Tolakanahalli; Andre Williams; Martin C Tom; Jason D Vadhan; Haley Appel; Matthew D Hall; D Jay J Wieczorek; Stephen Davis; Michael W McDermott; Manmeet S Ahluwalia; Minesh P Mehta; Alonso N Gutierrez; Rupesh Kotecha Journal: Neurooncol Pract Date: 2021-07-28
Authors: Nzhde Agazaryan; Steve Tenn; Chul Lee; Michael Steinberg; John Hegde; Robert Chin; Nader Pouratian; Isaac Yang; Won Kim; Tania Kaprealian Journal: Radiat Oncol Date: 2021-11-17 Impact factor: 3.481