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KMID : 1038620120300020053
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Radiation Oncology Journal
2012 Volume.30 No. 2 p.53 ~ p.61
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Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases
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Lee Seung-Heon
Lee Kyu-Chan
Choi Jin-Ho
Kim Hye-Young
Lee Seok-Ho
Sung Ki-Hoon
Kim Yun-Mi
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Abstract
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Purpose: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases.
Materials and Methods: Nine patients with multiple (≥4) brain metastases were analyzed. Three patients were classifi ed as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive defi cit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10- 12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions.
Results: The median biologically effective dose to metastatic tumors was 68.1 Gy10 and 67.2 Gy10 and the median brain volume irradiated more than 100 Gy3 were 1.9% (24 cm3) and 0.8% (13 cm3) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively.
Conclusion: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.
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KEYWORD
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Multiple brain metastases, Poor prognostic, RapidArc, Volumetric modulated arc therapy
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