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Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial.

Publication ,  Journal Article
Kirkpatrick, JP; Wang, Z; Sampson, JH; McSherry, F; Herndon, JE; Allen, KJ; Duffy, E; Hoang, JK; Chang, Z; Yoo, DS; Kelsey, CR; Yin, F-F
Published in: Int J Radiat Oncol Biol Phys
January 1, 2015

PURPOSE: To identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence. METHODS AND MATERIALS: Adult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS). RESULTS: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed. CONCLUSIONS: SRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2015

Volume

91

Issue

1

Start / End Page

100 / 108

Location

United States

Related Subject Headings

  • Tumor Burden
  • Radiotherapy, Image-Guided
  • Radiosurgery
  • Radiation Injuries
  • Quality of Life
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Melanoma
  • Male
 

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Kirkpatrick, J. P., Wang, Z., Sampson, J. H., McSherry, F., Herndon, J. E., Allen, K. J., … Yin, F.-F. (2015). Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial. Int J Radiat Oncol Biol Phys, 91(1), 100–108. https://doi.org/10.1016/j.ijrobp.2014.09.004
Kirkpatrick, John P., Zhiheng Wang, John H. Sampson, Frances McSherry, James E. Herndon, Karen J. Allen, Eileen Duffy, et al. “Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial.Int J Radiat Oncol Biol Phys 91, no. 1 (January 1, 2015): 100–108. https://doi.org/10.1016/j.ijrobp.2014.09.004.
Kirkpatrick JP, Wang Z, Sampson JH, McSherry F, Herndon JE, Allen KJ, et al. Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2015 Jan 1;91(1):100–8.
Kirkpatrick, John P., et al. “Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial.Int J Radiat Oncol Biol Phys, vol. 91, no. 1, Jan. 2015, pp. 100–08. Pubmed, doi:10.1016/j.ijrobp.2014.09.004.
Kirkpatrick JP, Wang Z, Sampson JH, McSherry F, Herndon JE, Allen KJ, Duffy E, Hoang JK, Chang Z, Yoo DS, Kelsey CR, Yin F-F. Defining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial. Int J Radiat Oncol Biol Phys. 2015 Jan 1;91(1):100–108.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2015

Volume

91

Issue

1

Start / End Page

100 / 108

Location

United States

Related Subject Headings

  • Tumor Burden
  • Radiotherapy, Image-Guided
  • Radiosurgery
  • Radiation Injuries
  • Quality of Life
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Melanoma
  • Male