Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases.

Abstract:

OBJECTIVE:The use of Gamma Knife stereotactic radiosurgery (GKSRS) for the treatment of extensive intracranial metastases has been expanding due to its superior dosimetry and efficacy. However, there remains a dearth of data regarding the dose parameters in actual clinical scenarios. The authors endeavored to calculate the radiation dose to the brain when treating ≥ 15 brain metastases with GKSRS. METHODS:This retrospective analysis reviewed dosage characteristics for patients requiring single-session GKSRS for the treatment of ≥ 15 brain metastases. Forty-two patients met the inclusion criteria between 2008 and 2017. The median number of tumors at the initial GKSRS procedure was 20 (range 15-39 tumors), accounting for 865 tumors in this study. The median aggregate tumor volume was 3.1 cm3 (range 0.13-13.26 cm3), and the median marginal dose was 16 Gy (range 14-19 Gy). RESULTS:The median of the mean brain dose was 2.58 Gy (range 0.95-3.67 Gy), and 79% of patients had a dose < 3 Gy. The 12-Gy dose volume was a median of 12.45 cm3, which was equivalent to 0.9% of the brain volume. The median percentages of brain receiving 5 Gy and 3 Gy were 6.7% and 20.4%, respectively. There was no correlation between the number of metastases and the mean dose to the brain (p = 0.8). A greater tumor volume was significantly associated with an increased mean brain dose (p < 0.001). The median of the mean dose to the bilateral hippocampi was 2.3 Gy. Sixteen patients had supplementary GKSRS, resulting in an additional mean dose of 1.4 Gy (range 0.2-3.8 Gy) to the brain. CONCLUSIONS:GKSRS is a viable means of managing extensive brain metastases. This procedure provides a relatively low dose of radiation to the brain, especially when compared with traditional whole-brain radiation protocols.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Bowden GN,Kim JO,Faramand A,Fallon K,Flickinger J,Lunsford LD

doi

10.3171/2020.3.JNS193369

subject

Has Abstract

pub_date

2020-05-08 00:00:00

pages

1-5

eissn

0022-3085

issn

1933-0693

pii

2020.3.JNS193369

pub_type

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