Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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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

  • Lee, Seung-Heon (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Lee, Kyu-Chan (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Choi, Jin-Ho (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Kim, Hye-Young (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Lee, Seok-Ho (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Sung, Ki-Hoon (Department of Radiation Oncology, Gachon University Gil Hospital) ;
  • Kim, Yun-Mi (Department of Nursing, Gachon University Gil Hospital)
  • Received : 2012.03.06
  • Accepted : 2012.05.04
  • Published : 2012.06.30
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Abstract

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 (${\geq}4$) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, 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 $Gy_{10}$ and 67.2 $Gy_{10}$ and the median brain volume irradiated more than 100 $Gy_3$ were 1.9% (24 $cm^3$) and 0.8% (13 $cm^3$) 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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References

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