How do you stereotactically treat brain metastases greater than 3 cm +/- additional brain mets?
It is my impression that for brain metastases >3 cm it may be preferable to deliver fractionated SRT versus the RTOG dose of 15 Gy SRS, if WBRT is omitted. If delivering fractionated SRT, is there a current optimal scheme? I am familiar with 5 Gy x 5 to a 1 mm PTV, but am also aware that some are giving 6Gy x 5 (EQD2 >=35 Gy) or 8Gy x 3. Is there a current "right dose" or range of dose fractionation schemes?
In a related question, what is the best approach when there is a met >3cm with perhaps 2 or 3 smaller distributed mets <= 2 cm? Hypofractionate all or SRT the larger lesion and SRS the smaller ones?
1 Answer
Mednet MemberInvited Expert
Radiation Oncology · Yale School of Medicine
Answered on
Interestingly, we have had a number of cases where a patient presents with several small (0.5-1 cm mets) and a single dominant lesion (3-5 cm), particuarly in melanoma. Becuase of a presumed radioresistance for melanoma, we have desired to use as much single fraction or hypo-fractionation as possible to acheive high doses in a short period of time with stereotactic set-up. To this end, we have treated several patients with single fraction GKRS (e.g., 22 Gy) to the small lesions and then deliver ...
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