
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.072
vdae090.072
Final Category: Neuroimaging/Radiologic Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
NIRL-11 3D-FSE IMAGING FOR RADIOSURGERY PLANNING IMPROVES BRAIN METASTASIS DETECTION AND REDUCES INTRACRANIAL RELAPSE
Akdemir Eyub Y Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Press Robert H Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Hodgson Lydia C Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Rubens Muni B Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

La Rosa Alonso Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Kutuk Tugce Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Wieczorek D Jay Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Lee Cecillia Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Bejarano Tatiana Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA

Tolakanahalli Ranjini Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Gutierrez Alonso N Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

McDermott Michael W Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA
Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami/FL, USA

Mehta Minesh P Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

Kotecha Rupesh Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami/FL, USA
Herbert Wertheim College of Medicine, Florida International University, Miami/FL, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i22i22
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

INTRODUCTION: Stereotactic radiosurgery (SRS) is an effective treatment for brain metastasis (BM), but patients remain at significant risk for distant intracranial failure (DIF) due to undetected lesions at the time of SRS or subsequent seeding. We implemented dedicated treatment planning imaging with novel MR sequences with the goals of enhancing lesion detection and consequentially increasing time to DIF, correspondingly reducing the need for whole-brain radiotherapy (WBRT). METHODS: Patients treated with SRS for BM between 05/2019-01/2024 were evaluated. MPRAGE sequences were performed for all, and 3D-FSE sequences were added starting in 02/2020. Median times to DIF and WBRT for both cohorts were estimated using the Kaplan–Meier method. RESULTS: 194 patients underwent 310 SRS courses for 1326 BM imaged with both MPRAGE and 3D-FSE (primary cohort), compared to the control cohort (88 patients, 116 SRS courses, 373 BM). MPRAGE sequences detected 1456 lesions in all 282 patients (373 in 88 control patients, 1083 in 194 primary cohort patients). In the primary cohort, an additional 204 lesions were identified with 3D-FSE (18% increase). An additional 39 lesions (3.6% increase) were identified on multidisciplinary review of both MR modalities. Although there was no statistically significant difference in median time to DIF between the cohorts (11.3 vs. 6.7 months, p=0.14), there was a trend towards longer DIF in the 1-4 metastases subgroup (14.6 vs. 7.9 months, p=0.052) and a statistically significant difference in those with a single BM (35.9 vs. 11.8 months, p=0.017). WBRT rates at 2-years were similar between the cohorts, 15% vs. 20%, p=0.2, respectively. CONCLUSIONS: A dual sequence approach at the time of SRS with multidisciplinary review improves lesion detection and lengthens time to DIF and, ultimately, next intervention. This is especially useful in confirming true BM number in those with limited intracranial disease.
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