NDLI: Biological implications of whole-brain radiotherapy versus stereotactic radiosurgery of multiple brain metastases.

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Biological implications of whole-brain radiotherapy versus stereotactic radiosurgery of multiple brain metastases.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Xue, Jinyu Kubicek, Gregory J. Grimm, Jimm LaCouture, Tamara Chen, Yan Goldman, H. Warren Yorke, Ellen
Description	Author Affiliation: Xue J ( Department of Radiation Oncology, MD Anderson Cancer Center at Cooper, and.)
Abstract	OBJECT: The efficacy and safety of treatment with whole-brain radiotherapy (WBRT) or with stereotactic radiosurgery (SRS) for multiple brain metastases (> 10) are topics of ongoing debate. This study presents detailed dosimetric and biological information to investigate the possible clinical outcomes of these 2 modalities. METHODS: Five patients with multiple brain metastases (n = 11-23) underwent SRS. Whole-brain radiotherapy plans were retrospectively designed with the same MR image set and the same structure set for each patient, using the standard opposing lateral beams and fractionation (3 Gy × 10). Physical radiation doses and biologically effective doses (BEDs) in WBRT and SRS were calculated for each lesion target and for the normal brain tissues for comparison of the 2 modalities in the context of clinical efficacy and published toxicities. RESULTS: The BEDs targeted to the tumor were higher in SRS than in WBRT by factors ranging from 2.4- to 3.0- fold for the mean dose and from 3.2- to 5.3-fold for the maximum dose. In the 5 patients, mean BEDs in SRS (calculated as percentages of BEDs in WBRT) were 1.3%-34.3% for normal brain tissue, 0.7%-31.6% for the brainstem, 0.5%-5.7% for the chiasm, 0.2%-5.7% for optic nerves, and 0.6%-18.1% for the hippocampus. CONCLUSIONS: The dose-volume metrics presented in this study were essential to understanding the safety and efficacy of WBRT and SRS for multiple brain metastases. Whole-brain radiotherapy results in a higher incidence of radiation-related toxicities than SRS. Even in patients with > 10 brain metastases, the normal CNS tissues receive significantly lower doses in SRS. The mean normal brain dose in SRS correlated with the total volume of the lesions rather than with the number of lesions treated.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	Suppl
Volume Number	121
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2014-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Brain Neoplasms Carcinoma, Non-small-cell Lung Lung Neoplasms Pathology Radiosurgery Radiotherapy Dosage Radiotherapy Surgery Breast Neoplasms Cranial Irradiation Adverse Effects Radiation Injuries Etiology Retrospective Studies Severity Of Illness Index Comparative Study
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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