The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases

Abstract

Whole brain radiotherapy (WBRT) is the standard non-surgical treatment for brain metastatic disease, but rarely eradicates bulky metastases from most common cancers. Recent literature has demonstrated the safety and efficacy of delivering very high focal doses of radiation (by radiosurgical techniques) to the gross tumour volume of bulky brain metastases, thereby obtaining more certain local control than is achieved by WBRT. In this paper we report a study of 11 patients with bulky brain metastases in whom an intensity-modulated radiation therapy (IMRT) facility has been used to concomitantly boost the gross tumour volume of bulky brain metastatic disease (to 40 Gy) during a standard 30 Gy in 10 fractions WBRT schedule. No acute or subacute morbidity was encountered, and good early control data were noted. We discuss the perceived advantages of such a technique.

Figures

Figure 1

Axial planning CT scan depicting the radiation isodosimetry that delivered 10 × 3 Gy to the whole brain, while concomitantly boosting a bulky single metastasis with 10 × 4 Gy.

Figure 2

Coronal planning CT scan depicting the radiation isodosimetry of whole brain fractionated radiotherapy to 30 Gy while two bulky metastases concomitantly received 40 Gy to the gross tumour volume.