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Strategies and Technologies for Radiosurgery of Multiple Intracranial Metastases

M Milano1*, N Agazaryan2*, G Kim3*, (1) University of Rochester Medical Center, Rochester, NY, (2) UCLA School of Medicine, Los Angeles, CA, (3) University of California, San Diego, La Jolla, CA


(Monday, 7/15/2019) 1:45 PM - 2:45 PM

Room: Stars at Night Ballroom 4

Within the past ten years, the field of radiosurgery has seen numerous technological enhancements, including the development of dedicated devices for stereotactic delivery, the use of re-locatable frames to facilitate fractionated delivery and the development of image-guided frameless approach. Also, patients with systemic malignancies live longer with improved systemic therapies, and the brain becomes a more important potential site of failure. It becomes increasingly more common to re-treat patients multiple times over several years and leads to a greater number of metastatic lesions. The first speaker will review the recent data on radiosurgery for multiple brain metastases and the factors which are potentially important for intracranial tumor control, survival and toxicity. We will summarize the data on SRS alone vs. whole brain radiation therapy for patients with 1 to 3 or 4 brain metastases and then discuss the potential role of SRS alone for patients with more than a few brain metastases. Then 2nd and 3rd speakers will review the techniques of radiosurgery for multiple metastases. Treatment of multiple cranial targets with single isocenter techniques are gaining momentum in clinical practice. We will review 2 different vendors technological aspects of single isocenter treatment techniques for multiple cranial targets; discuss practical impact of these treatments, including patient and provider benefits; review commissioning and quality control options for single isocenter treatments; review critical items involved in treatment planning and treatment delivery.

Learning Objectives:
1. Summarize the published data on SRS alone for multiple brain metastases
2. Review new techniques of planning and delivery system and quality assurance
3. Learn about the treatment planning strategy and dose tolerance of critical structure and understand challenges of multiple metastases planning.
4. Interactive clinical case planning and evaluation of the plan quality metrics.

Funding Support, Disclosures, and Conflict of Interest: Dr. Milano: Royalties from UpTpDate (Wolters Kluwer) Dr. Agazaryan: Clinical Collaboration Grant, Brainlab, and Consultant, Brainlab & an Expert Member, Novalis Accreditation Expert Panel Dr. Kim: Consultant, Varian



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