Journal Article

BM-17FINAL RESULTS OF A RANDOMIZED TRIAL TO IDENTIFY THE OPTIMAL PLANNING TARGET VOLUME IN IMAGE-GUIDED STEREOTACTIC RADIOSURGERY OF BRAIN METASTASES

John Kirkpatrick, Zhiheng Wang, John Sampson, Frances McSherry, James Herndon, Karen Allen, Eileen Duffy, Zheng Chang, Jenny Hoang, Chris Kelsey, David Yoo, Alvin Cabrera and Fang-Fang Yin

in Neuro-Oncology

Published on behalf of Society for Neuro-Oncology

Volume 16, issue suppl_5, pages v35-v35
Published in print November 2014 | ISSN: 1522-8517
Published online November 2014 | e-ISSN: 1523-5866 | DOI: https://dx.doi.org/10.1093/neuonc/nou240.17
BM-17FINAL RESULTS OF A RANDOMIZED TRIAL TO IDENTIFY THE OPTIMAL PLANNING TARGET VOLUME IN IMAGE-GUIDED STEREOTACTIC RADIOSURGERY OF BRAIN METASTASES

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BACKGROUND: Our objective was to identify an optimal margin for SRS of brain metastases, minimizing toxicity and local recurrence. METHODS: Adult patients with 1-3 brain metastases, no previous brain radiotherapy and KPS >70 were eligible for this IRB-approved trial. Individual lesions were randomized to 1 or 3mm uniform expansion of the gross tumor volume (GTV) defined on MRI. The resulting planning target volume (PTV) was treated to 24, 18 or 15Gy marginal dose for PTV diameters <2, 2-2.9 and 3-4.0cm, respectively, using a LINAC-based radiosurgery system with 3D image guidance. The primary endpoint was local recurrence (LR.) Secondary endpoints included neurocognition (mini-mental state exam, Trailmaking tests A/B), quality of life (QOL, FACT-Br), radionecrosis (RN), distant failure in the brain (DF) and overall survival (OS). RESULTS: Between February 2010 and November 2012, 49 patients with 80 brain metastases were treated. Median age was 61 years and median KPS 90, with the predominant histologies non-small-cell lung cancer (25 patients) and melanoma (8). 55, 19 and 6 lesions were treated with 24, 18 and 15Gy, respectively. PTV/GTV ratio, V12Gy and minimum dose to GTV were significantly higher in the 3mm group (all p < 0.01), while GTV was similar (p = 0.76.) At a median follow-up of 32.2 months, 11 patients are alive with median OS 10.6 months. One-year post SRS, DF was 45.7%. LR was observed in 3 of 69 lesions with sufficient follow-up imaging, (2 in the 1mm group, p = 0.51) with a one-year post-SRS LR rate of 6.7%. Biopsy-proven RN alone was observed in 6 lesions (5 in the 3mm group, p = 0.10). Three months post-SRS, no significant change in neurocognition or QOL was observed (p > 0.05 for all measures). CONCLUSION: SRS was well-tolerated with low rates of LR in both cohorts. Given the higher potential risk of RN, a 1mm margin appears more appropriate.

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Subjects: Medical Oncology ; Neurology

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