Optically-guided frameless linac-based radiosurgery for brain metastases: clinical experience.
The purpose of this study was to describe our clinical experience using optically-guided linear accelerator (linac)-based frameless stereotactic radiosurgery (SRS) for the treatment of brain metastases. Sixty-five patients (204 lesions) were treated between 2005 and 2008 with frameless SRS using an optically-guided bite-block system. Patients had a median of 2 lesions (range, 1-13). Prescription dose ranged from 14 to 22 Gy (median, 18 Gy) and was given in a single fraction. Clinical and radiographic evaluation occurred every 2-4 months following treatment. At a median follow-up of 6.2 months, actuarial survival at 12 months was 40% [95% confidence interval (CI), 28-52). Of 135 lesions that were evaluable for local control (LC), 119 lesions (88%) did not show evidence of progression. Actuarial 12 month LC was 76% (95% CI, 66-86). Tumors <or=2 cm in size had a better 12 month LC rate (81% vs. 36%, P = 0.017) than those >2 cm. Adverse events occurred in three patients (5%). Optically-guided linac-based frameless SRS can produce clinical outcomes that compare favorably to frame-based techniques. As this technique is convenient to use and allows for the uncomplicated delivery of hypofractionated radiotherapy, frameless SRS will likely have an increasingly important role in the management of brain metastases.
Nath
Sameer K
SK
Department of Radiation Oncology, Rebecca and John Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, CA 92093-0843, USA. sameerknath@gmail.com
Lawson
Joshua D
JD
Wang
Jia-Zhu
JZ
Simpson
Daniel R
DR
Newman
C Benjamin
CB
Alksne
John F
JF
Mundt
Arno J
AJ
Murphy
Kevin T
KT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016371:Cranial Irradiation / Q000295:instrumentation / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D010315:Particle Accelerators / Q000295:instrumentation*; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods*; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D055815:Young Adult
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