Radiosurgery for multiple brain metastases using volumetric modulated arc therapy: a single institutional series

Area of Science:

• Radiation Oncology
• Neurosurgery
• Medical Physics

Background:

• Improved diagnosis and oncologic treatments have increased survival for patients with brain metastases (BM).
• Volumetric modulated arc therapy (VMAT) combined with image-guided radiation therapy (IGRT) enables complex dose distributions for brain radiosurgery (SRS).
• This technology allows for faster treatment delivery to multiple metastatic lesions in the brain.

Purpose of the Study:

• To evaluate the efficacy and safety of VMAT-SRS for treating multiple brain metastases.
• To assess local disease-free survival (LDFS) and overall survival (OS) as primary endpoints.
• To determine intracranial disease-free survival (IDFS) and meningeal disease-free survival (MDFS) as secondary outcomes.

Main Methods:

• Retrospective analysis of 113 patients with brain metastases treated with VMAT-SRS.
• Average of 5.79 lesions treated per patient (range: 2-20).
• Mean prescribed dose of 18 Gy (range: 12-24 Gy).

Main Results:

• Median LDFS was 46 months; 6-, 12-, and 24-month LDFS rates were 86%, 79%, and 63%.
• Median OS was 47 months; 6-, 12-, and 24-month OS rates were 75%, 69%, and 61%.
• Low rates of toxicity, radionecrosis (10%), and neurocognitive impairment were observed.

Conclusions:

• VMAT-SRS is a feasible and effective technique for treating multiple brain metastases.
• The treatment is associated with favorable local control and survival outcomes.
• VMAT-SRS demonstrates a favorable safety profile with low toxicity rates.