Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning

Stereotactic radiosurgery is a widely used treatment modality for brain metastases, particularly in cases with a limited number and volume of lesions. While adaptive strategies have gained prominence in the stereotactic treatment of extracranial, their application in intracranial SRS remains largely...

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Main Authors: Menekse Turna, Hale Başak Çağlar
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Clinical and Translational Radiation Oncology
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Online Access:http://www.sciencedirect.com/science/article/pii/S2405630825000928
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author Menekse Turna
Hale Başak Çağlar
author_facet Menekse Turna
Hale Başak Çağlar
author_sort Menekse Turna
collection DOAJ
description Stereotactic radiosurgery is a widely used treatment modality for brain metastases, particularly in cases with a limited number and volume of lesions. While adaptive strategies have gained prominence in the stereotactic treatment of extracranial, their application in intracranial SRS remains largely unexplored. This case study presents a 45-year-old female with multiple brain metastases and significant perilesional edema, treated with fractionated stereotactic radiotherapy. Due to tumor displacement during the treatment course, adaptive SRS was implemented after the third fraction, utilizing an updated MRI scan to account for changes in tumor volume and midline shift. The total GTV decreased by 34.2 %, and five lesions were found to be partially outside the prescribed treatment target. Based on this MRI, an offline adaptive SRS plan was generated, and the remaining two fractions were delivered according to the updated plan. This case underscores the potential for significant changes in target volume and spatial displacement during FSRT in patients with brain metastases exhibiting extensive edema and emphasizes the importance of mid-treatment imaging and the potential role of offline adaptive SRS strategies in managing intracranial tumors.
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spelling doaj-art-689b3cd800ab4ced8a8519481d693d0d2025-08-20T03:36:15ZengElsevierClinical and Translational Radiation Oncology2405-63082025-09-015410100010.1016/j.ctro.2025.101000Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planningMenekse Turna0Hale Başak Çağlar1Anadolu Medical Center, Department of Radiation Oncology, Gebze, Kocaeli, Turkey; Corresponding author at: Cumhuriyet Mahallesi, 2255, Sokak 41100, Turkey.Anadolu Medical Center, Department of Radiation Oncology, Gebze, Kocaeli, TurkeyStereotactic radiosurgery is a widely used treatment modality for brain metastases, particularly in cases with a limited number and volume of lesions. While adaptive strategies have gained prominence in the stereotactic treatment of extracranial, their application in intracranial SRS remains largely unexplored. This case study presents a 45-year-old female with multiple brain metastases and significant perilesional edema, treated with fractionated stereotactic radiotherapy. Due to tumor displacement during the treatment course, adaptive SRS was implemented after the third fraction, utilizing an updated MRI scan to account for changes in tumor volume and midline shift. The total GTV decreased by 34.2 %, and five lesions were found to be partially outside the prescribed treatment target. Based on this MRI, an offline adaptive SRS plan was generated, and the remaining two fractions were delivered according to the updated plan. This case underscores the potential for significant changes in target volume and spatial displacement during FSRT in patients with brain metastases exhibiting extensive edema and emphasizes the importance of mid-treatment imaging and the potential role of offline adaptive SRS strategies in managing intracranial tumors.http://www.sciencedirect.com/science/article/pii/S2405630825000928Stereotactic radiotherapyStereotactic radiosurgeryAdaptive radiotherapyBrain metastasesTumor displacement
spellingShingle Menekse Turna
Hale Başak Çağlar
Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
Clinical and Translational Radiation Oncology
Stereotactic radiotherapy
Stereotactic radiosurgery
Adaptive radiotherapy
Brain metastases
Tumor displacement
title Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
title_full Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
title_fullStr Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
title_full_unstemmed Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
title_short Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning
title_sort volumetric and spatial changes in brain metastases during stereotactic radiosurgery a case for off line adaptive planning
topic Stereotactic radiotherapy
Stereotactic radiosurgery
Adaptive radiotherapy
Brain metastases
Tumor displacement
url http://www.sciencedirect.com/science/article/pii/S2405630825000928
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