AROMA therapy.

In 2022, traditional whole brain radiation (WBRT) is typically reserved for the very highest volume brain mets. And while no one can argue with the efficiency with which it can be delivered, it is in this scenario you worry most about insufficient dose to gross disease. Here is a UK dosimetric feasibility study of volumetric modulated arc therapy (VMAT)-WBRT to effectively dose-escalate gross disease during WBRT. Ten patients receiving WBRT for brain mets, one of which at least 15 cc in size, were retrospectively identified with five plans created for each patient: conventional WBRT, hippocampal-sparing WBRT, and three additional iterations of VMAT-WBRT all delivering 20Gy/5 to the whole brain with various techniques for dose escalating gross disease. The “best” plans, delivering the highest doses to visible lesions while avoiding hotspots in normal brain or organs at risk, used a technique that delivered a 10 Gy simultaneous integrated boost to stepwise isotropically shrinking gross tumor volumes in 5 mm steps. It may sound complicated, but the authors assure it is quicker to plan and deliver than multi-lesion radiosurgery and are currently planning its evaluation in the prospective AROMA trial. | Chen, Radiother Oncol 2022