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Related Concept Videos

Brainstem: Control Centers of Medulla01:21

Brainstem: Control Centers of Medulla

The medulla oblongata is a crucial part of the brainstem responsible for controlling various autonomic and involuntary functions. It contains several nuclei, including the olivary, cuneate, gracile, and solitary nuclei.
Olivary Nucleus
The olivary nucleus, or inferior olivary nucleus, is located within the ventrolateral part of the medulla oblongata. It is primarily involved in motor coordination and motor learning. The olivary nucleus receives input from the spinal cord, cerebellum, and motor...

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Stereotactic Radiosurgery for Gynecologic Cancer
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Local Control After Single-Isocenter Dynamic Conformal Arc SRS for Brain Metastases.

Maciej Blok1,2, Izabela Zarebska1, Izabela Miechowicz3

  • 1Franciszek Lukaszczyk Memorial Oncology Center, Department of Neurooncology and Radiosurgery, 85-796 Bydgoszcz, Poland.

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Summary

Dynamic conformal arc single-isocenter, multi-target (DCA-SIMT) stereotactic radiosurgery provides excellent local control for multiple brain metastases. Key factors for success include conformity index and margin expansion, with systemic therapy enhancing outcomes.

Keywords:
DCASRSbrainmetastasesradiosurgery

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Area of Science:

  • Radiation Oncology
  • Neurosurgery
  • Medical Physics

Background:

  • Brain metastases are a common complication of advanced cancer, posing significant treatment challenges.
  • Whole-brain radiation therapy (WBRT) has limited efficacy and significant neurocognitive side effects.
  • Stereotactic radiosurgery (SRS) has emerged as a preferred treatment, with advancements enabling efficient management of multiple lesions.

Purpose of the Study:

  • To evaluate the local control rates of dynamic conformal arc single-isocenter, multi-target (DCA-SIMT) radiosurgery for multiple brain metastases.
  • To identify factors influencing treatment outcomes in patients undergoing DCA-SIMT radiosurgery.
  • To assess the role of geometric parameters and systemic therapies in local control.

Main Methods:

  • Retrospective analysis of 195 brain metastases treated with DCA-SIMT SRS on a Varian TrueBeam LINAC.
  • Treatment planning utilized Brainlab Elements MultiMets software with ExacTrac image guidance.
  • Local control assessed via MRI (BM-RANO criteria); radiation-induced contrast enhancements (RICE) identified using multiparametric MRI.

Main Results:

  • High local control at 6 months (93%) with 82% complete or partial response.
  • Conformity index < 1.42 and margin expansion ≥ 0.5 mm were associated with improved local control.
  • Systemic therapy (immunotherapy/targeted therapy) within 4 months post-SRS significantly increased radiographic response, especially in lung adenocarcinoma.

Conclusions:

  • DCA-SIMT SRS is effective in achieving high local control for multiple brain metastases.
  • Conformity index, margin expansion, and concurrent systemic therapy are crucial factors influencing outcomes.
  • Further research is needed to optimize margins, particularly in scenarios with high distance-to-isocenter.