Phase I Trial of Simultaneous In-Field Boost With Helical Tomotherapy for Patients With One to Three Brain Metastases

Journal Article · Fri Jul 15 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.03.047· OSTI ID:21587594

Rodrigues, George ^[1]; Yartsev, Slav; Yaremko, Brian; Perera, Francisco; Dar, A Rashid; Hammond, Alex; Lock, Michael; Yu, Edward; Ash, Robert ^[1]; Caudrelier, Jean-Michelle ^[2]; Khuntia, Deepak ^[3]; Bailey, Laura; Bauman, Glenn ^[1]

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1. Department of Oncology, University of Western Ontario and London Regional Cancer Program, London Health Sciences Centre, London, ON (Canada)
2. Department of Radiation Oncology, University of Ottawa, Ottawa, ON (Canada)
3. Department of Human Oncology, University of Wisconsin, Madison, WI (United States)

Purpose: Stereotactic radiosurgery is an alternative to surgical resection for selected intracranial lesions. Integrated image-guided intensity-modulated-capable radiotherapy platforms such as helical tomotherapy (HT) could potentially replace traditional radiosurgery apparatus. The present study's objective was to determine the maximally tolerated dose of a simultaneous in-field boost integrated with whole brain radiotherapy for palliative treatment of patients with one to three brain metastases using HT. Methods and Materials: The inclusion/exclusion criteria and endpoints were consistent with the Radiation Therapy Oncology Group 9508 radiosurgery trial. The cohorts were constructed with a 3 + 3 design; however, additional patients were enrolled in the lower dose tolerable cohorts during the toxicity assessment periods. Whole brain radiotherapy (30 Gy in 10 fractions) was delivered with a 5-30-Gy (total lesion dose of 35-60 Gy in 10 fractions) simultaneous in-field boost delivered to the brain metastases. The maximally tolerated dose was determined by the frequency of neurologic Grade 3-5 National Cancer Institute Common Toxicity Criteria, version 3.0, dose-limiting toxicity events within each Phase I cohort. Results: A total of 48 patients received treatment in the 35-Gy (n = 3), 40-Gy (n = 16), 50-Gy (n = 15), 55-Gy (n = 8), and 60-Gy (n = 6) cohorts. No patients experienced dose-limiting toxicity events in any of the trial cohorts. The 3-month RECIST assessments available for 32 of the 48 patients demonstrated a complete response in 2, a partial response in 16, stable disease in 6, and progressive disease in 8 patients. Conclusion: The delivery of 60 Gy in 10 fractions to one to three brain metastases synchronously with 30 Gy whole brain radiotherapy was achieved without dose-limiting central nervous system toxicity as assessed 3 months after treatment. This approach is being tested in a Phase II efficacy trial.

• OSTI ID: 21587594
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 80, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2010.03.047; PII: S0360-3016(10)00605-X; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRAIN
CLINICAL TRIALS
COMPUTERIZED TOMOGRAPHY
CT-GUIDED RADIOTHERAPY
METASTASES
NEOPLASMS
RADIATION DOSES
SURGERY
TOXICITY
BODY
CENTRAL NERVOUS SYSTEM
DIAGNOSTIC TECHNIQUES
DISEASES
DOSES
MEDICINE
NERVOUS SYSTEM
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
RADIOTHERAPY
TESTING
THERAPY
TOMOGRAPHY