NCCI Clinical & Radiation Oncology Case Reports

SRS / VMAT For Multiple Brain Metastases On Synergy-S

CT simulation was performed with thermoplastic sheet and SRS / VMAT planning was carried out on ERGO ++. Excellent Dose distribution was achieved on two arcs and calculated treatment time was 11 minutes. SRS dose prescription was 20 Gy single fraction at 70 % isodose line.

NCCI Clinical & Radiation Oncology Case Reports

Pic-(1)- Location and Volumes of Six brain metastases were contoured

Left temporal met: 1.8 cc

Left parietal met: 2.1 cc

Left posterior parietal met: 2.2 cc

Left Occipital met: 1.2 cc

Right parietal met: 0.3 cc

Right cerebellar met: 2.9 cc

Pic-(2)- SRS/ VMAT Plan was prepared with the help of two arcs, all the contoured mets were well covered with prescription isodose line of 70 %.

Total treatment time was 11 minutes.

Pic-(3)- Computerized Planning on Treatment planning system ERGO ++. Green line around the target is prescription isodose line of 70 %. Blue line is 50 % isodose line.

In conclusion following benefits were achieved from this treatment.

Shortest treatment time (4-11 min) to execute the standard dose of radiation therapy.
Non-Invasive procedure (no fiducials or screws), No anesthesia, No bleeding, No pain.
Very high doses to each metastasis – Good local control.
Lowest dose to the critical organs at risk. Minimal side effects.
Sparing of hippocampus.
No long-term memory impairment.
No cognitive impairment.
Rapid improvement in performance status to continue the systemic therapy.
Continue daily routine work, no rest, no hospitalization, no holidays required. Day care procedure. Discharged on the same day, 60 min after the procedure.
Treatment of choice in brain metastases for the oncologist, neurosurgeons and other clinicians.