Journal Article

Simultaneous stereotactic radiosurgery of multiple brain metastases using single-isocenter dynamic conformal arc therapy: a prospective monocentric registry trial

Fleischmann Daniel Felix Dr med, Thon Niklas Prof Dr med, Corradini Stefanie PD Dr med Dr med univ, Anna-Lena, Kaempfel, brig, Robert Dr, Hadi, Indrawati Dr, Hofmaier, Jan, Bodensohn, Raphael Dr, Niyazi Maximilian Prof Dr med Dipl-Phys, Garny Sylvia Dr rer nat, Reiner Michael Dr rer nat, Belka Claus Prof Dr med

2021

Overview

BackgroundSingle-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.MethodsAll 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.ResultsA 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.ConclusionSimultaneous SRS using SIDCA seems to be a feasible and safe treatment for patients with multiple brain metastases.

• Publisher: Springer Nature B.V
• Subject: Brain / Brain cancer / Collimators / Feasibility / Lesions / Linear accelerators / Magnetic resonance imaging / Median (statistics) / Metastasis / Necrosis / Radiation therapy / Radiology / Radiosurgery / Surgery / Survival / Therapy