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Ocaña-Tienda B, Pérez-García VM. Mathematical modeling of brain metastases growth and response to therapies: A review. Math Biosci 2024; 373:109207. [PMID: 38759950 DOI: 10.1016/j.mbs.2024.109207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/04/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
Brain metastases (BMs) are the most common intracranial tumor type and a significant health concern, affecting approximately 10% to 30% of all oncological patients. Although significant progress is being made, many aspects of the metastatic process to the brain and the growth of the resulting lesions are still not well understood. There is a need for an improved understanding of the growth dynamics and the response to treatment of these tumors. Mathematical models have been proven valuable for drawing inferences and making predictions in different fields of cancer research, but few mathematical works have considered BMs. This comprehensive review aims to establish a unified platform and contribute to fostering emerging efforts dedicated to enhancing our mathematical understanding of this intricate and challenging disease. We focus on the progress made in the initial stages of mathematical modeling research regarding BMs and the significant insights gained from such studies. We also explore the vital role of mathematical modeling in predicting treatment outcomes and enhancing the quality of clinical decision-making for patients facing BMs.
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Affiliation(s)
- Beatriz Ocaña-Tienda
- Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain.
| | - Víctor M Pérez-García
- Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain.
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Takata S, Kosen K, Matsumoto A, Tanabe M, Itaya T, Asayama Y. Growth speed of large brain metastases between diagnostic and radiosurgical planning MRI and predictors of rapid tumor growth. Jpn J Radiol 2024; 42:546-552. [PMID: 38212514 PMCID: PMC11056330 DOI: 10.1007/s11604-023-01524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE We aimed to assess volumetric changes of large brain metastases (≥ 2 cm) between their diagnosis and planning for treatment with fractionated stereotactic radiation surgery (fSRS). Predictors of rapid tumor growth were also analyzed. MATERIALS AND METHODS One hundred nine patients harboring 126 large brain metastases were retrospectively evaluated. Tumor characteristics were evaluated on diagnostic magnetic resonance imaging (dMRI) and MRI performed when planning fSRS (pMRI). Average tumor growth rate and percentage growth rate were calculated. Predictors of rapid growth (percentage growth rate > 5%) were determined using multivariate logistic regression. RESULTS Both tumor diameter and volume were significantly larger on pMRI than on dMRI (P < 0.001). Median tumor percentage growth rate was 2.6% (range, - 10.8-43.3%). Eighty-eight tumors (70%) were slow-growing (percentage growth rate < 5%) and 38 (30%) grew rapidly (percentage growth rate ≥ 5%). Major peritumoral edema and no steroids were predictors of rapid tumor growth. CONCLUSION Large brain metastases can grow considerably between the time of diagnosis and the time of fSRS treatment planning. We recommend the time between dMRI and fSRS treatment initiation be as short as possible.
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Affiliation(s)
- Shoko Takata
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
- Department of Radiology, Oita Prefectural Hospital, 2-8-1, Bunyo, Oita, 870-8511, Japan.
| | - Kazuhisa Kosen
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
- Keiwakai Oka Hospital, 3-7-11 Nishitsurusaki, Oita, 870-0105, Japan
| | - Akira Matsumoto
- Department of Radiation Therapy, Central Japan International Medical Center, 1-1 Kenkonomachi, Minokamo, Gifu, 505-8510, Japan
| | - Motoko Tanabe
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takayoshi Itaya
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yoshiki Asayama
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Samanci Y, Askeroglu MO, Düzkalir AH, Peker S. Assessing the impact of distortion correction on Gamma Knife radiosurgery for multiple metastasis: Volumetric and dosimetric analysis. BRAIN & SPINE 2024; 4:102791. [PMID: 38584868 PMCID: PMC10995810 DOI: 10.1016/j.bas.2024.102791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
Introduction Magnetic resonance imaging (MRI) is a robust neuroimaging technique and is the preferred method for stereotactic radiosurgery (SRS) planning. However, MRI data always contain distortions caused by hardware and patient factors. Research question Can these distortions potentially compromise the effectiveness and safety of SRS treatments? Material and methods Twenty-six MR datasets with multiple metastatic brain tumors (METs) used for Gamma Knife radiosurgery (GKRS) were retrospectively evaluated. A commercially available software was used for distortion correction. Geometrical agreement between corrected and uncorrected tumor volumes was evaluated using MacDonald criteria, Euclidian distance, and Dice similarity coefficient (DSC). SRS plans were generated using uncorrected tumor volumes, which were assessed to determine their coverage of the corrected tumor volumes. Results The median target volume was 0.38 cm3 (range,0.01-12.38 cm3). A maximum displacement of METs of up to 2.87 mm and a median displacement of 0.55 mm (range,0.1-2.87 mm) were noted. The median DSC between uncorrected and corrected MRI was 0.92, and the most concerning case had a DSC of 0.46. Although all plans met the optimization criterion of at least 98% of the uncorrected tumor volume (median 99.55%, range 98.1-100%) receiving at least 100% of the prescription dose, the percent of the corrected tumor volume receiving the total prescription dose was a median of 95.45% (range,23.1-99.5%). Discussion and conclusion MRI distortion, though visually subtle, has significant implications for SRS planning. Regular utilization of corrected MRI is recommended for SRS planning as distortion is sometimes enough to cause a volumetric miss of SRS targets.
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Affiliation(s)
- Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - M. Orbay Askeroglu
- Gamma Knife Center, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Ali Haluk Düzkalir
- Gamma Knife Center, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
- Gamma Knife Center, Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
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Putz F, Bock M, Schmitt D, Bert C, Blanck O, Ruge MI, Hattingen E, Karger CP, Fietkau R, Grigo J, Schmidt MA, Bäuerle T, Wittig A. Quality requirements for MRI simulation in cranial stereotactic radiotherapy: a guideline from the German Taskforce "Imaging in Stereotactic Radiotherapy". Strahlenther Onkol 2024; 200:1-18. [PMID: 38163834 PMCID: PMC10784363 DOI: 10.1007/s00066-023-02183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
Accurate Magnetic Resonance Imaging (MRI) simulation is fundamental for high-precision stereotactic radiosurgery and fractionated stereotactic radiotherapy, collectively referred to as stereotactic radiotherapy (SRT), to deliver doses of high biological effectiveness to well-defined cranial targets. Multiple MRI hardware related factors as well as scanner configuration and sequence protocol parameters can affect the imaging accuracy and need to be optimized for the special purpose of radiotherapy treatment planning. MRI simulation for SRT is possible for different organizational environments including patient referral for imaging as well as dedicated MRI simulation in the radiotherapy department but require radiotherapy-optimized MRI protocols and defined quality standards to ensure geometrically accurate images that form an impeccable foundation for treatment planning. For this guideline, an interdisciplinary panel including experts from the working group for radiosurgery and stereotactic radiotherapy of the German Society for Radiation Oncology (DEGRO), the working group for physics and technology in stereotactic radiotherapy of the German Society for Medical Physics (DGMP), the German Society of Neurosurgery (DGNC), the German Society of Neuroradiology (DGNR) and the German Chapter of the International Society for Magnetic Resonance in Medicine (DS-ISMRM) have defined minimum MRI quality requirements as well as advanced MRI simulation options for cranial SRT.
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Affiliation(s)
- Florian Putz
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Michael Bock
- Klinik für Radiologie-Medizinphysik, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Daniela Schmitt
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Christoph Bert
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Maximilian I Ruge
- Klinik für Stereotaxie und funktionelle Neurochirurgie, Zentrum für Neurochirurgie, Universitätsklinikum Köln, Cologne, Germany
| | - Elke Hattingen
- Institut für Neuroradiologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christian P Karger
- Abteilung Medizinische Physik in der Strahlentherapie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
- Nationales Zentrum für Strahlenforschung in der Onkologie (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Heidelberg, Germany
| | - Rainer Fietkau
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johanna Grigo
- Strahlenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manuel A Schmidt
- Neuroradiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Bäuerle
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Wittig
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Würzburg, Würzburg, Germany
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Miura H, Kenjo M, Doi Y, Ueda T, Nakao M, Ozawa S, Nagata Y. Effect of Target Changes on Target Coverage and Dose to the Normal Brain in Fractionated Stereotactic Radiation Therapy for Metastatic Brain Tumors. Adv Radiat Oncol 2023; 8:101264. [PMID: 37457819 PMCID: PMC10344692 DOI: 10.1016/j.adro.2023.101264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/27/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose We evaluated the dosimetric effect of tumor changes in patients with fractionated brain stereotactic radiation therapy (SRT) on the tumor and normal brain using repeat verification magnetic resonance imaging (MRI) in the middle of the treatment period. Methods and Materials Fifteen large intracranial metastatic lesions with fractionated SRT were scanned employing standardized planning MRI (MRI-1). Repeat verification MRI (MRI-2) were performed during the middle of the irradiation period. Gross tumor volume (GTV) was defined as the volume of the contrast-enhancing lesion on T1-weighted MRI with gadolinium contrast agent. The doses to the tumor and normal brain were evaluated on the MRI-1 scan. Beam configuration and intensity on the initial volumetric modulated arc therapy plan were used to evaluate the dose to the tumor and the normal brain on MRI-2. We evaluated the effect of D98% (percent dose irradiating 98% of the volume) on the GTV using the plans on the MRI-1 and MRI-2 scans. For the normal brain, the V90%, V80%, and V50% (volume of the normal brain receiving >90%, 80%, and 50% of the prescribed dose, respectively) were investigated. Results Three (20% of the total) and 4 (26% of the total) tumors exhibited volume shrinkage or enlargement changes of >10%. Five (33% of the total) tumors exhibited volume shrinkage and enlargement changes of <10%. Three tumors (20% of the total) showed no volume changes. D98% of the GTV increased in patients with tumor shrinkage because of dose inhomogeneity and decreased in patients with tumor enlargement, with a coefficient of determination of 0.28. The V90%, V80%, and V50% increase with decreasing tumor volumes and were linearly related to the tumor volume difference with a coefficient of determination values of 0.97, 0.98, and 0.97, respectively. Conclusions Repeat verification MRI for brain fractionated SRT during the treatment period should be considered to reduce the magnitude of target underdosing or normal brain overdosing.
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Affiliation(s)
- Hideharu Miura
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Masahiro Kenjo
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yoshiko Doi
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Taro Ueda
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
| | - Minoru Nakao
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
| | - Yasushi Nagata
- Hiroshima High-Precision Radiation therapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku Hiroshima-shi, Hiroshima 734-8553, Japan
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Ocaña-Tienda B, Pérez-Beteta J, Jiménez-Sánchez J, Molina-García D, Ortiz de Mendivil A, Asenjo B, Albillo D, Pérez-Romasanta LA, Valiente M, Zhu L, García-Gómez P, González-Del Portillo E, Llorente M, Carballo N, Arana E, Pérez-García VM. Growth exponents reflect evolutionary processes and treatment response in brain metastases. NPJ Syst Biol Appl 2023; 9:35. [PMID: 37479705 PMCID: PMC10361973 DOI: 10.1038/s41540-023-00298-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023] Open
Abstract
Tumor growth is the result of the interplay of complex biological processes in huge numbers of individual cells living in changing environments. Effective simple mathematical laws have been shown to describe tumor growth in vitro, or simple animal models with bounded-growth dynamics accurately. However, results for the growth of human cancers in patients are scarce. Our study mined a large dataset of 1133 brain metastases (BMs) with longitudinal imaging follow-up to find growth laws for untreated BMs and recurrent treated BMs. Untreated BMs showed high growth exponents, most likely related to the underlying evolutionary dynamics, with experimental tumors in mice resembling accurately the disease. Recurrent BMs growth exponents were smaller, most probably due to a reduction in tumor heterogeneity after treatment, which may limit the tumor evolutionary capabilities. In silico simulations using a stochastic discrete mesoscopic model with basic evolutionary dynamics led to results in line with the observed data.
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Affiliation(s)
| | | | | | | | | | - Beatriz Asenjo
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Manuel Valiente
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Lucía Zhu
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Pedro García-Gómez
- Brain Metastasis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
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Leu J, Akerman M, Mendez C, Lischalk JW, Carpenter T, Ebling D, Haas JA, Witten M, Barbaro M, Duic P, Tessler L, Repka MC. Time interval from diagnosis to treatment of brain metastases with stereotactic radiosurgery is not associated with radionecrosis or local failure. Front Oncol 2023; 13:1132777. [PMID: 37091181 PMCID: PMC10113671 DOI: 10.3389/fonc.2023.1132777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionBrain metastases are the most common intracranial tumor diagnosed in adults. In patients treated with stereotactic radiosurgery, the incidence of post-treatment radionecrosis appears to be rising, which has been attributed to improved patient survival as well as novel systemic treatments. The impacts of concomitant immunotherapy and the interval between diagnosis and treatment on patient outcomes are unclear.MethodsThis single institution, retrospective study consisted of patients who received single or multi-fraction stereotactic radiosurgery for intact brain metastases. Exclusion criteria included neurosurgical resection prior to treatment and treatment of non-malignant histologies or primary central nervous system malignancies. A univariate screen was implemented to determine which factors were associated with radionecrosis. The chi-square test or Fisher’s exact test was used to compare the two groups for categorical variables, and the two-sample t-test or Mann-Whitney test was used for continuous data. Those factors that appeared to be associated with radionecrosis on univariate analyses were included in a multivariable model. Univariable and multivariable Cox proportional hazards models were used to assess potential predictors of time to local failure and time to regional failure.ResultsA total of 107 evaluable patients with a total of 256 individual brain metastases were identified. The majority of metastases were non-small cell lung cancer (58.98%), followed by breast cancer (16.02%). Multivariable analyses demonstrated increased risk of radionecrosis with increasing MRI maximum axial dimension (OR 1.10, p=0.0123) and a history of previous whole brain radiation therapy (OR 3.48, p=0.0243). Receipt of stereotactic radiosurgery with concurrent immunotherapy was associated with a decreased risk of local failure (HR 0.31, p=0.0159). Time interval between diagnostic MRI and first treatment, time interval between CT simulation and first treatment, and concurrent immunotherapy had no impact on incidence of radionecrosis or regional failure.DiscussionAn optimal time interval between diagnosis and treatment for intact brain metastases that minimizes radionecrosis and maximizes local and regional control could not be identified. Concurrent immunotherapy does not appear to increase the risk of radionecrosis and may improve local control. These data further support the safety and synergistic efficacy of stereotactic radiosurgery with concurrent immunotherapy.
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Affiliation(s)
- Justin Leu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Meredith Akerman
- Division of Health Services Research, New York University (NYU) Long Island School of Medicine, Mineola, NY, United States
| | - Christopher Mendez
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
| | - Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
- NYCyberKnife at Perlmutter Cancer Center – Manhattan, New York, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
| | - David Ebling
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
| | - Jonathan A. Haas
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
- NYCyberKnife at Perlmutter Cancer Center – Manhattan, New York, NY, United States
| | - Matthew Witten
- Department of Medical Physics, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
| | - Marissa Barbaro
- Department of Neurology, New York University (NYU) Long Island School of Medicine, Mineola, NY, United States
| | - Paul Duic
- Department of Neurology, New York University (NYU) Long Island School of Medicine, Mineola, NY, United States
| | - Lee Tessler
- Department of Neurosurgery, Perlmutter Cancer Center at New York University (NYU) Long Island, Mineola, NY, United States
| | - Michael C. Repka
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
- *Correspondence: Michael C. Repka,
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Loftus JP, Shepard M, Liang Y, Yu A, Karlovits SM, Wegner RE. A Comparison of Single Fraction and Multi Fraction Radiosurgery on the Gamma Knife ICON: A Single Institution Review. Adv Radiat Oncol 2022; 8:101161. [PMID: 36845616 PMCID: PMC9943766 DOI: 10.1016/j.adro.2022.101161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Brain metastases are a common development in patients with malignant solid tumors. Stereotactic radiosurgery (SRS) has a long track record of effectively and safely treating these patients, with some limitations to the use of single fraction SRS based on size and volume. In this study, we reviewed outcomes of patients treated using SRS and fractionated SRS (fSRS) to compare predictors and outcomes of those treatments. Methods and Materials Two hundred patients treated with SRS or fSRS for intact brain metastases were included. We tabulated baseline characteristics and performed a logistic regression to identify predictors of fSRS. Cox regression was used to identify predictors of survival. Kaplan-Meier analysis was used to calculate survival, local failure, and distant failure rates. A receiver operating characteristic curve was generated to determine timepoint from planning to treatment associated with local failure. Results The only predictor of fSRS was tumor volume >2.061 cm3. There was no difference in local failure, toxicity, or survival by fractionation of biologically effective dose. Predictors of worse survival were age, extracranial disease, history of whole brain radiation therapy, and volume. Receiver operating characteristic analysis identified 10 days as potential factor in local failure. At 1 year, local control was 96.48 and 76.92% for those patients treated before or after that interval, respectively (P = .0005). Conclusions Fractionated SRS is a safe and effective alternative for patients with larger volume tumors not suitable for single fraction SRS. Care should be taken to treat these patients expeditiously as a delay was shown to affect local control in this study.
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Affiliation(s)
- Joseph P. Loftus
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Monroeville, Pennsylvania
| | - Matthew Shepard
- Allegheny Health Network, Department of Neurosurgery, Monroeville, Pennsylvania
| | - Yun Liang
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Monroeville, Pennsylvania
| | - Alexander Yu
- Allegheny Health Network, Department of Neurosurgery, Monroeville, Pennsylvania
| | - Stephen M. Karlovits
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Monroeville, Pennsylvania
| | - Rodney E. Wegner
- Allegheny Health Network Cancer Institute, Division of Radiation Oncology, Monroeville, Pennsylvania
- Corresponding author: Rodney E. Wegner, MD
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Masitho S, Putz F, Mengling V, Reißig L, Voigt R, Bäuerle T, Janka R, Fietkau R, Bert C. Accuracy of MRI-CT registration in brain stereotactic radiotherapy: Impact of MRI acquisition setup and registration method. Z Med Phys 2022; 32:477-487. [PMID: 35643799 PMCID: PMC9948832 DOI: 10.1016/j.zemedi.2022.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In MR-based radiotherapy (RT), MRI images are co-registered to the planning CT to leverage MR image information for RT planning. Especially in brain stereotactic RT, where typical CTV-PTV margins are 1-2 mm, high registration accuracy is critical. Several factors influence the registration accuracy, including the acquisition setup during MR simulation and the registration methods. PURPOSE In this work, the impact of the MRI acquisition setup and registration method was evaluated in the context of brain RT, both geometrically and dosimetrically. METHODS AND MATERIALS MRI of 20 brain radiotherapy patients was acquired in two MRI acquisition setups (RT and diagnostic). Three different automatic registration tools provided by three treatment planning systems were used to rigidly register both MRIs and CT in addition to the clinical registration. Segmentation-based evaluation using Hausdorff Distance (HD)/Dice Similarity Coefficient and landmark-based evaluation were used as evaluation metrics. Dose-volume-histograms were evaluated for target volumes and various organs at risks. RESULTS MRI acquisition in the RT setup provided a similar head extension as compared to the planning CT. The registration method had a more significant influence than the acquisition setup (Wilcoxon signed-rank test, p<0.05). When registering using a less optimal registration method, the RT setup improved the registration accuracy compared to the diagnostic setup (Difference: ΔMHD = 0.16 mm, ΔHDP95 = 0.64 mm, mean Euclidean distance (ΔmEuD) = 2.65 mm). Different registration methods and acquisition setups lead to the variation of the clinical DVH. Acquiring MRI in the RT setup can improve PTV and GTV coverage compared to the diagnostic setup. CONCLUSIONS Both MRI acquisition setup and registration method influence the MRI-CT registration accuracy in brain RT patients geometrically and dosimetrically. MR-simulation in the RT setup assures optimal registration accuracy if automatic registration is impaired, and therefore recommended for brain RT.
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Affiliation(s)
- Siti Masitho
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Veit Mengling
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Lisa Reißig
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Raphaela Voigt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Tobias Bäuerle
- Department of Radiology. Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rolf Janka
- Department of Radiology. Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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10
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Ganz JC. Cerebral metastases. PROGRESS IN BRAIN RESEARCH 2022; 268:229-258. [PMID: 35074082 DOI: 10.1016/bs.pbr.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Brain metastases are common and deadly. Over the last 25 years GKNS has been established as an invaluable treatment. It may be used as a primary treatment or after either surgery or WBRT. Patients are assessed using one of a number of available scales. GKNS may be repeated for new metastases and for unresponsive tumors. Prescription doses are usually between 18 and 20Gy. The use of advanced MR techniques to highlight sensitive structures like the hippocampi have extended the efficacy of the treatment. More recently GKNS has been used with different target therapies with improved results. More recently frameless treatments have become more popular in this group of very sick patients. GKNS controls tumors in between 80% and over 95% of cases and may even be used for brainstem tumors.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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11
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Kutuk T, Tolakanahalli R, Williams A, Tom MC, Vadhan JD, Appel H, Hall MD, Wieczorek DJJ, Davis S, McDermott MW, Ahluwalia MS, Mehta MP, Gutierrez AN, Kotecha R. Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery. Neurooncol Pract 2021; 8:674-683. [PMID: 34777836 DOI: 10.1093/nop/npab047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The objective of this study was to evaluate the impact of the time interval between planning imaging and stereotactic radiosurgery (SRS) delivery on tumor volumes and spatial anatomic displacements of brain metastases (BM). Methods Consecutive patients diagnosed with BM treated with SRS over a 3-year period were evaluated. Only patients who underwent an institutionally standardized diagnostic MRI (MRI-1) and a treatment planning MRI (MRI-2) were included. The impact of histology, inter-scan time interval, lesion location, tumor volume, and diameter were evaluated on final lesion diameter, volume, anatomic displacement, and ultimate need for change in management (ie, expanding margins, rescanning). Results 101 patients (531 lesions) with a median inter-scan time interval of 8 days (range: 1-42 days) met the inclusion criteria. The median percentage increase in BM diameter and volume were 9.5% (IQR: 2.25%-24.0%) and 20% (IQR: 0.7%-66.7%). Overall, 147 lesions (27.7%) in 57 patients (56.4%) required a change in management. There was a statistically significant relationship between initial tumor diameter (cm) and change in management (OR: 2.69, 95% CI: 1.93-3.75; P < .001). Each day between MRI-1 and MRI-2 was associated with a change in management with an OR of 1.05 (95% CI: 1.03-1.07; P < .001). Conclusions Changes in tumor diameter, volume, and spatial position occur as a function of time. Planning imaging for SRS is recommended to occur in close temporal proximity to treatment; for those with delays, a larger setup margin may need to be used to ensure tumor coverage and account for positional changes.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Ranjini Tolakanahalli
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Andre Williams
- Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Martin C Tom
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jason D Vadhan
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Haley Appel
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - D Jay J Wieczorek
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Stephen Davis
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael W McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Manmeet S Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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12
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Thrower SL, Al Feghali KA, Luo D, Paddick I, Hou P, Briere T, Li J, McAleer MF, McGovern SL, Woodhouse KD, Yeboa DN, Brock KK, Chung C. The Effect of Slice Thickness on Contours of Brain Metastases for Stereotactic Radiosurgery. Adv Radiat Oncol 2021; 6:100708. [PMID: 34124413 PMCID: PMC8175282 DOI: 10.1016/j.adro.2021.100708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives Stereotactic radiosurgery is a common treatment for brain metastases and is typically planned on magnetic resonance imaging (MRI). However, the MR acquisition parameters used for patient selection and treatment planning for stereotactic radiosurgery can vary within and across institutions. In this work, we investigate the effect of MRI slice thickness on the detection and contoured volume of metastatic lesions in the brain. Methods and Materials A retrospective cohort of 28 images acquired with a slice thickness of 1 mm were resampled to simulate acquisitions at 2- and 3-mm slice thickness. A total of 102 metastases ranging from 0.0030 cc to 5.08 cc (75-percentile 0.36 cc) were contoured on the original images. All 3 sets of images were recontoured by experienced physicians. Results Of all the images detected and contoured on the 1 mm images, 3% of lesions were missed on the 2 mm images, and 13% were missed on the 3 mm images. One lesion that was identified on both the 2 mm and 3 mm images was determined to be a blood vessel on the 1 mm images. Additionally, the lesions were contoured 11% larger on the 2 mm and 43% larger on the 3 mm images. Conclusions Using images with a slice thickness >1 mm effects detection and segmentation of brain lesions, which can have an important effect on patient management and treatment outcomes.
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Affiliation(s)
- Sara L Thrower
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karine A Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, England
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tina Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina Demas Woodhouse
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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13
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Benveniste RJ, Yechieli R, Diwanji T. Early Magnetic Resonance Imaging After Gamma Knife Radiosurgery of Brain Metastases. World Neurosurg 2020; 146:e1177-e1181. [PMID: 33253947 DOI: 10.1016/j.wneu.2020.11.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gamma knife radiosurgery (GKRS) is often performed to treat brain metastases (BrMs). Widely referenced guidelines have suggested post-treatment imaging studies at 3-month intervals. However, clinicians frequently obtain magnetic resonance imaging (MRI) studies at <3 months after GKRS. METHODS We performed a retrospective medical record review study to assess the utility of early (<3 months) MRI after GKRS in patients with BrMs. RESULTS A total of 415 GKRS procedures were performed. For 325 patients, early MRI studies were obtained. A total of 31 patients had new or worsened neurological symptoms. The early MRI studies showed adverse findings in 25 patients (78%), which in 23 (72%) had resulted in a change in treatment. For 294 patients, no new or worsened neurological symptoms were found on early MRI studies. Of these 294 patients, 86 (29%) had ≥1 adverse finding on MRI, and 60 (20%) had a change in management as a result. However, no rapidly growing tumors or other emergent adverse findings were seen. CONCLUSIONS Early MRI (within 3 months) after post GKRS will frequently show adverse findings even in asymptomatic patients, more often in patients aged <65 years and patients with multiple treated BrMs. However, according to the nature of the adverse findings observed in our retrospective study, it is unlikely that the clinical outcomes would have been affected if the post-GKRS MRI studies had been deferred to 3 months after treatment. Our data support deferring post-GKRS MRI to 3 months after treatment in the absence of new neurological signs or symptoms.
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Affiliation(s)
- Ronald J Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
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14
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Magnetic resonance imaging for brain stereotactic radiotherapy : A review of requirements and pitfalls. Strahlenther Onkol 2020; 196:444-456. [PMID: 32206842 PMCID: PMC7182639 DOI: 10.1007/s00066-020-01604-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/03/2020] [Indexed: 12/29/2022]
Abstract
Due to its superior soft tissue contrast, magnetic resonance imaging (MRI) is essential for many radiotherapy treatment indications. This is especially true for treatment planning in intracranial tumors, where MRI has a long-standing history for target delineation in clinical practice. Despite its routine use, care has to be taken when selecting and acquiring MRI studies for the purpose of radiotherapy treatment planning. Requirements on MRI are particularly demanding for intracranial stereotactic radiotherapy, where accurate imaging has a critical role in treatment success. However, MR images acquired for routine radiological assessment are frequently unsuitable for high-precision stereotactic radiotherapy as the requirements for imaging are significantly different for radiotherapy planning and diagnostic radiology. To assure that optimal imaging is used for treatment planning, the radiation oncologist needs proper knowledge of the most important requirements concerning the use of MRI in brain stereotactic radiotherapy. In the present review, we summarize and discuss the most relevant issues when using MR images for target volume delineation in intracranial stereotactic radiotherapy.
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15
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Susko MS, Garcia MA, Ma L, Nakamura JL, Raleigh DR, Fogh S, Theodosopoulos P, McDermott M, Sneed PK, Braunstein SE. Stereotactic Radiosurgery to More Than 10 Brain Metastases: Evidence to Support the Role of Radiosurgery for Ideal Hippocampal Sparing in the Treatment of Multiple Brain Metastases. World Neurosurg 2019; 135:e174-e180. [PMID: 31785436 DOI: 10.1016/j.wneu.2019.11.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Brain metastases are a common occurrence, with literature supporting the treatment of a limited number of brain metastases with stereotactic radiosurgery (SRS), as opposed to whole brain radiotherapy (WBRT). Less well understood is the role of SRS in patients with ≥10 brain metastases. METHODS Patients treated with SRS to ≥10 brain metastases without concurrent WBRT between March 1999 and December 2016 were reviewed. Analysis was performed for overall survival, treated lesion freedom from progression (FFP), freedom from new metastases (FFNMs), and adverse radiation effect. Hippocampal volumes were retrospectively generated in patients treated with up-front SRS for evaluation of dose volume metrics. RESULTS A total of 143 patients were identified with 75 patients having up-front SRS and 68 patients being treated as salvage therapy after prior WBRT. The median number of lesions per patient was 13 (interquartile range [IQR], 11-17). Median total volume of treatment was 4.1 cm3 (IQR, 2.0-9.9 cm3). The median 12-month FFP for up-front and salvage treatment was 96.8% (95% confidence interval [CI], 95.5-98.1) and 83.6% (95% CI, 79.9-87.5), respectively (P < 0.001). Twelve-month FFNMs for up-front and salvage SRS was 18.8% (95% CI, 10.9-32.3) versus 19.2% (95% CI, 9.7-37.8), respectively (P = 0.90). The mean hippocampal dose was 150 cGy (IQR, 100-202 cGy). CONCLUSIONS Excellent rates of local control can be achieved when treating patients with >10 intracranial metastases either in the up-front or salvage setting. Hippocampal sparing is readily achievable with expected high rates of new metastatic lesions in treated patients.
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Affiliation(s)
- Matthew S Susko
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Michael A Garcia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Jean L Nakamura
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Shannon Fogh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McDermott
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Penny K Sneed
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA.
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16
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Bronnimann C, Huchet A, Benech-Faure J, Dutriaux C, Saut O, Blais E, Mollier O, Trouette R, Vendrely V. Interval between planning and frameless stereotactic radiosurgery for brain metastases: are our margins still accurate? Neurooncol Pract 2019; 7:211-217. [PMID: 32626589 DOI: 10.1093/nop/npz048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Advances in intracranial stereotactic radiosurgery (SRS) have led to dramatically reduced planning target volume (PTV) margins. However, tumor growth between planning and treatment may lead to treatment failure. Our purpose was to assess the kinetics of tumor growth before SRS for brain metastases. Methods This retrospective, monocentric study included all consecutive patients (pts) treated for brain metastases secondary to melanoma (ML) and non-small cell lung cancer (NSCLC) between June 2015 and May 2016. All pts underwent diagnostic brain imaging and a radiosurgery planning MRI, during which gross tumor volume (GTV) was delineated. Linear and exponential models were used to extrapolate a theoretical GTV at first day of treatment, and theoretical time to outgrow the PTV margins. Results Twenty-three ML and 31 NSCLC brain metastases (42 pts, 84 brain imaging scans) were analyzed. Comparison of GTV at diagnosis and planning showed increased tumor volume for 20 ML pts (96%) and 22 NSCLC pts (71%). The shortest time to outgrow a 1 mm margin was 6 days and 3 days for ML and 14 and 8 days for NSCLC with linear and exponential models, respectively. Conclusions Physicians should bear in mind the interval between SRS planning and treatment. A mathematical model could screen rapidly progressing tumors.
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Affiliation(s)
| | | | | | - Caroline Dutriaux
- Centre Hospitalier Universitaire (CHU)-Bordeaux, Oncology Department, France
| | | | | | | | | | - Veronique Vendrely
- CHU-Bordeaux, Radiotherapy Department, France.,INRIA Bordeaux Sud-Ouest, France.,CHU-Bordeaux, Neurosurgery Department, France.,University of Bordeaux, INSERM U1035, France
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17
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Nicholls LW, Pinkham MB, Bernard A, Lusk R, Watkins T, Hall B, Olson S, Foote MC. Radiological Kinetics of Brain Metastases and Clinical Implications for Patients Treated With Stereotactic Radiosurgery. Clin Oncol (R Coll Radiol) 2018; 31:34-40. [PMID: 30279038 DOI: 10.1016/j.clon.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/03/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
AIMS Select patients with brain metastases receive stereotactic radiosurgery (SRS) with the objective of improving survival and intracranial disease control. Brain metastases number and volume are prognostic factors used to inform patient selection. The aim of this study was to assess the rate of change of brain metastases size and number (growth kinetics) between the diagnostic and day of SRS magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS All patients treated with Gamma Knife SRS between October 2015 and April 2017 were included in this single-centre retrospective analysis. Brain metastases number and diameter were recorded at diagnosis and treatment. For patients with multiple brain metastases, the largest lesion was the index lesion. Distant intracranial control and overall survival were reported from the date of SRS. RESULTS In total, 146 patients received 156 episodes of SRS. The median interval between diagnostic and SRS MRI was 20 days (range 1-68). Interval growth in the index lesion of at least 3 mm or the development of a new brain metastasis was noted in 60.2% of patients. This was associated with age less than 60 years (P = 0.001), Eastern Cooperative Oncology Group (ECOG) performance status 2 or above (P = 0.04), non-small cell lung carcinoma (NSCLC) (P = 0.03) or melanoma histologies (P = 0.05) and uncontrolled extracranial disease (P = 0.05). These patients were also more likely to develop distant intracranial recurrence (P = 0.046). Clinically significant growth was not associated with scan interval or differences in overall survival. The Kaplan-Meier estimate of probability of survival at 12 months was 59.3% (95% confidence interval 46.7-75.2%) for all patients. CONCLUSION Intracranial progression between diagnosis and day of SRS is common. Risk factors are uncontrolled extracranial disease, poorer performance status, NSCLC or melanoma histologies and age less than 60 years. These patients would benefit from an MRI closer to treatment to inform patient selection and target delineation for SRS planning.
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Affiliation(s)
- L W Nicholls
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
| | - M B Pinkham
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - A Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - R Lusk
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - T Watkins
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - B Hall
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - S Olson
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - M C Foote
- Gamma Knife Centre of Queensland, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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