Interval between planning and frameless stereotactic radiosurgery for brain metastases: are our margins still accurate?

Neuro oncology pratices, Mar 2020

C Bronnimann , A Huchet , J Benech-Faure , C Dutriaux , Or Saut , E Blais , O Mollier , R Trouette , V Vendrely

doi: 10.1093/nop/npz048


Background: Advances in intracranial stereotactic radiosurgery (SRS) have led to dramatically reduced planning target volume (PTV) margins. However, tumor growth between planning and treatment may lead to treatment failure. Our purpose was to assess the kinetics of tumor growth before SRS for brain metastases.

Methods: This retrospective, monocentric study included all consecutive patients (pts) treated for brain metastases secondary to melanoma (ML) and non-small cell lung cancer (NSCLC) between June 2015 and May 2016. All pts underwent diagnostic brain imaging and a radiosurgery planning MRI, during which gross tumor volume (GTV) was delineated. Linear and exponential models were used to extrapolate a theoretical GTV at first day of treatment, and theoretical time to outgrow the PTV margins.

Results: Twenty-three ML and 31 NSCLC brain metastases (42 pts, 84 brain imaging scans) were analyzed. Comparison of GTV at diagnosis and planning showed increased tumor volume for 20 ML pts (96%) and 22 NSCLC pts (71%). The shortest time to outgrow a 1 mm margin was 6 days and 3 days for ML and 14 and 8 days for NSCLC with linear and exponential models, respectively.

Conclusions: Physicians should bear in mind the interval between SRS planning and treatment. A mathematical model could screen rapidly progressing tumors.

Keywords: brain metastases; interval; margins; stereotactic radiosurgery.