PURPOSE: Fractionated stereotactic radiotherapy (FSRT) using gamma knife is useful for brain metastases. However, several uncertainties derived from fractionation pose issues for maintaining high-level accuracy. This study analyzed interfractional tumor change by performing radiological reassessment at the midterm of FSRT with ≥ 10 fractions, and the significance of replanning was evaluated. METHODS: Data of FSRT using gamma knife with ≥ 10 fractions were retrospectively collected. Interfractional volume changes in MRI at the midterm of the irradiation period were analyzed. Radiological changes after FSRT and final outcomes were also investigated. RESULTS: Overall, 114 lesions in 74 treatments from 66 patients were included, with previously irradiated lesions accounting for 46%. The median interval between planning and the interfractional MRI was 7 days. The interfractional change rates of tumor volume ranged from - 48 to + 72%. Significant interfractional enlargement was observed in 16 lesions (14%); evident regression was confirmed in 17 lesions (15%). Predictive factors for interfractional enlargement were small tumor and cystic lesion; high biologically effective dose was associated with regression. After FSRT, most lesions regressed within 6 months despite interfractional change type. The incidences of tumor control and radiation necrosis indicated no differences between interfractionally-regressed lesions and others. CONCLUSION: This is the first study to evaluate interfractional tumor change in FSRT using gamma knife with ≥ 10 fractions, indicating significant volume changes in 29% of the lesions. These preliminary results suggest that interfractional reassessment of a treatment plan in FSRT with irradiation periods exceeding a week is necessary for more adaptive treatment.
PURPOSE: Fractionated stereotactic radiotherapy (FSRT) using gamma knife is useful for brain metastases. However, several uncertainties derived from fractionation pose issues for maintaining high-level accuracy. This study analyzed interfractional tumor change by performing radiological reassessment at the midterm of FSRT with ≥ 10 fractions, and the significance of replanning was evaluated. METHODS: Data of FSRT using gamma knife with ≥ 10 fractions were retrospectively collected. Interfractional volume changes in MRI at the midterm of the irradiation period were analyzed. Radiological changes after FSRT and final outcomes were also investigated. RESULTS: Overall, 114 lesions in 74 treatments from 66 patients were included, with previously irradiated lesions accounting for 46%. The median interval between planning and the interfractional MRI was 7 days. The interfractional change rates of tumor volume ranged from - 48 to + 72%. Significant interfractional enlargement was observed in 16 lesions (14%); evident regression was confirmed in 17 lesions (15%). Predictive factors for interfractional enlargement were small tumor and cystic lesion; high biologically effective dose was associated with regression. After FSRT, most lesions regressed within 6 months despite interfractional change type. The incidences of tumor control and radiation necrosis indicated no differences between interfractionally-regressed lesions and others. CONCLUSION: This is the first study to evaluate interfractional tumor change in FSRT using gamma knife with ≥ 10 fractions, indicating significant volume changes in 29% of the lesions. These preliminary results suggest that interfractional reassessment of a treatment plan in FSRT with irradiation periods exceeding a week is necessary for more adaptive treatment.
Authors: Eric J Lehrer; Jennifer L Peterson; Nicholas G Zaorsky; Paul D Brown; Arjun Sahgal; Veronica L Chiang; Samuel T Chao; Jason P Sheehan; Daniel M Trifiletti Journal: Int J Radiat Oncol Biol Phys Date: 2018-11-02 Impact factor: 7.038
Authors: Benjamin H Kann; Henry S Park; Skyler B Johnson; Veronica L Chiang; James B Yu Journal: J Natl Compr Canc Netw Date: 2017-12 Impact factor: 11.908
Authors: Kristin J Redmond; Chengcheng Gui; Stanley Benedict; Michael T Milano; Jimm Grimm; J Austin Vargo; Scott G Soltys; Ellen Yorke; Andrew Jackson; Issam El Naqa; Lawrence B Marks; Jinyu Xue; Dwight E Heron; Lawrence R Kleinberg Journal: Int J Radiat Oncol Biol Phys Date: 2020-12-31 Impact factor: 7.038
Authors: Riccardo Soffietti; Ufuk Abacioglu; Brigitta Baumert; Stephanie E Combs; Sara Kinhult; Johan M Kros; Christine Marosi; Philippe Metellus; Alexander Radbruch; Salvador S Villa Freixa; Michael Brada; Carmine M Carapella; Matthias Preusser; Emilie Le Rhun; Roberta Rudà; Joerg C Tonn; Damien C Weber; Michael Weller Journal: Neuro Oncol Date: 2017-02-01 Impact factor: 12.300
Authors: Vinai Gondi; Glenn Bauman; Lisa Bradfield; Stuart H Burri; Alvin R Cabrera; Danielle A Cunningham; Bree R Eaton; Jona A Hattangadi-Gluth; Michelle M Kim; Rupesh Kotecha; Lianne Kraemer; Jing Li; Seema Nagpal; Chad G Rusthoven; John H Suh; Wolfgang A Tomé; Tony J C Wang; Alexandra S Zimmer; Mateo Ziu; Paul D Brown Journal: Pract Radiat Oncol Date: 2022-05-06
Authors: Paul D Brown; Kurt Jaeckle; Karla V Ballman; Elana Farace; Jane H Cerhan; S Keith Anderson; Xiomara W Carrero; Fred G Barker; Richard Deming; Stuart H Burri; Cynthia Ménard; Caroline Chung; Volker W Stieber; Bruce E Pollock; Evanthia Galanis; Jan C Buckner; Anthony L Asher Journal: JAMA Date: 2016-07-26 Impact factor: 56.272
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