Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing.
Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, University Hospital in Olomouc, Olomouc 77900, Czech Republic; Toxicogenomics Unit, National Institute of Public Health, Prague 10042, Czech Republic.
David
D
Vrána
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Hana
H
Študentová
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Marcel
M
Matzenauer
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Zuzana
Z
Vlachová
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Karel
K
Cwiertka
Department of Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
David
D
Gremlica
Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University, Olomouc 77900, Czech Republic.
Ondřej
O
Kalita
brain metastases; hippocampal-avoidance whole brain radiotherapy; renal cell cancer; stereotactic radiosurgery; stereotactic radiotherapy; whole brain radiotherapy