Autor: |
López, Escarlata, Rivas, Daniel, Arregui, Gregorio, Lazo, Antonio, Gómez, Joaquin, Sacchetti, Antonio |
Zdroj: |
Stereotactic & Functional Neurosurgery; 2016 Supplement 1, Vol. 94, p50-50, 1/2p |
Abstrakt: |
Introduction: Frameless radiosurgery has become a technique increasingly used for the treatment of brain metastases. A non-invasive system mask with Image Guided Radiation Therapy (IGRT) is a very attractive and comfortable alternative (Elekta ® system). Objective: We evaluate our clinical results in brain metastases treated with frameless radiosurgery plus IGRT. Patients and Methods: In ONCOSUR-Granada, between August 2010 and April 2016, we have treated 40 patients (50% male) with 131 brain metastases (1-11) and a mean age of 58.68 years (33-83). We have performed a total of 62 treatments. Our PTV margin was 2-3 mm. We have evaluated the clinical and therapeutic data. Results: Primary tumors were 17 lung, 10 breast, 5 melanomas, 2 kidneys, 1 cervix, 1 esophagus, 1 rectum, 1 ovary, 1 unknown primary, and 1 bladder. Only 16 patients were also treated with whole brain radiotherapy (WBRT). Radiation therapy techniques used were: 41 Volume Modulated Arc Therapy (VMAT); 21 Intensity Modulated Radiation Therapy Step-and-Shoot (IMRT SS). The hypofractionation schemes used were: 6 x 6 Gy fractions (8 cases) and 10 Gy x 3 fractions (16 cases). All patients received 2-3 weekly fractions. In the literature the positioning accuracy was between 1 to 4 mm for frameless stereotactic systems. In our series, the variation in repositioning with IGRT was: X = 0.24 mm (0.01- 0.65); Y = 0.23 mm (0.06-0.66); and Z = 0.23 mm (0.01-0.45). No severe side effects were detected. With a mean follow-up of 11.1 months (1-102), 7 patients are alive, 32 died (19 of them without WBRT). Our local control was 60% (treated patients have an average of 3.3 lesions). The causes of death were: brain progression in 16 patients; lung progression in 8 patients; liver progression in 2 patients; unknown reason in 4 patients and general deterioration in 3 patients. Conclusions: Frameless radiosurgery is effective for local control and a comfortable treatment in the treatment of brain metastases. The noninvasive mask system plus IGRT is associated with a highly accurate repositioning. [ABSTRACT FROM AUTHOR] |
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