Cargando…

Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts

There is an ongoing debate as to the maximum number of brain metastases that can safely and practically be treated with a single course of radiosurgery. Despite evidence of durable local control and favorable overall survival when treating 10 or more brain metastases with radiosurgery alone, some in...

Descripción completa

Detalles Bibliográficos
Autores principales: Hyde, Christian, Kinser, Shannon, Croft, Christopher, Schantz, Patricia, Brown, Kayla, Vazirani, Rajendra, Wei, Jikun, Bonta, Ioana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825047/
https://www.ncbi.nlm.nih.gov/pubmed/29503779
http://dx.doi.org/10.7759/cureus.1985
_version_ 1783302130675744768
author Hyde, Christian
Kinser, Shannon
Croft, Christopher
Schantz, Patricia
Brown, Kayla
Vazirani, Rajendra
Wei, Jikun
Bonta, Ioana
author_facet Hyde, Christian
Kinser, Shannon
Croft, Christopher
Schantz, Patricia
Brown, Kayla
Vazirani, Rajendra
Wei, Jikun
Bonta, Ioana
author_sort Hyde, Christian
collection PubMed
description There is an ongoing debate as to the maximum number of brain metastases that can safely and practically be treated with a single course of radiosurgery. Despite evidence of durable local control and favorable overall survival when treating 10 or more brain metastases with radiosurgery alone, some institutions and guidelines still limit radiosurgery to an arbitrary number of metastases. As demonstrated by this case report, the number of lesions is not so important when the patient’s life expectancy is otherwise good and body tumors are controllable. In the current era of effective targeted therapies, multi-year survival with brain metastases is increasingly common. Treating 37 brain metastases simultaneously in a five-fraction stereotactic course is technically feasible and in this case, resulted in 100% local and distant control in the brain for 18 months ongoing without any additional brain radiation. We discuss patient selection factors when treating large numbers of brain metastases, and present a possible class solution when using five daily fractions of 6 Gray (Gy) with a single plan and isocenter.
format Online
Article
Text
id pubmed-5825047
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-58250472018-03-02 Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts Hyde, Christian Kinser, Shannon Croft, Christopher Schantz, Patricia Brown, Kayla Vazirani, Rajendra Wei, Jikun Bonta, Ioana Cureus Medical Physics There is an ongoing debate as to the maximum number of brain metastases that can safely and practically be treated with a single course of radiosurgery. Despite evidence of durable local control and favorable overall survival when treating 10 or more brain metastases with radiosurgery alone, some institutions and guidelines still limit radiosurgery to an arbitrary number of metastases. As demonstrated by this case report, the number of lesions is not so important when the patient’s life expectancy is otherwise good and body tumors are controllable. In the current era of effective targeted therapies, multi-year survival with brain metastases is increasingly common. Treating 37 brain metastases simultaneously in a five-fraction stereotactic course is technically feasible and in this case, resulted in 100% local and distant control in the brain for 18 months ongoing without any additional brain radiation. We discuss patient selection factors when treating large numbers of brain metastases, and present a possible class solution when using five daily fractions of 6 Gray (Gy) with a single plan and isocenter. Cureus 2017-12-25 /pmc/articles/PMC5825047/ /pubmed/29503779 http://dx.doi.org/10.7759/cureus.1985 Text en Copyright © 2017, Hyde et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Medical Physics
Hyde, Christian
Kinser, Shannon
Croft, Christopher
Schantz, Patricia
Brown, Kayla
Vazirani, Rajendra
Wei, Jikun
Bonta, Ioana
Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title_full Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title_fullStr Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title_full_unstemmed Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title_short Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts
title_sort fractionated radiosurgery alone for thirty-seven brain metastases: not everything that can be counted counts
topic Medical Physics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825047/
https://www.ncbi.nlm.nih.gov/pubmed/29503779
http://dx.doi.org/10.7759/cureus.1985
work_keys_str_mv AT hydechristian fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT kinsershannon fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT croftchristopher fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT schantzpatricia fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT brownkayla fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT vaziranirajendra fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT weijikun fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts
AT bontaioana fractionatedradiosurgeryaloneforthirtysevenbrainmetastasesnoteverythingthatcanbecountedcounts