title: Single-isocenter frameless intensity-modulated stereotactic radiosurgery for simultaneous treatment of multiple brain metastases: clinical experience.
abstract: OBJECTIVE
  To describe our clinical experience using a unique single-isocenter technique for frameless intensity-modulated stereotactic radiosurgery (IM-SRS) to treat multiple brain metastases.
  
  
  METHODS
  Twenty-six patients with a median of 5 metastases (range, 2-13) underwent optically guided frameless IM-SRS using a single, centrally located isocenter. Median prescription dose was 18 Gy (range, 14-25). Follow-up magnetic resonance imaging (MRI) and clinical examination occurred every 2-4 months.
  
  
  RESULTS
  Median follow-up for all patients was 3.3 months (range, 0.2-21.3), with 20 of 26 patients (77%) followed up until their death. For the remaining 6 patients alive at the time of analysis, median follow-up was 14.6 months (range, 9.3-18.0). Total treatment time ranged from 9.0 to 38.9 minutes (median, 21.0). Actuarial 6- and 12-month overall survivals were 50% (95% confidence interval [C.I.], 31-70%) and 38% (95% C.I., 19-56%), respectively. Actuarial 6- and 12-month local control (LC) rates were 97% (95% C.I., 93-100%) and 83% (95% C.I., 71-96%), respectively. Tumors <or=1.5 cm had a better 6-month LC than those >1.5 cm (98% vs. 90%, p = 0.008). New intracranial metastatic disease occurring outside of the treatment volume was observed in 7 patients. Grade >or=3 toxicity occurred in 2 patients (8%).
  
  
  CONCLUSIONS
  Frameless IM-SRS using a single-isocenter approach for treating multiple intracranial metastases can produce clinical outcomes that compare favorably with those of conventional SRS in a much shorter treatment time (<40 minutes). Given its faster treatment time, this technique is appealing to both patients and personnel in busy clinics.
authors.affiliation: Department of Radiation Oncology, Rebecca and John Moores Cancer Comprehensive Cancer Center, University of California San Diego, La Jolla, CA 92093-0843, USA. sameerknath@gmail.com
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Nath
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lawson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Simpson
authors.forename: Lauren
authors.initials: L
authors.lastname: Vanderspek
authors.forename: Jia-Zhu
authors.initials: JZ
authors.lastname: Wang
authors.forename: John F
authors.initials: JF
authors.lastname: Alksne
authors.forename: Joseph
authors.initials: J
authors.lastname: Ciacci
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult