| Frameless Linac-based Novalis Radiosurgery for Brainstem Metastases |
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Hyeongseok Jeon, Dong Ah Shin, Jack Rock, Samuel Ryu |
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Department of Neurosurgery, Yonsei University Health System, Seoul, Korea Departments of Neurosurgery, Radiation Oncology, Henry Ford Hospital, Detroit, Michigan |
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| Abstract |
Background
Stereotactic radiosurgery (SRS) has become an important treatment alternative for a variety of brain lesions. However, the use of linear accelerator (LINAC)-based SRS using Novalis system for the management of brainstem metastasis remains controversial. This study aims to discuss the feasibility and efficacy of frameless SRS for treatment of brainstem metastasis.
Methods
Ten patients with brainstem metastases treated with frameless SRS at Henry Ford Hospital were retrospectively reviewed. The mean age at presentation was 64.0 years with a range of 49-73 years. There was 1 tectum, 4 midbrain and 5 pons lesions. The frameless radiosurgery procedure used techniques of intensity-modulated and dynamic arc radiation using a fused CT-MR image. The median dose was 16.0Gy with a range of 14-16. All patients had clinical follow-up with an emphasis on evaluating the initial symptoms, neurological status, and imaging studies. Median follow-up was 9 months after the procedure.
Results
The presenting symptoms were improved in 5 patients (50%), unchanged in 2 (20%) and worsened in 3 (30%). Radiographic evaluation showed complete response in 3 patients (30%), partial response in 5 (50%), stable disease in 1 (10%), and progressive disease in 1 (10%). The overall median survival after SRS was 9 months with a range of 2-24 months. There was no radiation toxicity detected clinically during the follow-up period.
Conclusion
SRS using Novalis system offers an alternative palliation for patients with brainstem metastases, whom otherwise have limited expected overall survival. Frameless SRS is a feasible and safe treatment option, noninvasive, and equally effective compared to other radiosurgical techniques for these patients. |
| Key Words:
Linac-based radiosurgery, Brainstem, Metastasis, Survival, Brain tumor. |
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