The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases
Purpose/Objective(s): Stereotactic radiosurgery (SRS) for metastatic disease to the brain is associated with higher in-brain failures compared to whole brain radiation therapy (WBRT). Here we investigated the relationship between low-dose fall off during SRS and location of new brain lesions. Materi...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-05-01
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| Series: | Clinical and Translational Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630821000288 |
| _version_ | 1818437603168354304 |
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| author | Shiby Paul Nitin Ohri Christian Velten Patrik Brodin Dinesh Mynampati Wolfgang Tomé Serena P.H. Mao Rafi Kabarriti Madhur Garg Jana Fox |
| author_facet | Shiby Paul Nitin Ohri Christian Velten Patrik Brodin Dinesh Mynampati Wolfgang Tomé Serena P.H. Mao Rafi Kabarriti Madhur Garg Jana Fox |
| author_sort | Shiby Paul |
| collection | DOAJ |
| description | Purpose/Objective(s): Stereotactic radiosurgery (SRS) for metastatic disease to the brain is associated with higher in-brain failures compared to whole brain radiation therapy (WBRT). Here we investigated the relationship between low-dose fall off during SRS and location of new brain lesions. Materials and Methods: One hundred sixty-seven patients treated with single fraction or fractionated SRS for intact or resected brain metastases at our institution from January 2016 to June 2018 were reviewed. Patients with imaging findings of new brain metastases after the initial SRS were included. Patients with WBRT before SRS were excluded. MRI scans for repeat treatments were fused with initial SRS plan. New lesions were outlined on the initial SRS planning CT. The mean dose that the site of new lesions received from initial SRS was tabulated. Results: Thirty-eight patients met inclusion criteria. 165 new lesions were evaluated. There was a lower propensity to develop new brain lesions with increasing dose received by the regions from prior SRS, with 66%, 34%, 19%, 13%, 6%, 5%, 2% and 1% of new lesions appearing in regions that received less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively. Higher doses are received by smaller brain volumes during SRS. After accounting for volume, 14, 14, 11, 7, 2, 2, 1 and 1 new lesions appeared per 100 cm3 of brain in regions that received doses of less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively, from prior SRS. Conclusions: We identified low dose spillage during SRS to be associated with lower incidence of new brain metastases. Validation in larger dataset or prospective study of the combination of SRS with low dose WBRT would be crucial in order to establish causality of these findings. |
| first_indexed | 2024-12-14T17:27:18Z |
| format | Article |
| id | doaj.art-b7da8a29cb034621a4a9a258a5ded980 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-12-14T17:27:18Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-b7da8a29cb034621a4a9a258a5ded9802022-12-21T22:53:12ZengElsevierClinical and Translational Radiation Oncology2405-63082021-05-01287984The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastasesShiby Paul0Nitin Ohri1Christian Velten2Patrik Brodin3Dinesh Mynampati4Wolfgang Tomé5Serena P.H. Mao6Rafi Kabarriti7Madhur Garg8Jana Fox9Corresponding author at: Department of Radiation Oncology, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467, USA.; Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USAPurpose/Objective(s): Stereotactic radiosurgery (SRS) for metastatic disease to the brain is associated with higher in-brain failures compared to whole brain radiation therapy (WBRT). Here we investigated the relationship between low-dose fall off during SRS and location of new brain lesions. Materials and Methods: One hundred sixty-seven patients treated with single fraction or fractionated SRS for intact or resected brain metastases at our institution from January 2016 to June 2018 were reviewed. Patients with imaging findings of new brain metastases after the initial SRS were included. Patients with WBRT before SRS were excluded. MRI scans for repeat treatments were fused with initial SRS plan. New lesions were outlined on the initial SRS planning CT. The mean dose that the site of new lesions received from initial SRS was tabulated. Results: Thirty-eight patients met inclusion criteria. 165 new lesions were evaluated. There was a lower propensity to develop new brain lesions with increasing dose received by the regions from prior SRS, with 66%, 34%, 19%, 13%, 6%, 5%, 2% and 1% of new lesions appearing in regions that received less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively. Higher doses are received by smaller brain volumes during SRS. After accounting for volume, 14, 14, 11, 7, 2, 2, 1 and 1 new lesions appeared per 100 cm3 of brain in regions that received doses of less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively, from prior SRS. Conclusions: We identified low dose spillage during SRS to be associated with lower incidence of new brain metastases. Validation in larger dataset or prospective study of the combination of SRS with low dose WBRT would be crucial in order to establish causality of these findings.http://www.sciencedirect.com/science/article/pii/S2405630821000288 |
| spellingShingle | Shiby Paul Nitin Ohri Christian Velten Patrik Brodin Dinesh Mynampati Wolfgang Tomé Serena P.H. Mao Rafi Kabarriti Madhur Garg Jana Fox The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases Clinical and Translational Radiation Oncology |
| title | The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| title_full | The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| title_fullStr | The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| title_full_unstemmed | The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| title_short | The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| title_sort | effect of low dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases |
| url | http://www.sciencedirect.com/science/article/pii/S2405630821000288 |
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