دورية أكاديمية
Repeated HyperArc radiosurgery for recurrent intracranial metastases and dosimetric analysis of recurrence pattern to account for diffuse dose effect on microscopical disease
| العنوان: | Repeated HyperArc radiosurgery for recurrent intracranial metastases and dosimetric analysis of recurrence pattern to account for diffuse dose effect on microscopical disease |
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| المؤلفون: | Luca Nicosia, Andrea Gaetano Allegra, Niccolò Giaj-Levra, Reyhaneh Bayani, Nima Mousavi Darzikolaee, Rosario Mazzola, Edoardo Pastorello, Paolo Ravelli, Francesco Ricchetti, Michele Rigo, Ruggero Ruggieri, Davide Gurrera, Riccardo Filippo Borgese, Simona Gaito, Giuseppe Minniti, Pierina Navarria, Marta Scorsetti, Filippo Alongi |
| المصدر: | Clinical and Translational Radiation Oncology, Vol 48, Iss , Pp 100811- (2024) |
| بيانات النشر: | Elsevier, 2024. |
| سنة النشر: | 2024 |
| المجموعة: | LCC:Medical physics. Medical radiology. Nuclear medicine LCC:Neoplasms. Tumors. Oncology. Including cancer and carcinogens |
| مصطلحات موضوعية: | Brain metastases, SRS, Radiosurgery, HyperArc, Radiotherapy, Stereotactic radiotherapy, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282 |
| الوصف: | Aims: Evaluate effectiveness and safety of multiple HyperArc courses and patterns of progression in patients affected by BMs with intracranial progression. Methods: 56 patients were treated for 702 BMs with 197 (range 2–8) HyperArc courses in case of exclusive intracranial progression. Primary end-point was the overall survival (OS), secondary end-points were intracranial progression-free survival (iPFS), toxicity, local control (LC), neurological death (ND), and whole-brain RT (WBRT)-free survival. Site of progression was evaluated against isodoses levels (0, 1, 2, 3, 5, 7, 8, 10, 13, 15, 20, and 24 Gy.). Results: The 1-year OS was 70 %, and the median was 20.8 months (17–36). At the univariate analysis (UVA) biological equivalent dose (BED) > 51.3 Gy and non-melanoma histology significantly correlated with OS. The median time to iPFS was 4.9 months, and the 1-year iPFS was 15 %. Globally, 538 new BMs occurred after the first HA cycle in patients with extracranial disease controlled. 96.4 % of them occurred within the isodoses range 0–7 Gy as follows: 26.6 % (0 Gy), 16.5 % (1 Gy), 16.5 % (2 Gy), 20.1 % (3 Gy), 13.1 % (5 Gy), 3.4 % (7 Gy) (p = 0.00). Radionecrosis occurred in 2 metastases (0.28 %). No clinical toxicity of grade 3 or higher occurred during follow-up. One- and 2-year LC was 90 % and 79 %, respectively. At the UVA BED > 70 Gy and non-melanoma histology were significant predictors of higher LC. The 2-year WBRT-free survival was 70 %. After a median follow-up of 17.4 months, 12 patients deceased by ND. Conclusion: Intracranical relapses can be safely and effectively treated with repeated HyperArc, with the aim to postpone or avoid WBRT. Diffuse dose by volumetric RT might reduce microscopic disease also at relatively low levels, potentially acting as a virtual CTV. Neurological death is not the most common cause of death in this population, which highlights the impact of extracranial disease on overall survival. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2405-6308 |
| Relation: | http://www.sciencedirect.com/science/article/pii/S2405630824000880; https://doaj.org/toc/2405-6308 |
| DOI: | 10.1016/j.ctro.2024.100811 |
| URL الوصول: | https://doaj.org/article/2270ce9ed9164019aefa1a108e526837 |
| رقم الأكسشن: | edsdoj.2270ce9ed9164019aefa1a108e526837 |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 24056308 |
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| DOI: | 10.1016/j.ctro.2024.100811 |