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Clinical outcomes for a novel 6 degrees of freedom image guided localization method for frameless radiosurgery for intracranial brain metastases

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Abstract

Stereotactic radiosurgery (SRS) is an accepted method of treatment for intracranial brain metastases with sub-millimeter accuracy. Frameless radiosurgery (FRS) is becoming an alternative to framed SRS due to its less invasive requirements. The purpose of this study is to describe the clinical outcomes and local patterns of failure for a novel 6 degrees of freedom CT guided method of localization for FRS of intracranial brain metastases. 42 patients underwent linear accelerator-based FRS to 94 intracranial brain metastases between 01/2009 and 07/2011. 78 and 22 % of treated sites were intact metastases and resection cavities, respectively. 55 % of patients had undergone prior brain radiotherapy (45 % SRS, 26 % whole brain radiation therapy). The 1 year actuarial local recurrence rate was 18 %, with a median imaging follow-up period of 13.2 months. Single fraction equivalent dose was the most important predictor of local recurrence. The 1 year actuarial first distant brain recurrence and total intracranial recurrence rate was 58 and 69 %, respectively. The crude radiographic radiation necrosis rate was 3 %. Of the 10 local recurrence events, 8 (80 %) were in-field only, 1 (10 %) was marginal only, and 1 (10 %) was both. The preponderance of in-field only patterns of failure suggests that geographic miss is not a major contributor to local recurrence using this novel localization method for FRS. The 1 year local control rate is comparable to other similar published series of framed and frameless radiosurgery.

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Conflict of interest

No conflicts of interest exist for any of the authors except: Ian Crocker—Velocity Medical Systems shareholder and subject to receiving royalties through an agreement between Emory University Office of Technology Transfer (OTT) and Velocity Medical Systems

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Authors and Affiliations

  1. Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Room AT-225, Atlanta, GA, 30322, USA

    Roshan S. Prabhu, Anees Dhabaan, William A. Hall, Tomi Ogunleye, Ian Crocker, Walter J. Curran & Hui-Kuo G. Shu

  2. Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA

    Roshan S. Prabhu, Anees Dhabaan, William A. Hall, Tomi Ogunleye, Ian Crocker, Walter J. Curran & Hui-Kuo G. Shu

Authors
  1. Roshan S. Prabhu
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  2. Anees Dhabaan
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  3. William A. Hall
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  4. Tomi Ogunleye
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  5. Ian Crocker
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  6. Walter J. Curran
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  7. Hui-Kuo G. Shu
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Correspondence to Roshan S. Prabhu.

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Prabhu, R.S., Dhabaan, A., Hall, W.A. et al. Clinical outcomes for a novel 6 degrees of freedom image guided localization method for frameless radiosurgery for intracranial brain metastases. J Neurooncol 113, 93–99 (2013). https://doi.org/10.1007/s11060-013-1093-7

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  • DOI: https://doi.org/10.1007/s11060-013-1093-7

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