ArticleRadiation oncology (London, England)2021
Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience.
Article in Radiation oncology (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Increasing demands on commissioning and quality assurance for cone-based multiple brain metastases robotic radiosurgery: evaluation in a custom phantom.Physical and engineering sciences in medicine · 2026Article
- Article
- Control-point-specific plan robustness in volumetric modulated arc therapy-based cranial radiotherapy.Journal of applied clinical medical physics · 2026Article
- Virtual phantom methodology for assessment of MRI distortion correction in high-precision stereotactic radiosurgery treatment planning.Frontiers in oncology · 2025Article
- Article
- Stereotactic Radiosurgery in the Management of Brain Metastases: A Case-Based Radiosurgery Society Practice Guideline.Advances in radiation oncology · 2024Review
- Single isocenter HyperArc treatment of multiple intracranial metastases: Targeting accuracy.Journal of applied clinical medical physics · 2024Article
- Assessing the impact of distortion correction on Gamma Knife radiosurgery for multiple metastasis: Volumetric and dosimetric analysis.Brain & spine · 2024Article
- Going from 3D/3D to 2D/3D registration for noncoplanar setup verification in intracranial single-isocenter multiple-target hypofractionated stereotactic radiotherapy: comparison between kilo-voltage/mega-voltage image pairs and noncoplanar cone-beam computed tomography.Quantitative imaging in medicine and surgery · 2023Article
- Single-Isocenter Linac-Based Radiosurgery for Brain Metastases with Coplanar Arcs: A Dosimetric and Clinical Analysis.Cancers · 2023Article
- Geometric accuracy in patient positioning for stereotactic radiotherapy of intracranial tumors.Physics and imaging in radiation oncology · 2023Article
- Optimization of isocenter position for multiple targets with nonuniform-margin expansion.Journal of applied clinical medical physics · 2023Article
- Single-isocenter multiple-target stereotactic radiosurgery for multiple brain metastases: dosimetric evaluation of two automated treatment planning systems.Radiation oncology (London, England) · 2022Article
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Authors and funding
10 authors.
Funding
Abstract
PURPOSE/OBJECTIVE(S): To communicate our institutional experience with single isocenter radiosurgery treatments for multiple brain metastases, including challenges with determining planning target volume (PTV) margins and resulting consequences, image-guidance translational and rotational tolerances, intra-fraction patient motion, and prescription considerations with larger PTV margins. MATERIALS/
methodsEight patient treatments with 51 targets were planned with various margins using Elements Multiple Brain Mets SRS treatment planning software (Brainlab, Munich, Germany). Forty-eight plans with 0 mm, 1 mm and 2 mm margins were created, including plans with variable margins, where targets more than 6 cm away from the isocenter were planned with larger margins. The dosimetric impact of the margins were analyzed with V5Gy, V8Gy, V10Gy, V12Gy values. Additionally, 12 patient motion data were analyzed to determine both the impact of the repositioning threshold and the distributions of the patient translational and rotational movements.
resultsThe V5Gy, V8Gy, V10Gy, V12Gy volumes approximately doubled when margins change from 0 to 1 mm and tripled when change from 0 to 2 mm. With variable margins, the aggregated results are similar to results from plans using the lower of two margins, since only 12.2% of the targets were more than 6 cm away from the isocenter. With 0.5 mm re-positioning threshold, 57.4% of the time the patients are repositioned. Reducing the threshold to 0.25 mm results in 91.7% repositioning rate, due to limitations of the fusion algorithm and actual patient motion. The 90th percentile of translational movements in all directions is 0.7 mm, while the 90th percentile of rotational movements in all directions is 0.6 degrees. Median translations and rotations are 0.2 mm and 0.2 degrees, respectively.
conclusionsBased on the data presented, we have switched our modus operandi from 2 to 1 mm PTV margins, with an eventual goal of using 0.5 and 1.0 mm variable margins when an automated margin assignment method becomes available. The 0.5 mm and 0.5 degrees repositioning thresholds are clinically appropriate with small residual patient movements.
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