Radiosurgery for Multiple Brain Metastases Using Volumetric Modulated Arc Therapy: a Single Institutional Series

Overview

Journal Rep Pract Oncol Radiother

Specialty Oncology

Date 2022 Oct 5

PMID 36196425

Authors

Rie Nadia Asso

Anselmo Mancini

Daniel Moore Freitas Palhares

Wellington Furtado Pimenta Palhares Neves Junior

Gustavo Nader Marta

Joao Luis Fernandes da Silva

Bibiana Ferreira Gouvea Ramos

Rafael Gadia

Samir Abdallah Hanna

Affiliations

Soon will be listed here.

Abstract

Background: Patients with brain metastases (BM) live longer due to improved diagnosis and oncologic treatments. The association of volumetric modulated arc therapy (VMAT) and image-guided radiation therapy (IGRT) with brain radiosurgery (SRS) allows complex dose distributions and faster treatment delivery to multiple lesions.

Materials And Methods: This study is a retrospective analysis of SRS for brain metastasis using VMAT. The primary endpoints were local disease-free survival (LDFS) and overall survival (OS). The secondary outcomes were intracranial disease-free survival (IDFS) and meningeal disease-free survival (MDFS).

Results: The average number of treated lesions was 5.79 (range: 2-20) per treatment in a total of 113 patients. The mean prescribed dose was 18 Gy (range: 12-24 Gy). The median LDFS was 46 months. The LDFS in 6, 12, and 24 months was for 86%, 79%, and 63%, respectively. Moreover, brain progression occurred in 50 patients. The median overall survival was 47 months. The OS in 75%, 69%, and 61% patients was 6, 12, and 24 months, respectively. IDFS was 6 and 24 months in 35% and 14% patients, respectively. The mean MDFS was 62 months; it was 6 and 24 months for 87% and 83% of patients. Acute severe toxicity was relatively rare. During follow-up, the rates of radionecrosis and neurocognitive impairment were low (10%).

Conclusion: The use of VMAT-SRS for multiple BM was feasible, effective, and associated with low treatment-related toxicity rates. Thus, treatment with VMAT is a safe technique to plan to achieve local control without toxicity.

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