Clinical Application of RapidArc Volumetric Modulated Arc Therapy As a Component in Whole Brain Radiation Therapy for Poor Prognostic, Four or More Multiple Brain Metastases

Overview

Journal Radiat Oncol J

Specialty Oncology

Date 2012 Sep 18

PMID 22984683

Citations 9

Authors

Seung Heon Lee

Kyu Chan Lee

Jinho Choi

Hye Young Kim

Seok Ho Lee

Ki Hoon Sung

Yunmi Kim

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases.

Materials And Methods: Nine patients with multiple (≥4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions.

Results: The median biologically effective dose to metastatic tumors was 68.1 Gy(10) and 67.2 Gy(10) and the median brain volume irradiated more than 100 Gy(3) were 1.9% (24 cm(3)) and 0.8% (13 cm(3)) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively.

Conclusion: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

Citing Articles

Frameless stereotactic radiosurgery for brain metastasis: a systematic review and meta-analysis.

Habibi M, Mirjnani M, Ghazizadeh Y, Norouzi A, Minaee P, Eazi S Neurosurg Rev. 2024; 47(1):423.

PMID: 39136823 DOI: 10.1007/s10143-024-02666-9.

Radiosurgery for multiple brain metastases using volumetric modulated arc therapy: a single institutional series.

Asso R, Mancini A, Palhares D, Junior W, Marta G, da Silva J Rep Pract Oncol Radiother. 2022; 27(4):593-601.

PMID: 36196425 PMC: 9521688. DOI: 10.5603/RPOR.a2022.0058.

Cranial irradiation impairs intrinsic excitability and synaptic plasticity of hippocampal CA1 pyramidal neurons with implications for cognitive function.

Wu M, Zou W, Yu P, Yang Y, Li S, Liu Q Neural Regen Res. 2022; 17(10):2253-2259.

PMID: 35259846 PMC: 9083168. DOI: 10.4103/1673-5374.336875.

Frameless Image-Guided Radiosurgery for Multiple Brain Metastasis Using VMAT: A Review and an Institutional Experience.

Hanna S, Mancini A, Dal Col A, Asso R, Neves-Junior W Front Oncol. 2019; 9:703.

PMID: 31440464 PMC: 6693418. DOI: 10.3389/fonc.2019.00703.

Short Survival Time after Palliative whole Brain Radiotherapy: Can We Predict Potential Overtreatment by Use of a Nomogram?.

Nieder C, Norum J, Hintz M, Grosu A J Cancer. 2017; 8(9):1525-1529.

PMID: 28775771 PMC: 5535707. DOI: 10.7150/jca.18600.

References

Patchell R, Tibbs P, Walsh J, Dempsey R, Maruyama Y, Kryscio R . A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990; 322(8):494-500. DOI: 10.1056/NEJM199002223220802. View

Muacevic A, Wowra B, Siefert A, Tonn J, Steiger H, Kreth F . Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol. 2007; 87(3):299-307. DOI: 10.1007/s11060-007-9510-4. View

Deutsch M, Parsons J, MERCADO Jr R . Radiotherapy for intracranial metastases. Cancer. 1974; 34(5):1607-11. DOI: 10.1002/1097-0142(197411)34:5<1607::aid-cncr2820340508>3.0.co;2-n. View

Gavrilovic I, Posner J . Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005; 75(1):5-14. DOI: 10.1007/s11060-004-8093-6. View

Rades D, Bohlen G, Pluemer A, Veninga T, Hanssens P, Dunst J . Stereotactic radiosurgery alone versus resection plus whole-brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients. Cancer. 2007; 109(12):2515-21. DOI: 10.1002/cncr.22729. View

Delattre J, Krol G, Thaler H, Posner J . Distribution of brain metastases. Arch Neurol. 1988; 45(7):741-4. DOI: 10.1001/archneur.1988.00520310047016. View

Horton J, BAXTER D, OLSON K . The management of metastases to the brain by irradiation and corticosteroids. Am J Roentgenol Radium Ther Nucl Med. 1971; 111(2):334-6. DOI: 10.2214/ajr.111.2.334. View

Takahashi M, Narabayashi I, Kuroiwa T, Uesugi Y, Tatsumi T, Inomata T . Stereotactic radiosurgery (SRS) for multiple metastatic brain tumors: effects of the number of target tumors on exposure dose in normal brain tissues. Int J Clin Oncol. 2003; 8(5):289-96. DOI: 10.1007/s10147-003-0331-y. View

Lagerwaard F, van der Hoorn E, Verbakel W, Haasbeek C, Slotman B, Senan S . Whole-brain radiotherapy with simultaneous integrated boost to multiple brain metastases using volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys. 2009; 75(1):253-9. DOI: 10.1016/j.ijrobp.2009.03.029. View

10.

Nieder C, Andratschke N, Grosu A, Molls M . Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases. Strahlenther Onkol. 2003; 179(1):16-20. DOI: 10.1007/s00066-003-1028-x. View

11.

Lawrence Y, Li X, El Naqa I, Hahn C, Marks L, Merchant T . Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S20-7. PMC: 3554255. DOI: 10.1016/j.ijrobp.2009.02.091. View

12.

Vecht C, Haaxma-Reiche H, Noordijk E, Padberg G, Voormolen J, Hoekstra F . Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?. Ann Neurol. 1993; 33(6):583-90. DOI: 10.1002/ana.410330605. View

13.

Pollock B, Brown P, Foote R, Stafford S, Schomberg P . Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. J Neurooncol. 2003; 61(1):73-80. DOI: 10.1023/a:1021262218151. View

14.

Li J, Bentzen S, Li J, Renschler M, Mehta M . Relationship between neurocognitive function and quality of life after whole-brain radiotherapy in patients with brain metastasis. Int J Radiat Oncol Biol Phys. 2008; 71(1):64-70. DOI: 10.1016/j.ijrobp.2007.09.059. View

15.

Wolff H, Wagner D, Christiansen H, Hess C, Vorwerk H . Single fraction radiosurgery using Rapid Arc for treatment of intracranial targets. Radiat Oncol. 2010; 5:77. PMC: 2949676. DOI: 10.1186/1748-717X-5-77. View

16.

Andrews D, Scott C, Sperduto P, Flanders A, Gaspar L, Schell M . Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004; 363(9422):1665-72. DOI: 10.1016/S0140-6736(04)16250-8. View

17.

Gaspar L, Mehta M, Patchell R, Burri S, Robinson P, Morris R . The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2009; 96(1):17-32. PMC: 2808517. DOI: 10.1007/s11060-009-0060-9. View

18.

Silverberg E, Lubera J . Cancer statistics, 1988. CA Cancer J Clin. 1988; 38(1):5-22. DOI: 10.3322/canjclin.38.1.5. View

19.

Schoggl A, Kitz K, Reddy M, Wolfsberger S, Schneider B, Dieckmann K . Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir (Wien). 2000; 142(6):621-6. DOI: 10.1007/s007010070104. View

20.

Komarnicky L, Phillips T, Martz K, Asbell S, ISAACSON S, Urtasun R . A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases (RTOG-7916). Int J Radiat Oncol Biol Phys. 1991; 20(1):53-8. DOI: 10.1016/0360-3016(91)90137-s. View