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Evaluation of Target Volume Determination for Single Session Stereotactic Radiosurgery (SRS) of Brain Metastases

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... Target volume definition plays a central role in radiosurgical treatments. Multimodality imaging may be utilized for determining radiosurgery treatment volumes [28]. For radiotherapeutic management of meningiomas, Magnetic Resonance Imaging (MRI) has been utilized for several purposes including detection, localization and target definition, lesion characterization, differentiation of meningioma grades based on imaging features, prediction of clinical agressiveness, assessment of treatment response and prognosis [29][30][31][32][33][34][35][36]. ...
... IGRT techniques may offer improved target localization, and combined use of registered CT and MR images may assist in optimization of treatment volume definition for precise RT delivery. Multimodality imaging for irradiation treatment volume determination has been assessed in several studies [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Our study may add to the literature with regard to addressing of multimodality imaging for treatment volume determination for chordoma irradiation. ...
... Steep dose gradients around the radiosurgical target typically provides improved sparing of surrounding normal tissues, which is a prerequisite for radiation treatments delivering high fractional doses. In this context, accurate target definition is a rule of thumb in precision radiosurgical treatments [24]. While treatment planning is mostly performed by using Computed Tomography (CT) simulation in several departments of radiation oncology, additional imaging data from multimodality imaging may be exploited to tailor and refine optimal target determination for radiosurgery. ...
... Screening of familial CCMs may be performed by using susceptibility weighted MRI. Utility of neuroimaging with MRI for determination of central nervous system radiotherapy and radiosurgery target volumes has been addressed in the literature [41][42][43][44][45][46][47][48][49]. In the context of CCM radiosurgery, MRI improves precision in target definition by producing additional imaging data for accurate target localization. ...
... In this context, our study may add to the existing body of literature by reporting improved target determination by incorporation of MRI in radiation treatment planning of CNs. Several other studies have also suggested a role for multimodality imaging in target volume definition for precision RT [51][52][53][54][55][56][57][58][59][60][61][62]. ...
Article
Objective Meningiomas are most common intracranial benign tumors comprising around one third of all intracranial neoplasms, and typically have benign and indolent nature with slow-growing behaviour. Benign meningiomas are slow growing tumors typically following an indolent disease course. Nevertheless, atypical or anaplastic meningiomas may follow a more aggressive disease course with invasion of critical structures and recurrences. In the current study, we evaluate the incorporation of magnetic resonance imaging (MRI) for radiosurgery treatment planning of atypical meningiomas. Materials and Methods Atypical meningioma radiosurgery target volume determination with and without incorporation of MRI has been evaluated. Ground truth target volume used as the reference has been outlined by the board-certified group of radiation oncologists after comprehensive assessment, thorough collaboration and consensus. Results Target volume definition by use of Computed Tomography (CT)-only imaging and by CT-MR fusion based imaging has been comparatively evaluated in this study for linear accelerator (LINAC)-based radiosurgical management of atypical meningioma. Ground truth target volume defined by the board-certified radiation oncologists after detailed evaluation, collaboration, colleague peer review and consensus has been found to be identical to target determination by use of CT-MR fusion based imaging. Conclusion Despite significant progress in neurosurgical techniques over the years, complete surgical resection may not be feasible in the presence of meningiomas located at eloquent brain areas in close association with important neurovascular structures. RT may have a role in multidisciplinary management of meningiomas. Incorporation of MRI into treatment planning for radiosurgery of atypical meningiomas may improve target definition despite the need for further supporting evidence.
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p>Breast cancer (Ca) remains to be the most frequent cancer among females and a leading cause of cancer associated mortality worldwide. Main modalities for management of breast Ca include surgery, Radiation Therapy (RT), and systemic treatments. Diagnosis at earlier stages of breast Ca is increasing with rigorous utilization of screening and raised public awareness. Improvements in therapy contribute to longer life expectancies for patients with breast Ca. In this context, adverse radiation effects are being a more pronounced aspect of breast Ca management recently. While the adverse effects of irradiation in earlier studies may have led to unfavorable outcomes for some patients with breast Ca, toxicity profile of radiation delivery has been improved with introduction of modernized equipment and contemporary techniques such as Breathing Adapted Radiation Therapy (BART), Image Guided Radiation Therapy (IGRT), Intensity Modulated Radiation Therapy (IMRT) and Adaptive Radiation Therapy (ART). Individualized patient positioning has also been utilized for improved normal tissue sparing while maintaining target coverage. While the conflicting results of cardiac dosimetry among different studies may partly be explained by variations in delineation and treatment techniques between treatment centers, prone positioning may be considered for at least a selected group of breast Ca patients as a viable alternative to supine positioning. Herein, we evaluate critical organ dosimetry with focus on heart exposure in supine versus prone patient positioning for breast irradiation. </p
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p>Objective: Management options for bone metastases include surgical interventions, Radiation Therapy (RT), chemotherapy and other systemic and targeted agents. RT as external beam irradiation and by use of stereotactic radiotherapeutic approaches has been utilized for safe and efficacious management of bone metaseses. In the context of bone metastases with extraosseous soft tissue mass, the issue of irradiation target definition is a critical component of radiotherapeutic management for successful treatment. Herein, we evaluated target definition for irradiation of bone metastases with soft tissue component by incorporation of multimodality imaging. Materials and methods: RT target definition for irradiation of bone metastases with soft tissue component was assessed in this study. Results: Patients receiving palliative irradiation for bone metastases with soft tissue component were assessed for target volume determination. Treatment planning process was performed using the Elekta Precise treatment planning system (Elekta, UK) at our department. Definition of ground truth target volume was performed by the board certified radiation oncologists following meticulous evaluation, colleague peer review, collaboration, and ultimate consensus. Synergy (Elekta, UK) LINAC was used for irradiation. Comparative assessment in our study revealed that ground truth target volume was identical with target volume definition by CT-MR fusion based imaging. Conclusion: Incorporation of multimodality imaging in target definition of bone metastases with soft tissue component may be utilized for improving the accuracy for precise RT despite the need for further supporting evidence.</p
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p>Objective: Medulloblastoma is a frequent childhood brain tumor which may occur in the vermis, cerebellum and posterior fossa. Affected patients may suffer from a variety of symptoms due to elevated intracranial pressure and may present with headaches, nausea and vomiting, cranial deficits, truncal ataxia, titubation of the head, alterations in mental status and gait disturbances. Accuracy in target and treatment volume definition has been thoroughly studied to achieve better outcomes. Herein, we assessed posterior fossa target definition by multimodality imaging patients with medulloblastoma. Materials and methods: In this study, posterior fossa target definition with multimodality imaging by incorporation of Magnetic Resonance Imaging (MRI) or by Computed Tomography (CT)-simulation images only was evaluated comparatively for patients with medulloblastoma. Board certified radiation oncologists have outlined the ground truth target volume as the reference for actual treatment and for comparison purposes after thorough assessment, collaboration, colleague peer review, and ultimate consensus. Results: RT planning was performed by use of the available treatment planning systems at our tertiary referral institution with prioritization of target coverage and normal tissue sparing to improve the therapeutic ratio. Decision making for individualized patient management was performed by multidisciplinary evaluation of experts from neurosurgery, radiology, pediatric oncology, medical oncology, and radiation oncology. Synergy (Elekta, UK) LINAC was used for RT administration. Ground truth target volume was found to be identical with target volume definition with CT-MR fusion based imaging as the result of this study. Conclusion: Multimodality imaging should be strongly considered for improved posterior fossa RT target definition of medulloblastoma. Apparently, further studies may be needed to shed light on this issue.</p
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Surgery is the principal treatment for safely accessible hemorrhagic and symptomatic cavernous malformations. Nevertheless, the role of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in the management of high-risk, symptomatic cavernoma lesions warrants further refinement. In this study, we evaluate the use of LINAC-based SRS for cerebral cavernous malformations (CMs) and report our 15-year single-center experience. A retrospective study from the Department of Radiation Oncology and the Department of Neurosurgery at Gulhane Military Medical Academy and Medical Faculty, Ankara from April 1998 to June 2013. Fifty-two patients (22 females and 30 males) with cerebral CM referred to our department underwent high-precision single-dose SRS using a LINAC with 6-MV photons. All patients had at least 1 bleeding episode prior to radiosurgery along with related symptoms. Median dose prescribed to the 85% to 95% isodose line encompassing the target volume was 15 Gy (range, 10-20). Out of the total 52 patients, follow-up data were available for 47 patients (90.4%). Median age was 35 years (range, 19-63). Median follow-up time was 5.17 years (range, 0.08-9.5) after SRS. Three hemorrhages were identified in the post-SRS period. Statistically significant decrease was observed in the annual hemorrhage rate after radiosurgical treatment (pre-SRS 39% vs post-SRS 1.21, P < .0001). Overall, there were no radiosurgery-related complications resulting in mortality. LINAC-based SRS may be considered as a treatment option for high-risk, symptomatic cerebral CM of selected patients with prior bleeding from lesions located at surgically inaccessible or eloquent brain areas.
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Although benign histologically, craniopharyngiomas may display clinically malignant behavior with a strong propensity for recurrence. Contemporary therapeutic approaches for craniopharyngiomas include stereotactic irradiation in the form of Stereotactic Radiosurgery (SRS) or Fractionated Stereotactic Radiation Therapy (FSRT) as part of multimodality treatment particularly when complete surgical removal is not feasible. In this study, we evaluate the use of Linear Accelerator (LINAC)-based SRS in the multidisciplinary management of patients with craniopharyngiomas. Between July 1998 and July 2013, 20 patients (11 male, 9 female) with residual or recurrent craniopharyngiomas were treated using LINAC-based SRS at Department of Radiation Oncology, Gulhane Military Medical Academy. Median age was 37 (9-69) years. Median tumor volume was 1.1(0.9-6.9) cc. Median dose was 13 Gy (range: 10-16 Gy) prescribed to the 80%-95% isodose line encompassing the target volume. Median follow-up time was 47 (7-93) months. Overall local control rate was 88% at 1 year, 79% at 3 years and 66% at 5 years. Three and 5-year progression free survival rates were 95% and 91% whereras 3 and 5-year overall survival rates were 94% and 88%, respectively. Our study supports the usage of LINAC-based SRS as a safe and effective management strategy for patients with recurrent or residual craniopharyngiomas.
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SUMMARY Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
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The aim of this study was to evaluate the efficiency of stereotactic radiosurgery (SRS) in the management of pituitary adenomas. Between June 1998 and July 2011, 57 patients with pituitary adenomas were treated using SRS at our department. All patients underwent high-precision single dose SRS using a linear accelerator with 6-MV photons. Median follow-up time was 31.5 (3-92) months. Median age was 40 years (range: 19-57 years). Radiological tumor growth control was achieved in 48 patients (84.2%) (a decrease in tumor size in 25 patients and no change in tumor size in 23 patients). 13 patients with functioning adenomas had available biochemical follow-up and biochemical complete response was achieved in 8 (61.5%) of these 13 patients. Treatment of pituitary adenomas using LINAC-based single dose SRS is safe and effective in improving local tumor and biochemical control.
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Aims and background: The aim of the study was to evaluate the feasibility, toxicity and effectiveness of active breathing control-guided stereotactic body radiotherapy in the management of pulmonary oligometastases. Methods and study design: Between June 2010 and June 2012, 20 patients (13 males, 7 females) with 31 pulmonary metastases referred to the Department of Radiation Oncology, Gulhane Military Medical Academy were treated using active breathing control-guided stereotactic body radiotherapy. Response Evaluation Criteria in Solid Tumors and Common Terminology Criteria for Adverse Events were used in the assessment of treatment response and toxicity, respectively. Results: Assessment of treatment response revealed complete response, partial response, stable disease, and progressive disease in 30%, 25%, 30%, and 15% of the patients, respectively. At a median follow-up of 14 months, local control was 85% and overall survival was 70%, with negligible treatment-related toxicity. Conclusions: Stereotactic body radiotherapy is safe and effective in the management of pulmonary oligometastases. It offers favorable treatment outcomes as a viable non-invasive therapeutic modality.
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Purpose: Stereotactic radiosurgery (SRS) has emerged as a viable alternative to surgery in the management of meningioma through exploiting the advantage of being minimally invasive with few complications and acceptable local control rates. The aim of this study was to evaluate the efficiency of linear accelerator (LINAC)-based SRS in the management of meningiomas and to report our experience using this sophisticated technique. Methods: Between July 1998 and March 2012, 79 patients (42 female, 37 male) were treated using LINAC-based SRS in the Department of Radiation Oncology, Gulhane Military Medical Academy. Median dose was 13 Gy (range 10- 16) prescribed to the 80-95% isodose line encompassing the target. Results: Median follow-up time was 53 months (range 9-112). Median tumor volume was 3.43 cc (range 0.3-14.1). Local tumor control was 89.7% in the 68 patients with adequate follow-up. Conclusion: LINAC-based SRS offers a safe and effective treatment alternative to surgery in intracranial meningiomas with high local control rates and low morbidity.
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The purpose of this study is to evaluate the use of linear accelerator (LINAC)-based stereotactic body radiotherapy (SBRT) boost with multileaf collimator technique after pelvic radiotherapy (RT) in patients with endometrial cancer. Consecutive patients with endometrial cancer treated using LINAC-based SBRT boost after pelvic RT were enrolled in the study. All patients had undergone surgery including total abdominal hysterectomy and bilateral salpingo-oophorectomy ± pelvic/paraortic lymphadenectomy before RT. Prescribed external pelvic RT dose was 45 Gray (Gy) in 1.8 Gy daily fractions. All patients were treated with SBRT boost after pelvic RT. The prescribed SBRT boost dose to the upper two thirds of the vagina including the vaginal vault was 18 Gy delivered in 3 fractions with 1-week intervals. Gastrointestinal and genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events version 3 (CTCAE v 3).Between April 2010 and May 2011, 18 patients with stage I-III endometrial cancer were treated with LINAC-based SBRT boost after pelvic RT. At a median follow-up of 24 (8-26) months with magnetic resonance imaging (MRI) and gynecological examination, local control rate of the study group was 100 % with negligible acute and late toxicity.LINAC-based SBRT boost to the vaginal cuff is a feasible gynecological cancer treatment modality with excellent local control and minimal toxicity that may replace traditional brachytherapy boost in the management of endometrial cancer. Keywords: endometrial cancer, stereotactic body radiotherapy, brachytherapy.
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Brain metastasis is one of the most common diagnoses encountered by neurologists, neurosurgeons, radiologists, and oncologists. The aim of this article is to review imaging modalities used in the diagnosis and follow-up of brain metastases. Through the use of various imaging techniques more accurate preoperative diagnosis and more precise intraoperative planning can be made. Post-treatment evaluation can also be refined through the use of these imaging techniques.
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Brain metastases are common and often occur in patients whose systemic cancer is quiescent. When brain metastases occur, they considerably decrease the quality of life in patients who otherwise might be functional. An early diagnosis and vigorous treatment of the brain metastasis, while only rarely curative, may lead to a useful remission of the brain symptoms and may both enhance the quality of the patient's life and prolong survival. Patients with known cancer and neurological symptoms should all undergo appropriate diagnostic tests which include either CT scan or magnetic resonance imaging and, if a lesion is found and a definitive diagnosis can not be established, biopsy. Single or solitary brain metastases in patients with good systemic performance status should be strongly considered for surgical extirpation which will both make the diagnosis and deliver definitive treatment to the lesion. Patients with poor systemic performance status and/or multiple brain metastases are candidates for whole brain radiation therapy. Whole brain radiation therapy is also indicated in patients after successful surgical extirpation of a single metastasis. The role of focal radiation therapy and chemotherapy in the treatment of brain metastases is still being evaluated. Preliminary evidence suggests that focal radiation therapy is probably useful for the treatment of relapsed metastases and that chemotherapy may be useful in the primary treatment of small or asymptomatic brain metastases. Appropriate use of therapeutic modalities directed at brain tumors will ameliorate symptoms in most patients and usually increase survival and enhance the quality of the patient's life.
Article
A national survey, based on a probability sample of patients admitted to short-term hospitals in the United States during 1973 to 1974 with a discharge diagnosis of an intracranial neoplasm, was conducted in 157 hospitals. The annual incidence was estimated at 17,000 for primary intracranial neoplasms and 17,400 for secondary intracranial neoplasms--8.2 and 8.3 per 100,000 US population, respectively. Rates of primary intracranial neoplasms increased steadily with advancing age. The age-adjusted rates were higher among men than among women (8.5 versus 7.9 per 100,000). However, although men were more susceptible to gliomas and neuronomas, incidence rates for meningiomas and pituitary adenomas were higher among women.
Article
Metastatic brain tumors can be accurately identified by the appropriate combination of clinical and laboratory tests in almost all patients. Metastatic brain tumors produce devastating symptoms which can be effectively treated in over half the patients at least for several mth, and occasionally for longer than a yr. Steroid hormones are the first line of treatment for metastatic tumors, and will ameliorate symptoms in about two thirds of patients; however, these drugs are not sufficient for long term treatment. In most patients with metastatic brain tumors, radiation therapy following steroid hormones is the treatment of choice. The best treatment modalities are not known, and controlled trials are necessary to establish the best possible radiation parameters. Radiation therapy can be expected to improve the condition of the majority of patients and to yield a median survival somewhere between three and six mth, with about 15% of patients surviving longer than a yr. A controlled trial is necessary to establish whether or not surgical therapy of metastatic brain tumors produces a better quality and quantity of survival than radiation therapy. Whether single cerebral metastases should be operated on still remains unclear in the absence of a controlled trial. Indications for surgical treatment are given.
Article
Our experience with radiosurgery of brain metastases is based on 160 patients with 235 tumors treated over a 16-year period. In this material, 94% growth control was achieved. Radiosurgery appears to be an effective, low-morbidity substitute for surgical resection followed by whole brain radiotherapy and even indicated for multiple metastases and distant new tumors. More patients receive an effective treatment with less neurologically related deaths.
Article
With the advent of new therapies for metastatic carcinoma to the brain, patterns of intracranial disease and factors influencing survival become important considerations when examining potential treatment options. The records of 729 patients with metastases to the brain treated during the period between 1973 to 1993 were reviewed. Primary tumor histologic type in order of descending frequency included nonsmall cell lung carcinoma (NSCLC), breast carcinoma, small cell lung carcinoma (SCLC), malignant melanoma, renal cell carcinoma, gastrointestinal carcinoma, uterine/vulvar carcinoma, and unknown primary carcinoma. There were 384 patients (53%) with a single brain metastasis, which was encountered most commonly in patients with prostate carcinoma and least often in patients with SCLC. Multiple metastases were present in 345 patients (47%). The median duration from diagnosis to presentation with a brain metastasis was 12 months, ranging from 3 months for patients with NSCLC to 53 months for patients with breast carcinoma. The median duration from presentation with brain metastases to death was 4 months, ranging from 3 months for patients with SCLC to 13 months for patients with prostate carcinoma. Median survival from presentation with brain metastases to death was 5 months for patients with single lesions and 3 months for patients with multifocal disease (P = 0.0001). Median survival for patients with a single lesion was 11 months with surgery and 3 months without surgery (P = 0.0001). Surgery did not significantly influence survival in patients with multiple metastases. Dissemination of systemic carcinoma to the brain continues to carry a poor prognosis. Knowledge of the metastatic patterns and limited survival associated with specific tumor types may be useful for guiding future therapeutic intervention.
Article
This phase II, open-label, multicenter study assessed the efficacy and safety of the potential radiation enhancer RSR13 plus cranial radiation therapy (RT) in patients with brain metastases. The primary end point was patient survival in comparison with the Radiation Therapy Oncology Group Recursive Partitioning Analysis Brain Metastases Database (RTOG RPA BMD). Eligibility criteria were age > or = 18 years, Karnofsky performance score > or = 70, and brain metastases with solid tumor histology. Patients received cranial RT, 30 Gy in 10 fractions of 3 Gy each, preceded by RSR13, 50 to 100 mg/kg intravenously over 30 minutes. Univariate and multivariate comparisons of survival and cause of death were made between class II study patients and RTOG BMD patients. Fifty-seven RPA class II patients were enrolled. With a minimum follow-up of 24 months, the median survival time and 1- and 2-year survival rates were 6.4 months, 23%, and 11% for the RSR13-treated patients compared with 4.1 months, 15%, and 3% for the RTOG BMD patients (P =.0174). In an exact-matched case analysis (n = 38), median survival time for RSR13 patients was 7.3 months versus 3.4 months for the RTOG BMD patients (P =.006). There was a 54% reduction in the risk of death for RSR13 patients (P =.0267). RSR13-related adverse events of greater than or equal to grade 3 toxicity that occurred in more than one patient included hypoxia, headache, anemia, fatigue, hypertension, and intracranial hypertension. RSR13 plus cranial RT resulted in a significant improvement in survival, as well as a reduction in death due to brain metastases, compared with class II patients in the RTOG BMD.
Intracerebral metastases in solid-tumor patients: natural history and results of treatment
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Evaluation of Target Volume Determination for Single Session Stereotactic Radiosurgery (SRS) of Brain Metastases. Canc Therapy &
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How to cite this article: Selcuk D, Omer S, Ferrat D, Bora U, Hakan G, et al. Evaluation of Target Volume Determination for Single Session Stereotactic Radiosurgery (SRS) of Brain Metastases. Canc Therapy & Oncol Int J. 2018; 12(5): 555848. DOI: 10.19080/CTOIJ.2018.12.555848 004 Cancer Therapy & Oncology International Journal
Current therapy for brain tumors: back to the future
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  • M Nowosielski
  • A Radbruch
Nowosielski M, Radbruch A (2015) The emerging role of advanced neuroimaging techniques for brain metastases. Chin Clin Oncol 4(2): different formats ( Pdf, E-pub, Full Text, Audio) • Unceasing customer service Track the below URL for one-step submission https://juniperpublishers.com/online-submission.php