Improving on whole-brain radiotherapy in patients with large brain metastases: a planning study to support the AROMA clinical trial
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
PURPOSE: To develop a novel dose-escalated volumetric modulated arc therapy (VMAT) strategy for patients with single or multiple large brain metastases which can deliver a higher dose to individual lesions for better local control (LC), and to compare dosimetry between whole brain radiotherapy (WBRT), hippocampal-sparing whole brain radiotherapy (HS-WBRT) and different VMAT-based focal radiotherapy approaches. METHODS AND MATERIALS: We identified 20 patients with one to ten brain metastases and at least one lesion larger than 15 cm3 who had received WBRT as part of routine care. For each patient, we designed and evaluated five radiotherapy treatment plans, including WBRT, HS-WBRT and three VMAT dosing models. A dose of 20 Gy in 5 fractions was prescribed to the whole brain or target volumes depending on the plan, with higher doses to smaller lesions and dose-escalated inner planning target volumes (DE-iPTV) in VMAT plans, respectively. Treatment plans were evaluated using the efficiency index, mean dose and D0.1cc to the target volumes and organs at risk. RESULTS: Compared with WBRT, VMAT plans achieved a significantly more efficient dose distribution in brain lesions, especially with our DE-iPTV model, while minimising the dose to the normal brain and other organs at risks (OARs) (p < 0.05). CONCLUSIONS: VMAT plans obtained higher doses to brain metastases and minimised doses to OARs. Dose-escalated VMAT for larger lesions allows higher radiotherapy doses to be delivered to larger lesions while maintaining safe doses to OARs.
Date Issued
2022-05
Date Acceptance
2022-02-10
Citation
Radiotherapy and Oncology, 2022, 170, pp.176-183
ISSN
0167-8140
Publisher
Elsevier
Start Page
176
End Page
183
Journal / Book Title
Radiotherapy and Oncology
Volume
170
Copyright Statement
© 2022 The Authors. Published by Elsevier B.V. Under a Creative Commons license.
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/35182688
PII: S0167-8140(22)00096-2
Grant Number
RDB01 79560
Subjects
Brain metastases
Dose-escalated planning
Local control
VMAT
WBRT
Publication Status
Published
Coverage Spatial
Ireland
Date Publish Online
2022-02-17