Table 1.
VMAT in brain metastases
| Study | Study design | Setting | Number of patients (treated lesions) | Technique, dose (fractionation) | Image guidance | Acute ≥ Grade 3 toxicity | Late ≥ Grade 2 toxicity | Median FUP, months (range) | Clinical outcome | LC rate | OS |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Weber et al30 | P | EXC, ADJ | 29 | VMAT–SIB 2 arcs, 40 Gy (4) WBRT, 30 Gy (3) |
CBCT | 0% | 0% | 5.4 (2.6–8.2) | Local failure: 13% Brain failure: 13% Metastases and brain local control: 74% |
6 months: 77.9% | 6 months: 55.1% |
| Awad et al31 | R | EXC | 30 (73) | VMAT–SIB 2 arcs, 50 Gy, range 20–70.8 (3.3) WBRT, 30 Gy, range 28.6–37.5 (2) |
na | 0% | Radionecrosis: 3% | 3.5 (0.03–16.5) | Clinical benefit: 81.5%a | na | Median: 9.4 months |
| Nichol et al32 | P | EXC | 60 | VMAT–SIB 2 arcs, Total dose and fractionation 47.5 (9.5) WBRT, 20 Gy (4) |
Orthogonal kilovoltage imaging | Ataxia: 1.7% Radionecrosis: 1.7% Somnolence: 1.7% CTCAE |
Nausea: 1.7% Neuropathy: 1.7% Headache: 1.7% Cognitive impairment: 3.3% Ataxia: 5% Motor weakness: 9.9% Radionecrosis: 13.3% |
30.5 | 3 months objective response: 56% | 12 months: 88% 36 months: 84% |
Median: 10.1 months |
| Tsai et al33 | P | PRO, EXC, ADJ | 24 | VMAT (2 full arcs and 2 noncoplanar arcs), PRO: 25 (2.5) ADJ, EXC: 30 (2.5–3) |
na | na | na | 4 | Stable neurocognitive functions | na | na |
Note:
a
On 27 evaluable lesion.
Abbreviations: P, prospective study; R, retrospective study; EXC, exclusive; ADJ, adjuvant; PRO, prophylactic; VMAT, volumetric modulated arc therapy; SIB, simultaneous integrated boost; WBRT, whole-brain radiotherapy; CBCT, cone-beam computed tomography; na, not available; CTCAE, Common Terminology Criteria for Adverse Events scale; FUP, follow-up; LC, local control; OS, overall survival.