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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2015
Randomized Controlled TrialDefining the optimal planning target volume in image-guided stereotactic radiosurgery of brain metastases: results of a randomized trial.
- John P Kirkpatrick, Zhiheng Wang, John H Sampson, Frances McSherry, James E Herndon, Karen J Allen, Eileen Duffy, Jenny K Hoang, Zheng Chang, David S Yoo, Chris R Kelsey, and Fang-Fang Yin.
- Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Surgery, Duke University, Durham, North Carolina. Electronic address: john.kirkpatrick@dm.duke.edu.
- Int. J. Radiat. Oncol. Biol. Phys. 2015 Jan 1;91(1):100-8.
PurposeTo identify an optimal margin about the gross target volume (GTV) for stereotactic radiosurgery (SRS) of brain metastases, minimizing toxicity and local recurrence.Methods And MaterialsAdult patients with 1 to 3 brain metastases less than 4 cm in greatest dimension, no previous brain radiation therapy, and Karnofsky performance status (KPS) above 70 were eligible for this institutional review board-approved trial. Individual lesions were randomized to 1- or 3- mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging (MRI). The resulting planning target volume (PTV) was treated to 24, 18, or 15 Gy marginal dose for maximum PTV diameters less than 2, 2 to 2.9, and 3 to 3.9 cm, respectively, using a linear accelerator-based image-guided system. The primary endpoint was local recurrence (LR). Secondary endpoints included neurocognition Mini-Mental State Examination, Trail Making Test Parts A and B, quality of life (Functional Assessment of Cancer Therapy-Brain), radionecrosis (RN), need for salvage radiation therapy, distant failure (DF) in the brain, and overall survival (OS).ResultsBetween February 2010 and November 2012, 49 patients with 80 brain metastases were treated. The median age was 61 years, the median KPS was 90, and the predominant histologies were non-small cell lung cancer (25 patients) and melanoma (8). Fifty-five, 19, and 6 lesions were treated to 24, 18, and 15 Gy, respectively. The PTV/GTV ratio, volume receiving 12 Gy or more, and minimum dose to PTV were significantly higher in the 3-mm group (all P<.01), and GTV was similar (P=.76). At a median follow-up time of 32.2 months, 11 patients were alive, with median OS 10.6 months. LR was observed in only 3 lesions (2 in the 1 mm group, P=.51), with 6.7% LR 12 months after SRS. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3-mm group, P=.10). The 12-month DF rate was 45.7%. Three months after SRS, no significant change in neurocognition or quality of life was observed.ConclusionsSRS was well tolerated, with low rates of LR and RN in both cohorts. However, given the higher potential risk of RN with a 3-mm margin, a 1-mm GTV expansion is more appropriate.Copyright © 2015 Elsevier Inc. All rights reserved.
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