open access

Vol 20, No 4 (2015)
Published online: 2015-07-01
Submitted: 2013-12-17
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On the cutting edge of intensity modulated radiotherapy and simultaneous integrated boost (IMRT-SIB): The case of a patient with 8 brain metastases

Marica Ferro, Savino Cilla, Gabriella Macchia, Francesco Deodato, Antonio Pierro, Cinzia Digesu’, Gabriella Ferrandina, Matteo Ciuffreda, Giuseppina Sallustio, Alessio G. Morganti
DOI: 10.1016/j.rpor.2014.09.001
·
Rep Pract Oncol Radiother 2015;20(4):316-319.

open access

Vol 20, No 4 (2015)
Published online: 2015-07-01
Submitted: 2013-12-17

Abstract

Background

Patients with multiple brain metastases, especially those with more than 3 lesions, usually undergo to palliative whole brain (WB) radiotherapy (RT).

Methods

A breast cancer patient with 8 brain metastases was treated on the brain by a radical RT regimen. Prescription doses were according to the simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique with all lesions as well brain irradiated simultaneously in 20 daily fractions. Doses of 40.0[[ce:hsp sp="0.25"/]]Gy (2.0[[ce:hsp sp="0.25"/]]Gy/fraction) and 50.0[[ce:hsp sp="0.25"/]]Gy (2.5[[ce:hsp sp="0.25"/]]Gy/fraction) were prescribed to the whole brain and to eight individual metastases, respectively.

Results

Mean volume of the eight metastases was 8.1[[ce:hsp sp="0.25"/]]cc (range: 3.8–10.1[[ce:hsp sp="0.25"/]]cc). For all lesions, the volume receiving 95% of prescribed dose was 100% and dose homogeneity was within 3%. Moreover, maximum doses were less than 105% of prescribed dose, while average mean dose to lesions was 50.6[[ce:hsp sp="0.25"/]]Gy (range: 49.7–51.5[[ce:hsp sp="0.25"/]]Gy). Whole brain mean dose was 45.2[[ce:hsp sp="0.25"/]]Gy. Maximum doses to brainstem and optic chiasma were limited to 44.5[[ce:hsp sp="0.25"/]]Gy and 42.9[[ce:hsp sp="0.25"/]]Gy, respectively, while maximum doses to eyes, lens and optic nerves were limited to 9.2[[ce:hsp sp="0.25"/]]Gy, 4.9[[ce:hsp sp="0.25"/]]Gy and 41.0[[ce:hsp sp="0.25"/]]Gy, respectively. From a clinical point of view, subsequent MRI brain controls showed a complete clinical response. Forty months after treatment the patient is disease free and shows no late brain and skin toxicities.

Conclusion

This case demonstrates the technical feasibility of a SIB-IMRT treatment in patients with more than 3 brain metastases.

Abstract

Background

Patients with multiple brain metastases, especially those with more than 3 lesions, usually undergo to palliative whole brain (WB) radiotherapy (RT).

Methods

A breast cancer patient with 8 brain metastases was treated on the brain by a radical RT regimen. Prescription doses were according to the simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique with all lesions as well brain irradiated simultaneously in 20 daily fractions. Doses of 40.0[[ce:hsp sp="0.25"/]]Gy (2.0[[ce:hsp sp="0.25"/]]Gy/fraction) and 50.0[[ce:hsp sp="0.25"/]]Gy (2.5[[ce:hsp sp="0.25"/]]Gy/fraction) were prescribed to the whole brain and to eight individual metastases, respectively.

Results

Mean volume of the eight metastases was 8.1[[ce:hsp sp="0.25"/]]cc (range: 3.8–10.1[[ce:hsp sp="0.25"/]]cc). For all lesions, the volume receiving 95% of prescribed dose was 100% and dose homogeneity was within 3%. Moreover, maximum doses were less than 105% of prescribed dose, while average mean dose to lesions was 50.6[[ce:hsp sp="0.25"/]]Gy (range: 49.7–51.5[[ce:hsp sp="0.25"/]]Gy). Whole brain mean dose was 45.2[[ce:hsp sp="0.25"/]]Gy. Maximum doses to brainstem and optic chiasma were limited to 44.5[[ce:hsp sp="0.25"/]]Gy and 42.9[[ce:hsp sp="0.25"/]]Gy, respectively, while maximum doses to eyes, lens and optic nerves were limited to 9.2[[ce:hsp sp="0.25"/]]Gy, 4.9[[ce:hsp sp="0.25"/]]Gy and 41.0[[ce:hsp sp="0.25"/]]Gy, respectively. From a clinical point of view, subsequent MRI brain controls showed a complete clinical response. Forty months after treatment the patient is disease free and shows no late brain and skin toxicities.

Conclusion

This case demonstrates the technical feasibility of a SIB-IMRT treatment in patients with more than 3 brain metastases.

Get Citation

Keywords

Brain metastases; SIB-IMRT; Simultaneous integrated boost-intensity modulated radiation therapy

About this article
Title

On the cutting edge of intensity modulated radiotherapy and simultaneous integrated boost (IMRT-SIB): The case of a patient with 8 brain metastases

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 20, No 4 (2015)

Pages

316-319

Published online

2015-07-01

DOI

10.1016/j.rpor.2014.09.001

Bibliographic record

Rep Pract Oncol Radiother 2015;20(4):316-319.

Keywords

Brain metastases
SIB-IMRT
Simultaneous integrated boost-intensity modulated radiation therapy

Authors

Marica Ferro
Savino Cilla
Gabriella Macchia
Francesco Deodato
Antonio Pierro
Cinzia Digesu’
Gabriella Ferrandina
Matteo Ciuffreda
Giuseppina Sallustio
Alessio G. Morganti

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