(P111) Single-Isocenter Frameless Volumetric-Modulated Arc Radiosurgery for Multiple Intracranial Metastases

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Single-isocenter, frameless VMAR for multiple intracranial metastases can produce clinical outcomes comparable with those of conventional radiosurgery techniques.

Steven Lau, MD, PhD, Kaveh Zakeri, MD, Xiao Zhao, MD, Ruben Carmona, MAS, Erik Knipprath, Daniel R. Simpson, MD, Sameer K. Nath, MD, Gwe-Ya Kim, PhD, Parag Sanghvi, MD, Jona A. Hattangadi, MD, Clark C. Chen, MD, PhD, Kevin T. Murphy, MD; University of California, San Diego; University of California, Davis; Yale University

PURPOSE: Stereotactic radiosurgery is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric-modulated arc radiosurgery (VMAR) are poorly described. We report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases.

METHODS: Between 2009 and 2011, a total of 15 patients underwent frameless VMAR for multiple intracranial metastases using a single, centrally located isocenter. Among them, three patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median 3 per patient, range 2–13) were treated to a median dose of 20 Gy (range: 15–30 Gy). Three patients were treated with fractionated SRS. Follow-up, including clinical examination and magnetic resonance imaging (MRI), occurred every 3 months.

RESULTS: Median follow-up for all patients was 7.1 months (range: 1.1–24.3 mo), with 11 patients (73.3%) followed until death. For the remaining four patients alive at the time of analysis, median follow-up was 19.6 months (range: 9.2–24.3 mo). Overall survival (OS) at 6 months was 60.0% (95% confidence interval [CI], 40.3%–88.2%). Local control rates at 6 and 12 months were 91.7% (95% CI, 84.6%–100.0%) and 81.5% (95% CI, 67.9%–100.0%), respectively. Regional failure was observed in nine patients (60.0%), and seven patients (46.7%) received salvage therapy. Grade ≥ 3 treatment-related toxicity was not observed. Median total treatment time was 7.2 minutes (range: 2.8–13.2 min).

CONCLUSIONS: Single-isocenter, frameless VMAR for multiple intracranial metastases can produce clinical outcomes comparable with those of conventional radiosurgery techniques.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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