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Use of Helical TomoTherapy for the Focal Hypofractionated Treatment of Limited Brain Metastases in the Initial and Recurrent Setting.

Elson A, Walker A, Bovi JA, Schultz C - Front Oncol (2015)

Bottom Line: We reviewed our institutional experience to assess patient selection factors, fractionation scheme, and outcomes associated with this technique.Freedom from local failure for treated lesions was 71% and 59% at 6 and 12 months.TomoTherapy-based hypofractionated radiotherapy to a limited number of metastatic lesions is associated with acceptable intracranial disease control and survival outcomes and represents a viable treatment option in the primary and recurrent setting for select patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College of Wisconsin , Milwaukee, WI , USA.

ABSTRACT

Background: Whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), or both are commonly employed in the treatment of limited brain metastases in the initial or recurrent setting. Hypofractionated partial volume irradiation is also employed, however, published experience using helical TomoTherapy (HT) for this purposes is limited. We reviewed our institutional experience to assess patient selection factors, fractionation scheme, and outcomes associated with this technique.

Methods: A retrospective chart review was performed to evaluate patients treated with partial volume hypofractionated HT-based IMRT for brain metastases at our institution.

Results: Thirteen patients (7M/6F, median age 62, median KPS 90) with a limited (1-9) number of brain metastases in the primary or recurrent setting were identified. Primary malignancies included colorectal (3), NSCLC (5), RCC (1), breast (1), melanoma (1), uterine (1), and ovarian (1). The median time from initial diagnosis to brain metastases was 20.7 months (range 0-61.3). Treatment was delivered to intact metastases in six patients, to a single resection cavity in six patients, and to both in one patient. A total of 27 lesions were treated. The median number of intact metastases treated was two (range 1-9). Previous treatments included WBRT (5), WBRT + SRS (3), SRS alone (1), and none (4). The most common fractionation schemes were 25 Gy in five fractions and 27.5 Gy in five fractions to each lesion. At a median of 6 months follow up (range 1.26-20.13) after TomoTherapy, 10 patients were deceased, 2 were alive, and 1 was lost to follow up. Systemic progression occurred in seven patients and intracranial progression occurred in five. The median intracranial progression free survival and overall survival after TomoTherapy was 6.3 months. Freedom from local failure for treated lesions was 71% and 59% at 6 and 12 months.

Conclusion: TomoTherapy-based hypofractionated radiotherapy to a limited number of metastatic lesions is associated with acceptable intracranial disease control and survival outcomes and represents a viable treatment option in the primary and recurrent setting for select patients.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier survival curves depicting (A) overall survival from initial diagnosis of malignancy, (B) overall survival from the completion of TomoTherapy, (C) intracranial failure free survival, and (D) freedom from local failure for treated lesions.
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Figure 3: Kaplan–Meier survival curves depicting (A) overall survival from initial diagnosis of malignancy, (B) overall survival from the completion of TomoTherapy, (C) intracranial failure free survival, and (D) freedom from local failure for treated lesions.

Mentions: Figure 3 depicts Kaplan–Meier survival curves for OS from initial diagnosis, OS from the completion of TomoTherapy, intracranial FFS, and freedom from local failure for treated lesions.


Use of Helical TomoTherapy for the Focal Hypofractionated Treatment of Limited Brain Metastases in the Initial and Recurrent Setting.

Elson A, Walker A, Bovi JA, Schultz C - Front Oncol (2015)

Kaplan–Meier survival curves depicting (A) overall survival from initial diagnosis of malignancy, (B) overall survival from the completion of TomoTherapy, (C) intracranial failure free survival, and (D) freedom from local failure for treated lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321406&req=5

Figure 3: Kaplan–Meier survival curves depicting (A) overall survival from initial diagnosis of malignancy, (B) overall survival from the completion of TomoTherapy, (C) intracranial failure free survival, and (D) freedom from local failure for treated lesions.
Mentions: Figure 3 depicts Kaplan–Meier survival curves for OS from initial diagnosis, OS from the completion of TomoTherapy, intracranial FFS, and freedom from local failure for treated lesions.

Bottom Line: We reviewed our institutional experience to assess patient selection factors, fractionation scheme, and outcomes associated with this technique.Freedom from local failure for treated lesions was 71% and 59% at 6 and 12 months.TomoTherapy-based hypofractionated radiotherapy to a limited number of metastatic lesions is associated with acceptable intracranial disease control and survival outcomes and represents a viable treatment option in the primary and recurrent setting for select patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College of Wisconsin , Milwaukee, WI , USA.

ABSTRACT

Background: Whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), or both are commonly employed in the treatment of limited brain metastases in the initial or recurrent setting. Hypofractionated partial volume irradiation is also employed, however, published experience using helical TomoTherapy (HT) for this purposes is limited. We reviewed our institutional experience to assess patient selection factors, fractionation scheme, and outcomes associated with this technique.

Methods: A retrospective chart review was performed to evaluate patients treated with partial volume hypofractionated HT-based IMRT for brain metastases at our institution.

Results: Thirteen patients (7M/6F, median age 62, median KPS 90) with a limited (1-9) number of brain metastases in the primary or recurrent setting were identified. Primary malignancies included colorectal (3), NSCLC (5), RCC (1), breast (1), melanoma (1), uterine (1), and ovarian (1). The median time from initial diagnosis to brain metastases was 20.7 months (range 0-61.3). Treatment was delivered to intact metastases in six patients, to a single resection cavity in six patients, and to both in one patient. A total of 27 lesions were treated. The median number of intact metastases treated was two (range 1-9). Previous treatments included WBRT (5), WBRT + SRS (3), SRS alone (1), and none (4). The most common fractionation schemes were 25 Gy in five fractions and 27.5 Gy in five fractions to each lesion. At a median of 6 months follow up (range 1.26-20.13) after TomoTherapy, 10 patients were deceased, 2 were alive, and 1 was lost to follow up. Systemic progression occurred in seven patients and intracranial progression occurred in five. The median intracranial progression free survival and overall survival after TomoTherapy was 6.3 months. Freedom from local failure for treated lesions was 71% and 59% at 6 and 12 months.

Conclusion: TomoTherapy-based hypofractionated radiotherapy to a limited number of metastatic lesions is associated with acceptable intracranial disease control and survival outcomes and represents a viable treatment option in the primary and recurrent setting for select patients.

No MeSH data available.


Related in: MedlinePlus