Local recurrence and radionecrosis after single-isocenter multiple targets stereotactic radiotherapy for brain metastases
Scientific Reports, vol. 15, pp. 15722
Abstract
Stereotactic radiotherapy (SRT) is frequently used to treat brain metastases (BMs). The single-isocenter for multiple targets (SIMT) technique allows for faster treatment of large numbers of BMs, but may adversely affect planning target volume (PTV) coverage due to possible increased positioning uncertainties with an increased isocenter to tumor distance (ITD). This study aims to investigate the association of ITD with local recurrence (LR) and radionecrosis (RN). Patients treated with SRT using a single isocenter for multiple BMs were retrospectively analyzed. Previous cranial radiotherapy and inability to undergo MR imaging were exclusion criteria. Patients were irradiated using a Versa HD LINAC with 6 MV flattening filter-free (FFF) energy and a 6D robotic couch. A non-coplanar volumetric modulated arc technique was used and plans were delivered using 6MV FFF energy. Associations between potential risk factors and LR/RN were investigated with Cox regression analyses. Seventy-five patients with a total of 357 BMs were included. Median survival after SRT was nine months. LR occurred in 7 (9%) patients and 10 (13%) had RN. After 18 months, LR-free survival was 89% and RN-free survival was 85%, respectively. ITD was not significantly associated with LR and RN. GTV was significantly associated with both LR (HR 1.10, 95% CI 1.02-1.17, P 0.0079) and RN (HR 1.09, 95% CI 1.01-1.17, P 0.020). LINAC-based SIMT SRT is a safe and effective treatment modality for patients with multiple BMs. We found no increased risk of LR or RN for BMs located further away from the isocenter.
Authors 9
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Jaap D. Zindler corresponding
Medisch Centrum Haaglanden · Holland Particle Therapy Center · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. j.zindler@haaglandenmc.nl
Department of Radiotherapy, HollandPTC, Huismansingel 4, 2629 JH, Delft, The Netherlands. j.zindler@haaglandenmc.nl
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Medical Physics, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Radiotherapy, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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Marike L. D. Broekman Aachen Department of Cell and Chemical Biology Department of Neurosurgery, Leiden University Medical Center
Leiden University Medical Center · Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Cell and Chemical Biology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Medical Physics, Haaglanden Medical Center, Lijnbaan 32, 2512 VA, The Hague, The Netherlands
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