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Linac-based hypofractionated stereotactic radiotherapy for metastases involving the brainstem
Michael Ortiz1, Joseph Herbert1, Busha Hika1
1Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
Summary
Hypofractionated stereotactic radiotherapy (hSRT) offers effective brainstem metastasis treatment with good tumor control and mild toxicity. This 5-fraction regimen shows comparable survival and safety to single-fraction treatments.
Area of Science:
- Radiation Oncology
- Neuro-oncology
- Medical Physics
Background:
- Long-term data on hypofractionated stereotactic radiotherapy (hSRT) for brainstem metastases is limited.
- Brainstem involvement presents unique challenges for radiotherapy due to proximity to critical structures.
Purpose of the Study:
- To evaluate the efficacy and safety of hSRT in treating brainstem metastases.
- To assess survival, tumor control, and toxicity rates associated with hSRT for brainstem lesions.
Main Methods:
- Retrospective review of 20 patients treated with 5-fraction hSRT between 2016-2020.
- Treatment planning using Varian Eclipse v13.7 TPS with MRI-CT image fusion.
- Toxicity assessment using Radiation Therapy Oncology Group (RTOG) grading system.
Main Results:
- Median overall survival was 6.5 months; 12-month tumor control rate was 80%.
- Toxicity was generally mild, with only one case of Grade 3 toxicity.
- Radiographic progression occurred in two patients, neither requiring surgery.
Conclusions:
- hSRT in 5 fractions is a safe and effective treatment for brainstem metastases.
- This hypofractionated approach yields comparable outcomes to single-fraction radiotherapy.
- Dose escalation for lesions near the brainstem may be feasible with hSRT.
