Image Guided Intraoperative Radiation Therapy After Surgical Resection of Brain Metastases: A First In-Human Feasibility Report

Molina Grimmer, MSc; Gustavo R. Sarria, MD; Motaz Hamed, MD; Mohammed Banat, MD; Fabian Kugel, MSc; Hector Lorenzana, MHA; Davide Scafa, MD; Mümtaz Köksal, MD; Julian P. Layer, MD; Cas Dejonckheere, MD; Martin Fiebich, PhD; Frederic Carsten Schmeel, MD; Ana Kowark, MD; Hartmut Vatter, PhD; Leonard Christopher Schmeel, MD; Stephan Garbe, PhD

Advances in Radiation Oncology (May 2024)

Image Guided Intraoperative Radiation Therapy After Surgical Resection of Brain Metastases: A First In-Human Feasibility Report

Molina Grimmer, MSc,
Gustavo R. Sarria, MD,
Motaz Hamed, MD,
Mohammed Banat, MD,
Fabian Kugel, MSc,
Hector Lorenzana, MHA,
Davide Scafa, MD,
Mümtaz Köksal, MD,
Julian P. Layer, MD,
Cas Dejonckheere, MD,
Martin Fiebich, PhD,
Frederic Carsten Schmeel, MD,
Ana Kowark, MD,
Hartmut Vatter, PhD,
Leonard Christopher Schmeel, MD,
Stephan Garbe, PhD

Affiliations

Molina Grimmer, MSc: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Gustavo R. Sarria, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany; Corresponding author: Gustavo R. Sarria, MD
Motaz Hamed, MD: Department of Neurosurgery, University Hospital Bonn, University of Bonn, Bonn, Germany
Mohammed Banat, MD: Department of Neurosurgery, University Hospital Bonn, University of Bonn, Bonn, Germany
Fabian Kugel, MSc: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Hector Lorenzana, MHA: Department of Neurosurgery, University Hospital Bonn, University of Bonn, Bonn, Germany
Davide Scafa, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Mümtaz Köksal, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Julian P. Layer, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Cas Dejonckheere, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Martin Fiebich, PhD: Technische Hochschule Mittelhessen, Gießen, Germany
Frederic Carsten Schmeel, MD: Department of Neuroradiology, University Hospital Bonn, University of Bonn, Bonn, Germany
Ana Kowark, MD: Department of Neurosurgical Anesthesia, University Hospital Bonn, University of Bonn, Bonn, Germany
Hartmut Vatter, PhD: Department of Neurosurgery, University Hospital Bonn, University of Bonn, Bonn, Germany
Leonard Christopher Schmeel, MD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
Stephan Garbe, PhD: Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany

Journal volume & issue: Vol. 9, no. 5
p. 101466

Abstract

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Purpose: A correct placement of the applicator during intraoperative radiation therapy for brain metastasis is of paramount importance, to deliver a precise and safe treatment. The applicator-to-surface contact assessment cannot be performed under direct observation because the applicator itself limits the visual range. No image guided verification is currently performed intracranially. We hypothesize that image guided intraoperative radiation therapy would assure a more precise delivery in the target area. We describe our workflow in a first in-human experience. Methods and Materials: Phantom-based measurements were performed to reach the best cone beam computed tomography imaging quality possible. Once defined, a clinical feasibility study was initiated. An in-room cone beam computed tomography device is used to acquire intraoperative images after placing the applicator. Repositioning the applicator is thereafter discussed with the surgeon, according to the imaging outcomes, if required. Results: An optimal image quality was achieved with 120-kV voltage, 20-mA current, and a tube current time product of 150 mAs. An additional 0.51 mSv patient exposure was calculated for the entire procedure. The wide dynamic range (−600 HU to +600 HU) of cone beam computed tomography and a 27 HU mean computed tomography values difference between brain tissue and spherical applicator allows distinguishing both structures. In this first in-human experience, the applicator was repositioned after evidencing air gaps, assuring full applicator-to-surface contact. Conclusions: This first in-human procedure confirmed the feasibility of kilovoltage image guided intraoperative radiation therapy in a neurosurgical setting. A prospective study has been initiated and will provide further dosimetric details.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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