title: Simultaneous integrated boost with intensity modulated radiation therapy in brain oligometastases: A feasible technique for developing countries.
abstract: BACKGROUND
  To analyze the pattern of brain metastasis (BM), and to use intensity modulated radiation therapy (IMRT) for target dose escalation in cases with ≤3 metastatic lesions (oligometastases).
  
  
  METHODS
  Thirty-two consecutive cases of BM treated during September 2009 to August 2012 were analyzed retrospectively.
  
  
  RESULTS
  The study comprised 13 males (40.62%) and 19 females (59.37%). Thirteen (40%) patients presented with disseminated intracranial metastases, while 19 (60%) had ≤3 foci. In 25 cases (78%), the primary was located either in the breast (14 cases) or lung (11 cases). The 13 patients with disseminated intracranial metastases received whole brain radiation therapy to a dose of 30 Gy/10-12 daily fractions (Group A) while the 19 cases with ≤3 lesions received an additional dose of 6-10 Gy to gross lesions using a simultaneous integrated boost (SIB) with IMRT thus receiving a total dose of 36-40 Gy/12-15 fractions (Group B). Overall survival (OS) for the breast primary was 6.3 and lung primary was 5.3 months, respectively. The mean OS for breast cases in Group B was higher (9.5 months) as compared to Group A cases (1.9 months) and was statistically significant (P = 0.0056). Similarly, primary lung cancer cases in Group B showed a mean OS of 8.75 months versus 2.6 months for Group A cases (P = 0.213).
  
  
  CONCLUSIONS
  IMRT is a safe and effective technique in cases with oligometastases for dose escalation in the form of SIB.
authors.affiliation: Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Tiwari
authors.affiliation: Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Subodh C
authors.initials: SC
authors.lastname: Pande
authors.affiliation: Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Verma
authors.affiliation: Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Goel
keywords: Intensity modulated radiation therapy; oligometastases; simultaneous integrated boost
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