Speakers: Assoc Prof Gerald Fogerty, Michael Dally, John Kenny
Content: Windsor pointed out that little progress has been made with whole brain radiotherapy (WBRT) over the last 50 years with the median survival remaining 4 months. Some progress has been made with a small number (1-3) of intracerebral metastases with the advent of Stereotactic Radiosurgery. Recent studies have confirmed the adverse neurocognitive effects of WBRT while a novel Japanese study has shown no detriment in treating a larger number of metastases (5-10) in terms of survival. What is unknown is the effect of stereotactic radiosurgery on more than 3 metastases in terms of neurocognitive function and local control. Treating large numbers of metastases with SRS with Linac-based technology has remained difficult because of the integral dose associated with multiple isocentres. BrainlabAG Automatic Brain Metastases Planning “Elements” software has been commissioned at Epworth Healthcare and is being used in a Phase II study of Stereotactic Hypo-fractionated Radiosurgery including Neurological and Cognitive assessment. With “SHRINC” we hypothesize that there will be no decline in neurocognitive function with SRS to multiple brain metastases. We hope to question current practice and share our early experience in commissioning and using BrainlabAG Elements software, to simultaneously treat up to ten metastases.