Novalis Circle: Expert Clinicians Report on Promising Advancements in Treatments for Brain Metastasis

Brain metastasis is the focus of neurosurgeons and radiation oncologists working together to break down historic barriers in patient treatment. The latest Novalis Circle Symposium emphasizes a collaborative effort to redefine techniques that may help reduce death from metastatic brain tumors.

Novalis® Radiosurgery offers patients a greater chance to defeat their primary cancer when compared to general radiation therapy. Patients expect to achieve similar outcomes when faced with secondary tumors in the brain. Patients want their doctors to offer curative options, which are the focus of the Novalis Circle forum, “Stereotactic Radiosurgery Developments in the Treatment of Brain Metastases.”

David Andrews, MD, neurosurgeon and Director of the Division of Neuro-Oncologic Neurosurgery at Thomas Jefferson University in Philadelphia reviewed the published clinical evidence for brain metastasis. A key recommendation is that neurosurgeons should evaluate each patient using a neuro-oncologic approach so that stereotactic radiosurgery (SRS) would benefit more patients. Furthermore, modern advances in radiation delivery allow for and specialize in personalized treatments such as SRS. Cutting-edge personalized SRS treatment techniques are readily available and have the potential to neutralize the cranial disease as well as help retain quality of life and neuro-cognitive function.

Treatment of brain metastasis is evolving from simple whole brain therapeutic doses into more targeted, aggressive and curative strategies as access to SRS increases. An emerging body of evidence suggests that SRS is on par with or better than whole brain radiotherapy (WBRT) in terms of survival while also providing more flexibility because it can be repeated and offers a high level of functional preservation. Additionally, SRS can be offered over a few sessions to accommodate patients with very large tumors or with a large total volume of tumors.

“Due to the nature of brain metastasis, patients have multiple specialists working to make treatment decisions,” said Dwight Heron, MD, Director of Radiation Services at University of Pittsburgh Medical Center (UPMC) Cancer Center, Vice Chairman of Clinical Affairs and Chairman of the Department of Radiation Oncology at UPMC Shadyside. “Patients benefit immensely from the neuro-oncologic team because stereotactic radiosurgery has become a vital part of clinical care in patients with brain metastases allowing for the maintenance of quality of life.”

“General consensus among clinicians is to move past the traditional limitations of whole brain radiation therapy and expand the applications of ablative therapy to provide durable local control with improved side effect profile,” said Igor Barani, MD, Clinical Research Director and Vice Chairman, Department of Radiation Oncology, University of California at San Francisco. “We are designing modern clinical trials to define the impact on quality of life and neurocognitive function following ablative therapy to multiple brain mets.”

Brainlab Automatic Brain Metastases Planning¹ software will offer automatic, consistent planning within two minutes and time-efficient delivery of stereotactic radiosurgery. The software yields a conformal and ‘monitor-unit-efficient’ treatment of multiple metastases. Through intelligent manipulation of linear accelerator ‘leaf’ mechanics, the time-efficient technology will allow precision targeting of several metastases in a single session, taking full advantage of the rotation of the machine to deliver a conformity-optimized plan. Clinicians can achieve tight dose conformity around each tumor, helping reduce side effects that can occur when healthy tissue is exposed to excess radiation.

“We need dedicated technology that is intelligent enough to overcome the complexities of personalized metastasis treatment but also dynamic enough to offer a fast solution to adapt to the changing nature of a patient’s disease,” said Ufuk Abacioglu, MD, Professor in Radiation Oncology at Neolife Medical Center in Istanbul. “Elements Automatic Brain Metastases software can help us build a better way to personalize treatment for every patient. We can now create stereotactic radiosurgery plans on the fly, in real time for all patients, irrespective of their primary disease.”

For more information, visit www.brainlab.com/brainmets.