Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

Radiation Oncology

Takashi Nakano⁶  Hideyuki Sakurai⁵  Kota Torikai²  Ken-ichi Seto⁴  Shin-ei Noda⁶  Jun-ichi Saitoh⁶  Yoshiyuki Suzuki³  Hiro Sato⁴  Hiroshi K Inoue¹ 

[1] Neurosurgery and Radiation Oncology, Institute of Neural Organization, 1120 Dai, Kumagaya 360-0804, Saitama, Japan;Gunma University Heavy-ion Medical Research Center, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan;Department of Radiation Oncology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City 960-1295, Fukushima, Japan;Cyber Center, Kanto Neurosurgical Hospital, 1120 Dai, Kumagaya 360-0804, Saitama, Japan;Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba 365-8576, Ibaraki, Japan;Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi 371-8511, Gunma, Japan

关键词: V14;    Optimal dose and fraction;    Brain edema;    Radiation necrosis;    Prediction of complications;    Multi-session radiosurgery;    Hypofractionated conformal radiotherapy;    Large brain metastases;   

Others  :  1151141
DOI  :  10.1186/s13014-014-0231-5

 received in 2014-08-05, accepted in 2014-10-06,  发布年份 2014

【 摘 要 】

Background

A single-institutional prospective study of optimal hypofractionated conformal radiotherapy for large brain metastases with high risk factors was performed based on the risk prediction of radiation-related complications.

Methods

Eighty-eight patients with large brain metastases ?10 cm³ in critical areas treated from January 2010 to February 2014 using the CyberKnife were evaluated. The optimal dose and number of fractions were determined based on the surrounding brain volume circumscribed with a single dose equivalent (SDE) of 14 Gy (V14) to be less than 7 cm³ for individual lesions. Univariate and multivariate analyses were conducted.

Results

As a result of optimal treatment, 92 tumors ranging from 10 to 74.6 cm³ (median, 16.2 cm³) in volume were treated with a median prescribed isodose of 57% and a median fraction number of five. In order to compare the results according to the tumor volume, the tumors were divided into the following three groups: 1) 10¿19.9 cm³, 2) 20¿29.9 cm³ and 3) ?30 cm³. The lesions were treated with a median prescribed isodose of 57%, 56% and 55%, respectively, and the median fraction number was five in all three groups. However, all tumors ?20 cm³ were treated with???five fractions. The median SDE of the maximum dose in the three groups was 47.2 Gy, 48.5 Gy and 46.5 Gy, respectively. Local tumor control was obtained in 90.2% of the patients, and the median survival was nine months, with a median follow-up period of seven months (range, 3-41 months). There were no significant differences in the survival rates among the three groups. Six tumors exhibited marginal recurrence 7-36 months after treatment. Ten patients developed symptomatic brain edema or recurrence of pre-existing edema, seven of whom required osmo-steroid therapy. No patients developed radiation necrosis requiring surgical resection.

Conclusion

Our findings demonstrate that the administration of optimal hypofractionated conformal radiotherapy based on the dose-volume prediction of complications (risk line for hypofractionation), as well as Kjellberg¿s necrosis risk line used in single-session radiosurgery, is effective and safe for large brain metastases or other lesions in critical areas.

【 授权许可】

   
2014 Inoue et al.; licensee BioMed Central Ltd.

【 图 表 】

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