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LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation.

Publication ,  Journal Article
Hartgerink, D; Swinnen, A; Roberge, D; Nichol, A; Zygmanski, P; Yin, F-F; Deblois, F; Hurkmans, C; Ong, CL; Bruynzeel, A; Aizer, A; Fiveash, J ...
Published in: Acta Oncol
September 2019

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.

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Published In

Acta Oncol

DOI

EISSN

1651-226X

Publication Date

September 2019

Volume

58

Issue

9

Start / End Page

1275 / 1282

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Planning, Computer-Assisted
  • Radiosurgery
  • Quality Assurance, Health Care
  • Patient Selection
  • Patient Positioning
  • Oncology & Carcinogenesis
  • Multimodal Imaging
  • Magnetic Resonance Imaging
 

Citation

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Hartgerink, D., Swinnen, A., Roberge, D., Nichol, A., Zygmanski, P., Yin, F.-F., … Zindler, J. (2019). LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol, 58(9), 1275–1282. https://doi.org/10.1080/0284186X.2019.1633016
Hartgerink, Dianne, Ans Swinnen, David Roberge, Alan Nichol, Piotr Zygmanski, Fang-Fang Yin, François Deblois, et al. “LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation.Acta Oncol 58, no. 9 (September 2019): 1275–82. https://doi.org/10.1080/0284186X.2019.1633016.
Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin F-F, et al. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol. 2019 Sep;58(9):1275–82.
Hartgerink, Dianne, et al. “LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation.Acta Oncol, vol. 58, no. 9, Sept. 2019, pp. 1275–82. Pubmed, doi:10.1080/0284186X.2019.1633016.
Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin F-F, Deblois F, Hurkmans C, Ong CL, Bruynzeel A, Aizer A, Fiveash J, Kirckpatrick J, Guckenberger M, Andratschke N, de Ruysscher D, Popple R, Zindler J. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol. 2019 Sep;58(9):1275–1282.

Published In

Acta Oncol

DOI

EISSN

1651-226X

Publication Date

September 2019

Volume

58

Issue

9

Start / End Page

1275 / 1282

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy Planning, Computer-Assisted
  • Radiosurgery
  • Quality Assurance, Health Care
  • Patient Selection
  • Patient Positioning
  • Oncology & Carcinogenesis
  • Multimodal Imaging
  • Magnetic Resonance Imaging