Abstract
To determine whether there are any changes in brain metastases or resection cavity volumes between planning magnetic resonance imaging (MRI) and radiosurgery (RS) treatment and whether these led to a change in management or alteration in the RS plan. Patients undergoing RS for brain metastasis or tumor resection cavities had a standardized planning MRI (MRI-1) performed and a repeat verification MRI (MRI-2) 24hours before RS. Any change in management, including replanning based on MRI-2, was recorded. Thirty-four patients with a total of 59 lesions (44 metastases and 15 tumor resection cavities) were assessed with a median time between MRI-1 and MRI-2 of 7days. Seventeen patients (50%) required a change in management based on the changes seen on MRI-2. For patients with 7days or less between scans, 41% (9 of 22) required a change in management; among patients with 8days or more between scans, 78% (7 of 9) required a change in management. Per lesion, 32 out of 59 lesions required replanning, including 7 of 15 (47%) cavities and 25 of 44 (57%) metastases, with the most common reason (23 lesions) being an increase in gross target volume (tumor) or clinical target volume (tumor cavity). Measurable changes occur in brain metastasis over a short amount of time, with a change in management required in 41% of patients with 7days between MRI-1 and MRI-2 and in 78% of patients when there is a delay longer than 7days. We therefore recommend that the time between planning MRI and RS treatment be as short as possible.
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