Universität zu Köln

Kocher, Martin, Wittig, Andrea, Piroth, Marc Dieter, Treuer, Harald, Seegenschmiedt, Heinrich, Ruge, Maximilian, Grosu, Anca-Ligia and Guckenberger, Matthias ORCID: 0000-0002-7146-9071 (2014). Stereotactic radiosurgery for treatment of brain metastases A report of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther. Onkol., 190 (6). S. 521 - 533. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-099X

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Abstract

Background. This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (Deutsche Gesellschaft fur Radioonkologie, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate. Results and discussion.The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases-all less than 2.5 cm in diameter-in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible. Conclusion. A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22-25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5-3 cm. As the infiltration zone of the brain metastases is usually small, the GTV-CTV (gross tumor volume-clinical target volume) margin should be in the range of 0-1 mm. The CTV-PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0-2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kocher, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittig, Andrea UNSPECIFIED UNSPECIFIED UNSPECIFIED Piroth, Marc Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Treuer, Harald UNSPECIFIED UNSPECIFIED UNSPECIFIED Seegenschmiedt, Heinrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruge, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Grosu, Anca-Ligia UNSPECIFIED UNSPECIFIED UNSPECIFIED Guckenberger, Matthias UNSPECIFIED orcid.org/0000-0002-7146-9071 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-437657
DOI:	10.1007/s00066-014-0648-7
Journal or Publication Title:	Strahlenther. Onkol.
Volume:	190
Number:	6
Page Range:	S. 521 - 533
Date:	2014
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1439-099X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GAMMA-KNIFE RADIOSURGERY; QUALITY-OF-LIFE; RADIATION-THERAPY; SURGICAL RESECTION; SINGLE METASTASES; REPOSITIONING ACCURACY; CEREBRAL METASTASES; TREATMENT OPTIONS; AMERICAN SOCIETY; MANAGEMENT Multiple languages Oncology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43765