Summary:Course Description:
This course is the second session in a series focused on contouring techniques
for adult and pediatric CNS cases, specifically addressing brain metastasis
treatment using Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy
(SRT). The session covers essential principles for contouring intact and
post-operative brain metastases, emphasizing imaging protocols, timing
considerations, and practical contouring skills.
Key Topics Covered:
- Introduction
to Brain Metastasis Contouring
- Importance
of accurate contouring for SRS/SRT.
- Overview
of the session and its relevance to clinical practice.
- Imaging
Protocols for Brain Metastases
- Essential
MRI sequences: T1 with/without contrast, T2, and advanced 3D sequences
(e.g., FSPGR, FSE).
- Importance
of 1mm slice thickness for high-resolution imaging.
- Differences
between FSPGR (vessels bright) and FSE (vessels dark) sequences.
- Timing
Considerations
- Impact
of MRI timing on local control:
- MRI
within 10 days of treatment recommended for optimal accuracy.
- Growth
rates of metastases (e.g., 1.35x volume expansion every two weeks).
- Special
considerations for hemorrhagic metastases and steroid effects on tumor
size.
- Contouring
Intact Brain Metastases
- Techniques
for identifying and contouring gross disease on MRI.
- Importance
of reviewing prior imaging and performing image registration.
- No
CTV margins for intact metastases; PTV margins vary by system (Gamma
Knife: 0mm, LINAC: 1-2mm).
- Contouring
Post-Operative Brain Metastases
- Resection
cavity contouring with a 2mm CTV margin (supported by literature).
- Inclusion
of surgical tracts and dural expansions (5mm) for lesions with pre-op
dural contact.
- Timing
of post-op radiation (within 4 weeks for best outcomes).
- Interactive
Contouring Demonstration
- Live
examples of intact and post-op metastasis contouring.
- Audience
participation in contouring exercises to reinforce learning.
- Case
Studies and Clinical Pearls
- Real-world
cases highlighting challenges (e.g., cystic components, hemorrhagic
lesions).
- Balancing
toxicity and efficacy in margin selection.
- Q&A
and Discussion
- Addressing
common questions (e.g., MRI simulation vs. diagnostic MRI, Gamma Knife
vs. LINAC).
- Multidisciplinary
approaches for complex cases.
Learning Objectives:
- Understand
the critical role of imaging protocols and timing in SRS/SRT planning.
- Develop
proficiency in contouring intact and post-operative brain metastases.
- Apply
evidence-based margins and expansions to optimize local control and
minimize toxicity.
- Navigate
challenges such as hemorrhagic metastases, steroid effects, and surgical
tracts.
Target Audience:
- Radiation
oncologists, medical physicists, and dosimetrists.
- Trainees
and clinicians in low-to-middle-income settings seeking to establish
SRS/SRT programs.
Session Format:
- Didactic
lectures with case-based learning.
- Interactive
contouring exercises.
- Q&A
and collaborative problem-solving.
- Duration: 60 min
- Language: English
- Country: UK
- Level: Basic
Keywords:
