7 research outputs found

    Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis

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    <p>Abstract</p> <p>Purpose</p> <p>to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis.</p> <p>Patients and Methods</p> <p>Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications.</p> <p>Results</p> <p>Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm<sup>3 </sup>and V12 Gy >10.9 cm<sup>3 </sup>the risk of radionecrosis was 47%.</p> <p>Conclusions</p> <p>SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm<sup>3 </sup>carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.</p

    International Conference on Advances in Radiation Oncology (ICARO): Outcomes of an IAEA Meeting

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    The IAEA held the International Conference on Advances in Radiation Oncology (ICARO) in Vienna on 27-29 April 2009. The Conference dealt with the issues and requirements posed by the transition from conventional radiotherapy to advanced modern technologies, including staffing, training, treatment planning and delivery, quality assurance (QA) and the optimal use of available resources. The current role of advanced technologies (defined as 3-dimensional and/or image guided treatment with photons or particles) in current clinical practice and future scenarios were discussed

    Robotic Radiosurgery with Beams of Adaptable Shapes

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    : In radiosurgery, a moving beam of radiation acts as an ablative surgical instrument. Conventional systems for radiosurgery use a cylindrical radiation beam of fixed cross-section. The radiation source can only be moved along simple standardized paths. A new radiosurgical system based on a six degree-of-freedom robotic arm has been developed to overcome limitations of conventional systems. We address the following question: Can dose distributions generated by robotic radiosurgery be improved by using non-cylindrical radiation beams of adaptable cross-section? Geometric methods for planning the shape of the beam in addition to planning beam motion are developed. Design criteria considered in this context are: treatment time, radiation penumbra as well as transparency of interactive treatment planning. An experimental evaluation compares distributions generated with our new radiosurgical system using cylindrical beams to distributions generated with beams of adaptable shapes. 1 Introduc..
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