Single fraction stereotactic radiosurgery for multiple brain metastases.
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Introduction: Due to the neurocognitive side effects of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS) is being used with increasing frequency. The use of SRS is expanding for patients with multiple (>4) brain metastases (BM). This study summarizes our institutional experience with single-fraction, linear-accelerator-based SRS for multiple BM. Methods and materials: All patients who were treated between January 1, 2013, and September 30, 2015, with single-fraction SRS for ≥4 BM were included in this institutional review board-approved, retrospective, single-institution study. Patients were treated with linear accelerator-based image guided SRS. Results: A total of 59 patients with ≥4 BM were treated with single-fraction SRS. The median follow-up was 15.2 months, and the median overall survival for the entire cohort was 5.8 months. The median number of treated lesions per patient was 5 (range, 4-23). Per patient, the median planning target volume (PTV) was 4.8 cc (range, 0.7-28.8 cc). The prescribed dose across all 380 BM for the 59 patients ranged from 7 to 20 Gy. The median of the mean dose to the total PTV was 19.5 Gy. Although the number of treated lesions (4-5 vs ≥6) did not influence survival, better survival was noted for a total PTV <10 cc versus ≥10 cc (7.1 vs 4.2 months, respectively; P = .0001). A mean dose of ≥19 Gy to the entire PTV was also associated with increased survival (6.6 vs 5.0 months, respectively; P = .0172). Patients receiving a dose of >12 Gy to ≥10 cc of normal brain had worse survival (5.1 vs 8.6 months, respectively; P = .0028). Conclusion: In single-fraction SRS for patients with multiple BM, smaller total tumor volume, higher total dose, and lower volume of normal brain receiving >12 Gy were associated with increased survival. These data suggest that using SRS for the treatment of multiple BM is efficacious and that outcomes may be affected more by total tumor volume than by the number of lesions.
Published Version (Please cite this version)10.1016/j.adro.2017.09.002
Publication InfoAdamson, Justus D; Fecci, Peter Edward; Floyd, Scott Richard; Herndon, James Emmett II; Kim, Grace Jewel; Kirkpatrick, John P; ... Yin, Fang-Fang (2017). Single fraction stereotactic radiosurgery for multiple brain metastases. Adv Radiat Oncol, 2(4). pp. 555-563. 10.1016/j.adro.2017.09.002. Retrieved from http://hdl.handle.net/10161/15933.
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Associate Professor of Radiation Oncology
Radiosurgery and SBRTImage Guided Radiation Therapy (IGRT) Quality Assurance (QA) in Radiation Therapy 3D Dosimetry
Assistant Professor of Neurosurgery
As the Director of both the Brain Tumor Immunotherapy Program and the Center for Brain and Spine Metastasis at Duke University, I focus our programmatic interests on the design, optimization, and monitoring of immune-based treatment platforms for patients with intracranial tumors, whether primary or metastatic. Within this broad scope, however, my own group looks more specifically at limitations to immunotherapeutic success, with a particular focus on understanding and reversing T cell dysfun
Gary Hock and Lyn Proctor Associate Professor of Radiation Oncology
Professor of Biostatistics and Bioinformatics
Current research interests have application to the design and analysis of cancer clinical trials. Specifically, interests include the use of time-dependent covariables within survival models, the design of phase II cancer clinical trials which minimize some of the logistical problems associated with their conduct, and the analysis of longitudinal studies with informative censoring (in particular, quality of life studies of patients with advanced cancer).
Assistant Professor of Radiation Oncology
Professor of Radiation Oncology
Malignant and benign tumors of the brain, spine and base of skull. Mathematical modelling of tumor metabolism, mass transfer and the response to ionizing radiation. Enhancing clinical outcome in stereotactic radiosurgery, fractionated stereotactic radiotherapy and stereotactic body radiotherapy.
Associate Professor of Radiation Oncology
Professor in Radiation Oncology
Stereotactic radiosurgery, Stereotactic body radiation therapy, treatment planning optimization, knowledge guided radiation therapy, intensity-modulated radiation therapy, image-guided radiation therapy, oncological imaging and informatics
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