LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation

Area of Science:

• Medical Physics
• Radiation Oncology
• Neurosurgery

Background:

• Stereotactic radiosurgery (SRS) is an evolving treatment for multiple brain metastases (BM).
• LINAC-based SRS offers patient-friendly features like precise positioning and short treatment times.
• Ensuring high-quality SRS is crucial to prevent complications like radionecrosis in BM patients.

Purpose of the Study:

• To provide guidance for high-quality LINAC-based SRS in patients with multiple BM.
• To focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT) for optimal treatment delivery.

Main Methods:

• Consensus statement from coordinators and physicists of four multi-center trials on BM treatment (SRS vs. WBRT).
• Summarizes quality assurance measures for imaging, treatment planning, and delivery.
• Focuses on optimizing image acquisition, contouring, planning margins, and delivery techniques.

Main Results:

• Minimize interval between planning MRI and treatment (< two weeks).
• Utilize single isocenter non-coplanar VMAT with flattening filter-free beams for efficiency and organ sparing.
• Benchmark SRS plan quality through inter-hospital comparisons.

Conclusions:

• This paper offers essential guidance for quality assurance in LINAC-based SRS for multiple BM.
• Optimized treatment delivery using VMAT and specific QA measures can improve patient outcomes.
• Standardized quality assurance is key to safe and effective SRS for brain metastases.