TY - JOUR
T1 - LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation
AU - Hartgerink, Dianne
AU - Swinnen, Ans
AU - Roberge, David
AU - Nichol, Alan
AU - Zygmanski, Piotr
AU - Yin, Fang-Fang
AU - Deblois, François
AU - Hurkmans, Coen
AU - Ong, Chin Loon
AU - Bruynzeel, Anna
AU - Aizer, Ayal
AU - Fiveash, John
AU - Kirckpatrick, John
AU - Guckenberger, Matthias
AU - Andratschke, Nicolaus
AU - de Ruysscher, Dirk
AU - Popple, Richard
AU - Zindler, Jaap
N1 - Funding Information: MAASTRO Clinic has a research agreement with Varian Medical Systems, Palo Alto, CA, USA. DR — Honoraria and research support from Varian Medical Systems, Siemens Healthineers, Accuray, Brainlab. Research support from Elekta. Duke: Research funding from Varian Medical Systems. Publisher Copyright: © 2019, © 2019 Acta Oncologica Foundation. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/9/2
Y1 - 2019/9/2
N2 - Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
AB - Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
UR - http://www.scopus.com/inward/record.url?scp=85071783879&partnerID=8YFLogxK
U2 - https://doi.org/10.1080/0284186X.2019.1633016
DO - https://doi.org/10.1080/0284186X.2019.1633016
M3 - Review article
C2 - 31257960
SN - 0284-186X
VL - 58
SP - 1275
EP - 1282
JO - Acta Oncologica
JF - Acta Oncologica
IS - 9
ER -