Single-Isocenter Multitarget Stereotactic Radiosurgery Is Safe and Effective in the Treatment of Multiple Brain Metastases

Joshua D Palmer; Nikhil T Sebastian; Jacquline Chu; Dominic DiCostanzo; Erica H Bell; John Grecula; Andrea Arnett; Dukagjin M Blakaj; John McGregor; James B Elder; Lanchun Lu; Wesley Zoller; Mark Addington; Russell Lonser; Arnab Chakravarti; Paul D Brown; Raju Raval

doi:10.1016/j.adro.2019.08.013

Single-Isocenter Multitarget Stereotactic Radiosurgery Is Safe and Effective in the Treatment of Multiple Brain Metastases

Adv Radiat Oncol. 2019 Sep 16;5(1):70-76. doi: 10.1016/j.adro.2019.08.013. eCollection 2020 Jan-Feb.

Authors

Joshua D Palmer^{1

2}, Nikhil T Sebastian¹, Jacquline Chu¹, Dominic DiCostanzo¹, Erica H Bell¹, John Grecula¹, Andrea Arnett¹, Dukagjin M Blakaj¹, John McGregor², James B Elder², Lanchun Lu¹, Wesley Zoller¹, Mark Addington¹, Russell Lonser², Arnab Chakravarti¹, Paul D Brown³, Raju Raval¹

Affiliations

¹ Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus Ohio.
² Department of Neurosurgery, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
³ Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.

Abstract

Purpose: Multiple studies have reported favorable outcomes for stereotactic radiosurgery (SRS) in the treatment of limited brain metastases. An obstacle of SRS in the management of numerous metastases is the longer treatment time using traditional radiosurgery. Single-isocenter multitarget (SIMT) SRS is a novel technique that permits rapid therapy delivery to multiple metastases. There is a lack of clinical evidence regarding its efficacy and safety. We report the outcomes of patients treated with this technique.

Methods and materials: We reviewed the records of patients with intact or resected brain metastases treated with SRS in 1 to 5 fractions using SIMT technique at our institution, with at least 1 available follow-up brain magnetic resonance imaging. Survival, disease control, and toxicity were evaluated using Cox regression, logistic regression, and Kaplan-Meier analysis.

Results: We identified 173 patients with 1014 brain metastases. Median follow up was 12.7 months. Median beam-on time was 4.1 minutes. The median dose to the brain was 219.4 cGy. Median overall survival and freedom from intracranial progression were 13.2 and 6.3 months, respectively. Overall survival did not differ between patients treated with greater than or less than 4 lesions (hazard ratio, 1.03; 95% confidence interval 0.66-1.61; P = .91). Actuarial 1- and 2-year local control were 99.0% and 95.1%, respectively. Rates of grade 2 and grade 3 or higher radionecrosis were 1.4% and 0.9%, respectively.

Conclusions: SIMT radiosurgery delivered in 1 to 5 fractions offers excellent local control and acceptable toxicity in the treatment of multiple intact and postoperative brain metastases. This technique should be evaluated prospectively.