Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Steven K.M. Lau, Kaveh Zakeri, Xiao Zhao, Ruben Carmona, Erik Knipprath, Daniel R. Simpson, Sameer K. Nath, Gwe Ya Kim, Parag Sanghvi, Jona A. Hattangadi-Gluth, Clark C. Chen, Kevin T. Murphy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: Stereotactic radiosurgery (SRS) is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. OBJECTIVE: To report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases. METHODS: We performed a retrospective analysis of 15 patients undergoing frameless VMAR for multiple intracranial metastases using a single, centrally located isocenter in the period 2009 and 2011. Of these, 3 patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median, 3 per patient; range, 2-13) were treated to a median dose of 20 Gy (range, 15-30 Gy). Three patients were treated with fractionated SRS. Follow-up including clinical examination and magnetic resonance imaging (MRI) occurred every 3 months. RESULTS: The median follow-up for all patients was 7.1 months (range, 1.1-24.3), with 11 patients (73.3%) followed until death. For the remaining 4 patients alive at the time of analysis, the median follow-up was 19.6 months (range, 9.2-24.3). Local control at 6 and 12 months was 91.7% (95% confidence interval [CI], 84.6%-100.0%) and 81.5% (95% CI, 67.9%-100.0%), respectively. Regional failure was observed in 9 patients (60.0%), and 7 patients (46.7%) received salvage therapy. Overall survival at 6 months was 60.0% (95% CI, 40.3%-88.2%). Grade 3 or higher treatment-related toxicity was not observed. The median total treatment time was 7.2 minutes (range, 2.8-13.2 minutes). CONCLUSION: Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared with conventional radiosurgery.

Original languageEnglish (US)
Pages (from-to)233-240
Number of pages8
JournalNeurosurgery
Volume77
Issue number2
DOIs
StatePublished - Aug 20 2015
Externally publishedYes

Fingerprint

Radiosurgery
Neoplasm Metastasis
Confidence Intervals
Salvage Therapy
Therapeutics
Magnetic Resonance Imaging
Survival

Keywords

  • Brain metastasis
  • Frameless
  • Radiosurgery
  • Single isocenter
  • Surface imaging
  • Volumetric modulated arc therapy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Lau, S. K. M., Zakeri, K., Zhao, X., Carmona, R., Knipprath, E., Simpson, D. R., ... Murphy, K. T. (2015). Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases. Neurosurgery, 77(2), 233-240. https://doi.org/10.1227/NEU.0000000000000763

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases. / Lau, Steven K.M.; Zakeri, Kaveh; Zhao, Xiao; Carmona, Ruben; Knipprath, Erik; Simpson, Daniel R.; Nath, Sameer K.; Kim, Gwe Ya; Sanghvi, Parag; Hattangadi-Gluth, Jona A.; Chen, Clark C.; Murphy, Kevin T.

In: Neurosurgery, Vol. 77, No. 2, 20.08.2015, p. 233-240.

Research output: Contribution to journalArticle

Lau, SKM, Zakeri, K, Zhao, X, Carmona, R, Knipprath, E, Simpson, DR, Nath, SK, Kim, GY, Sanghvi, P, Hattangadi-Gluth, JA, Chen, CC & Murphy, KT 2015, 'Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases', Neurosurgery, vol. 77, no. 2, pp. 233-240. https://doi.org/10.1227/NEU.0000000000000763
Lau, Steven K.M. ; Zakeri, Kaveh ; Zhao, Xiao ; Carmona, Ruben ; Knipprath, Erik ; Simpson, Daniel R. ; Nath, Sameer K. ; Kim, Gwe Ya ; Sanghvi, Parag ; Hattangadi-Gluth, Jona A. ; Chen, Clark C. ; Murphy, Kevin T. / Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases. In: Neurosurgery. 2015 ; Vol. 77, No. 2. pp. 233-240.
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abstract = "BACKGROUND: Stereotactic radiosurgery (SRS) is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. OBJECTIVE: To report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases. METHODS: We performed a retrospective analysis of 15 patients undergoing frameless VMAR for multiple intracranial metastases using a single, centrally located isocenter in the period 2009 and 2011. Of these, 3 patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median, 3 per patient; range, 2-13) were treated to a median dose of 20 Gy (range, 15-30 Gy). Three patients were treated with fractionated SRS. Follow-up including clinical examination and magnetic resonance imaging (MRI) occurred every 3 months. RESULTS: The median follow-up for all patients was 7.1 months (range, 1.1-24.3), with 11 patients (73.3{\%}) followed until death. For the remaining 4 patients alive at the time of analysis, the median follow-up was 19.6 months (range, 9.2-24.3). Local control at 6 and 12 months was 91.7{\%} (95{\%} confidence interval [CI], 84.6{\%}-100.0{\%}) and 81.5{\%} (95{\%} CI, 67.9{\%}-100.0{\%}), respectively. Regional failure was observed in 9 patients (60.0{\%}), and 7 patients (46.7{\%}) received salvage therapy. Overall survival at 6 months was 60.0{\%} (95{\%} CI, 40.3{\%}-88.2{\%}). Grade 3 or higher treatment-related toxicity was not observed. The median total treatment time was 7.2 minutes (range, 2.8-13.2 minutes). CONCLUSION: Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared with conventional radiosurgery.",
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AU - Zhao, Xiao

AU - Carmona, Ruben

AU - Knipprath, Erik

AU - Simpson, Daniel R.

AU - Nath, Sameer K.

AU - Kim, Gwe Ya

AU - Sanghvi, Parag

AU - Hattangadi-Gluth, Jona A.

AU - Chen, Clark C.

AU - Murphy, Kevin T.

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AB - BACKGROUND: Stereotactic radiosurgery (SRS) is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. OBJECTIVE: To report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases. METHODS: We performed a retrospective analysis of 15 patients undergoing frameless VMAR for multiple intracranial metastases using a single, centrally located isocenter in the period 2009 and 2011. Of these, 3 patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median, 3 per patient; range, 2-13) were treated to a median dose of 20 Gy (range, 15-30 Gy). Three patients were treated with fractionated SRS. Follow-up including clinical examination and magnetic resonance imaging (MRI) occurred every 3 months. RESULTS: The median follow-up for all patients was 7.1 months (range, 1.1-24.3), with 11 patients (73.3%) followed until death. For the remaining 4 patients alive at the time of analysis, the median follow-up was 19.6 months (range, 9.2-24.3). Local control at 6 and 12 months was 91.7% (95% confidence interval [CI], 84.6%-100.0%) and 81.5% (95% CI, 67.9%-100.0%), respectively. Regional failure was observed in 9 patients (60.0%), and 7 patients (46.7%) received salvage therapy. Overall survival at 6 months was 60.0% (95% CI, 40.3%-88.2%). Grade 3 or higher treatment-related toxicity was not observed. The median total treatment time was 7.2 minutes (range, 2.8-13.2 minutes). CONCLUSION: Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared with conventional radiosurgery.

KW - Brain metastasis

KW - Frameless

KW - Radiosurgery

KW - Single isocenter

KW - Surface imaging

KW - Volumetric modulated arc therapy

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