Frameless, real-time, surface imaging-guided radiosurgery: Clinical outcomes for brain metastases

Hubert Pan, Laura I. Cerviño, Todd Pawlicki, Steve B. Jiang, John Alksne, Nicole Detorie, Michelle Russell, Bob S. Carter, Kevin T. Murphy, Arno J. Mundt, Clark Chen, Joshua D. Lawson

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


BACKGROUND: Frameless stereotactic radiosurgery is commonly used to treat intracranial metastases, but mask-based immobilization can be uncomfortable for patients. OBJECTIVE: To describe the clinical outcomes using a novel real-time, frameless, surface imaging-guided radiosurgery (SIG-RS) technique to treat brain metastases. METHODS: Data were prospectively gathered for 44 consecutive patients totaling 115 intracranial metastases treated with SIG-RS in a median of 1 fraction (range, 1-5) to a median dose of 20 Gy (range, 15-30 Gy). Local control, regional control, and overall survival were estimated by the Kaplan-Meier method. RESULTS: Median follow-up for all patients was 6.0 months (range, 0.3-21.6 months), with 31 of 44 (70%) deceased at the time of analysis. The 35 patients (80%) with follow-up imaging totaled 88 lesions evaluable for local control. Actuarial 6-and 12-month local control was 90% (95% confidence interval, 82-98) and 76% (95% confidence interval, 60-91), respectively. Regional failure was observed in 16 patients (46%). The median actuarial overall survival was 7.7 months (95% confidence interval, 5.7-9.7). Analysis of the subset of 22 patients (55 lesions) who received SIG-RS alone (no prior treatment) in a single fraction yielded comparable clinical outcomes. Grade 3 or greater toxicity occurred in 4 patients (9%). The median treatment time from beam on to beam off was 15 minutes (range, 3-36 minutes). CONCLUSION: SIG-RS for treating intracranial metastases can produce clinical outcomes comparable to those with conventional frame-based and frameless stereotactic radiosurgery techniques while providing greater patient comfort with an open-faced mask and fast treatment times.

Original languageEnglish (US)
Pages (from-to)844-851
Number of pages8
Issue number4
StatePublished - Oct 2012


  • Brain metastases
  • Frameless
  • Radiosurgery
  • Surface imaging

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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