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Control of brain metastases using frameless image-guided radiosurgery
Joseph C T Chen1, Darlene M Bugoci, Michael R Girvigian
1Department of Neurological Surgery, Southern California Permanente Medical Group, Los Angeles, California, USA. jctchen@yahoo.com
Neurosurgical Focus
|December 3, 2009
Summary
Image-guided radiosurgery (IGRS) effectively manages brain metastases, achieving high tumor control rates comparable to traditional frame-based methods. This technique shows particular promise for smaller lesions, enhancing treatment precision and patient outcomes.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Medical Imaging
Background:
- Radiosurgery is a standard treatment for brain metastases.
- Frame-based techniques offer high lesion control.
- Image-guided radiosurgery (IGRS) improves patient comfort and workflow but raises accuracy concerns.
Purpose of the Study:
- To evaluate the initial 15-month experience with image-guided radiosurgery (IGRS) using Novalis with ExacTrac for brain metastases.
- To compare the efficacy of IGRS with conventional frame-based radiosurgery.
Main Methods:
- Retrospective review of 54 patients with 108 brain metastases treated with IGRS over 15 months.
- Median prescribed dose of 18 Gy to the 80% isodose line.
- Post-treatment MR imaging every 2-3 months for lesion follow-up.
Main Results:
- Median follow-up of 9 months; median actuarial survival of 8.6 months.
- The 6-month actuarial lesion control rate was 88% for 90 lesions.
- Smaller lesions (< 1 cm³) showed a statistically significant improved likelihood of complete imaging response (p = 0.01).
Conclusions:
- IGRS for brain metastases achieves high tumor control rates, comparable to frame-based methods.
- High control rates are particularly noted for small lesions where dose delivery precision is crucial.
- IGRS using Novalis with ExacTrac is equivalent to frame-based radiosurgery for lesion control.
