title: Early clinical outcomes for 3 radiation techniques for brain metastases: focal versus whole-brain.
abstract: OBJECTIVE
  To present our novel technique for brain metastases (low-dose whole brain radiation therapy [WBRT] with simultaneous integrated boost (SIB) and focal, frameless stereotactic intensity modulated radiotherapy [IMRT]) in the context of patterns of failure, dosimetry, acute toxicity, and overall survival for 3 different radiation techniques.
  
  
  METHODS
  We retrospectively reviewed 92 patients undergoing radiation for brain metastases via the following: (1) "prophylactic" WBRT to a low dose (median 30 Gy) with an SIB to the gross tumor volume plus 2-3 mm margin (median dose 45 Gy) in 10-15 fractions; (2) focal, frameless image-guided stereotactic IMRT (S-IMRT) in 5 fractions to tumor only (median 30 Gy); or (3) conventional (c)WBRT using 2 lateral opposed beams in 10-15 fractions (30-37.5 Gy). The primary endpoints were local (LBC), distant (DBC), and total brain control (TBC) for each of the 3 types of brain radiation. Survival, toxicity, and dosimetry were reported as secondary endpoints.
  
  
  RESULTS
  LBC was achieved in 72%, 78%, and 56% for SIB, S-IMRT, and cWBRT, respectively. DBC (ie, no new brain metastases) was observed in 92%, 67%, and 81% for SIB, S-IMRT, and cWBRT, respectively. TBC (LBC + DBC) was 72%, 67%, and 56% for SIB, S-IMRT, and cWBRT, respectively. No statistical difference in overall survival was observed (P = .067), and only 1 patient experienced biopsy proven radionecrosis.
  
  
  CONCLUSIONS
  TBC after low-dose WBRT with SIB was acceptable and at least comparable to S-IMRT and cWBRT. SIB seems to be a safe and effective treatment strategy for patients with brain metastases and may efficiently combine the benefits of cWBRT and stereotactic radiosurgery.
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia.
authors.forename: John A
authors.initials: JA
authors.lastname: Vargo
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia. Electronic address: bplants@charlestonradiation.com.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Plants
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Mihailidis
authors.affiliation: Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Jack
authors.initials: J
authors.lastname: Mallah
authors.affiliation: Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Plants
authors.affiliation: Charleston Area Medical Center Health Education and Research Institution (CHERI), Charleston, West Virginia.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Welch
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Grant M
authors.initials: GM
authors.lastname: Clark
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: Farinash
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Prem
authors.initials: P
authors.lastname: Raja
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Harmon
authors.affiliation: West Virginia University School of Medicine, Charleston, West Virginia; Charleston Radiation Therapy Consultants (CRTC), PLLC, Charleston, West Virginia.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Whaley