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CC BY-NC-ND 4.0 · South Asian J Cancer 2015; 04(01): 011-014
DOI: 10.4103/2278-330X.149927
NEURO-ONCOLOGY : Original Article

Simultaneous integrated boost with intensity modulated radiation therapy in brain oligometastases: A feasible technique for developing countries

Vivek Tiwari
Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India
,
Pande C. Subodh
Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India
,
Kamal Verma
Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India
,
Sandeep Goel
Department of Radiation Oncology, Artemis Health Institute, Gurgaon, Haryana, India
› Author Affiliations Source of Support: Nill.
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Abstract

Introduction: To analyze the pattern of brain metastasis (BM), and to use intensity modulated radiation therapy (IMRT) for target dose escalation in cases with ≤3 metastatic lesions (oligometastases). Materials and Methods: Thirty-two consecutive cases of BM treated during September 2009 to August 2012 were analyzed retrospectively. Results: The study comprised 13 males (40.62%) and 19 females (59.37%). Thirteen (40%) patients presented with disseminated intracranial metastases, while 19 (60%) had ≤3 foci. In 25 cases (78%), the primary was located either in the breast (14 cases) or lung (11 cases). The 13 patients with disseminated intracranial metastases received whole brain radiation therapy to a dose of 30 Gy/10-12 daily fractions (Group A) while the 19 cases with ≤3 lesions received an additional dose of 6-10 Gy to gross lesions using a simultaneous integrated boost (SIB) with IMRT thus receiving a total dose of 36-40 Gy/12-15 fractions (Group B). Overall survival (OS) for the breast primary was 6.3 and lung primary was 5.3 months, respectively. The mean OS for breast cases in Group B was higher (9.5 months) as compared to Group A cases (1.9 months) and was statistically significant (P = 0.0056). Similarly, primary lung cancer cases in Group B showed a mean OS of 8.75 months versus 2.6 months for Group A cases (P = 0.213). Conclusions: IMRT is a safe and effective technique in cases with oligometastases for dose escalation in the form of SIB.

Key words

Intensity modulated radiation therapy - oligometastases - simultaneous integrated boost


Publication History

Article published online:
31 December 2020

© 2015. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Ellis TL, Neal MT, Chan MD. The role of surgery, radiosurgery and whole brain radiation therapy in the management of patients with metastatic brain tumors. Int J Surg Oncol 2012;2012:952345.
  • 2 Norden AD, Wen PY, Kesari S. Brain metastases. Curr Opin Neurol 2005;18:654-61.
  • 3 Rahmathulla G, Toms SA, Weil RJ. The molecular biology of brain metastasis. J Oncol 2012;2012:723541.
  • 4 Gupta T. Stereotactic radiosurgery for brain oligometastases: Good for some, better for all? Ann Oncol 2005;16:1749-54.
  • 5 Weber DC, Caparrotti F, Laouiti M, Malek K. Simultaneous in-field boost for patients with 1 to 4 brain metastasis/es treated with volumetric modulated arc therapy: A prospective study on quality-of-life. Radiat Oncol 2011;6:79.
  • 6 Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 1999;45:427-34.
  • 7 Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. Lancet 2004;363:1665-72.
  • 8 Casanova N, Mazouni Z, Bieri S, Combescure C, Pica A, Weber DC. Whole brain radiotherapy with a conformational external beam radiation boost for lung cancer patients with 1-3 brain metastasis: A multi institutional study. Radiat Oncol 2010;5:13.
  • 9 Bruzzaniti V, Abate A, Pedrini M, Benassi M, Strigari L. IsoBED: A tool for automatic calculation of biologically equivalent fractionation schedules in radiotherapy using IMRT with a simultaneous integrated boost (SIB) technique. J Exp Clin Cancer Res 2011;30:52.
  • 10 Tsao MN, Khuntia D, Mehta MP. Brain metastases: What′s new with an old problem? Curr Opin Support Palliat Care 2012;6:85-90.
  • 11 Khuntia D, Brown P, Li J, Mehta MP. Whole-brain radiotherapy in the management of brain metastasis. J Clin Oncol 2006;24:1295-304.
  • 12 Assouline A, Levy A, Chargari C, Lamproglou I, Mazeron JJ, Krzisch C. Whole brain radiotherapy: Prognostic factors and results of a radiation boost delivered through a conventional linear accelerator. Radiother Oncol 2011;99:214-7.
  • 13 Akhtar MS, Kousar F, Fatmi S, Jabeen K, Akhtar K. Quality of life and symptoms control in brain metastasis after palliative whole brain radiotherapy using two different protocols. J Coll Physicians Surg Pak 2012;22:311-6.
  • 14 Rades D, Kueter JD, Gliemroth J, Veninga T, Pluemer A, Schild SE. Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. Strahlenther Onkol 2012;188:143-7.
  • 15 Edwards AA, Keggin E, Plowman PN. The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases. Br J Radiol 2010;83:133-6.
  • 16 Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol 2006;7:584-95.
  • 17 Shirato H, Isu T, Shimizu Y, Nishioka T, Nonaka M, Abe S, et al. Prospective dose-escalation study in stereotactic radiotherapy utilizing a linear accelerator: Report from East Hokkaido Radiosurgery Study Group (EHRSSG). No Shinkei Geka 1993;21:1089-95.