@Gianfranco Angelo Pesce (1), M. Casiraghi (2), N. Andratschke (3), M. Gross (4), E. Ermis (5), E Hermann (5), H. Vees (6), D. Zwahlen(7), F. Castronovo (1), F. Martucci (1), P. Canino (1), L. Deantonio (1), A. Angrisani(1), E. Porro (8), M.C. Valli (1),F.Pupillo (2), V. Torri (9), F. Marchi (10), S. Presilla (2), T. Zilli (1) and D. Bosetti (1)

We look forward to receiving and sharing your anonymized patient cases to be discussed with an extended network of experts in the field of SRS & SBRT.

🏥 Just sharing an interesting case we recently had at CHR Metz-Thionville: Our patient presented with 3 brain metastases, with 12 cm between the two farthest volumes. One of the metastases was irregular and located 1 cm to the brainstem. The prescribed regimen was 3 fractions of 8.8 Gy @80% IDL.

💡 We utilized the new Hybrid Optimization of the Brainlab Elements Multiple Brain Mets V4.0 to quickly devise an optimal treatment plan. This involved mixing 10 DCA and VMAT arcs in a single isocenter, resulting in great coverage index (1.13-1.19) and treatment statistics.

⚙️ Moreover, all dose constraints to OARs were meticulously met, ensuring that the maximum dose to the brainstem was limited to 3.5 Gy.

📊 The 3%/1 mm local gamma passing rate for the whole plan was 99.6% 😍 (measured with the PTW Octavius 4D and the 1600 SRS matrix in non-coplanar mode and a low-dose threshold of 20%).

⏱️ The average treatment time was approximately 14 minutes, with the longest session taking less than 20 minutes for the patient to be in and out.

⁉ How would have managed this case? Let us know so we can continue improving our workflow!

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