Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases.
10.3857/roj.2012.30.2.53
- Author:
Seung Heon LEE
;
Kyu Chan LEE
;
Jinho CHOI
;
Hye Young KIM
;
Seok Ho LEE
;
Ki Hoon SUNG
;
Yunmi KIM
- Publication Type:Original Article
- Keywords:
Multiple brain metastases;
Poor prognostic;
RapidArc;
Volumetric modulated arc therapy
- MeSH:
Apraxias;
Brain;
Disease-Free Survival;
Follow-Up Studies;
Humans;
Magnetic Resonance Imaging;
Neoplasm Metastasis;
Paresis;
Radiotherapy, Intensity-Modulated
- From:Radiation Oncology Journal
2012;30(2):53-61
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. MATERIALS AND METHODS: Nine patients with multiple (> or =4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. RESULTS: The median biologically effective dose to metastatic tumors was 68.1 Gy10 and 67.2 Gy10 and the median brain volume irradiated more than 100 Gy3 were 1.9% (24 cm3) and 0.8% (13 cm3) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. CONCLUSION: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.
