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Japanese Journal of Clinical Oncology Advance Access published online on October 12, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp128
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© The Author (2009). Published by Oxford University Press. All rights reserved

Therapeutic Effect of Linac-based Stereotactic Radiotherapy with a Micro-multileaf Collimator for the Treatment of Patients with Brain Metastases from Lung Cancer

Jun-ichi Saitoh1, Yoshihiro Saito1, Tomoko Kazumoto1, Shigehiro Kudo1, Akihiro Ichikawa1, Nobuaki Hayase2, Kiyoshi Kazumoto2, Hiroshi Sakai3 and Kei Shibuya4

1 Division of Radiation Oncology, Saitama Cancer Center
2 Division of Neurosurgery, Saitama Cancer Center
3 Division of Respiratory disease, Saitama Cancer Center, Saitama
4 Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan

For reprints and all correspondence: Jun-ichi Saitoh, Division of Radiation Oncology, Saitama Cancer Center, 818 Komuro, Ina, Kita-adachi, Saitama 362-0806, Japan. E-mail: junsaito{at}sannet.ne.jp

Received June 11, 2009; accepted September 2, 2009

Objective: To assess the efficacy of hypofractionated linac-based stereotactic radiotherapy with a micro-multileaf collimator (mMLC) in lung cancer patients with brain metastases.

Methods: Seventy-eight lesions of brain metastases in 49 lung cancer patients treated by stereotactic radiotherapy between September 2003 and December 2006 were analyzed. In the treatment planning, the planning target volume (PTV) was defined as an enhanced lesion plus 3 mm margin. A total dose of 39–42 Gy in three fractions was delivered to the isocenters of the PTV.

Results: The median survival time after stereotactic radiotherapy was 17.4 months. The 1- and 2-year survival rates were 61% and 32%, respectively. The presence of extracranial tumors, the pre-treatment performance status, and the Radiation Therapy Oncology Group recursive partitioning analysis class were significant prognostic factors. The 1- and 2-year local recurrence rates were 14% and 17%, respectively, with no serious acute toxic effect. Injuries involving brain necrosis were observed in six patients. New brain metastases or meningeal carcinomatosis was seen in more than half of the patients following treatment with stereotactic radiotherapy.

Conclusions: Hypofactionated stereotactic radiotherapy with mMLC is considered to be an effective and safe modality for the treatment of brain metastases in lung cancer patients.

Key Words: stereotactic radiotherapy • micro-multileaf collimator • brain metastases • hypofractionated • lung cancer


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