MR-Linac Guided Adaptive FSRT for Brain Metastases From Non-small Cell Lung Cancer

Prior treatment

• Intracranial metastases needed surgical decompression
• Previous radiotherapy or excision for intracranial metastases
• Major surgery within 28 days or minor surgery or needle biopsy within 48 hours

Other illness

• Bleeding tendency or coagulation disorder
• Severe vascular disease occurred within 6 months
• Gastrointestinal fistula, perforation or abdominal abscess occurred within 6 months
• Hypertensive crisis, hypertensive encephalopathy, symptomatic heart failure (New York class II or above), active cerebrovascular disease or cardiovascular disease occurred within 6 months
• Uncontrolled hypertension (systolic \> 150mmHg and/or diastolic \> 100mmHg)
• Severe uncontrolled disease
• Uncontrollable seizure or psychotic patients without self-control ability
• Other not suitable conditions determined by the investigators

Other

• Small cell carcinoma of lung
• Patients with contraindications for MRI
• The tumor has completely approached, encircled, or invaded the intravascular space of the great vessels (e.g., the pulmonary artery or the superior vena cava)
• A cavity over 2cm in diameter of primary tumor or metastasis
• Hemoptysis (1/2 teaspoon blood/day) happened within 1 month
• The use of full-dose anticoagulation within the past 1 month
• Urine protein 3-4+, or 24h urine protein quantitative \>1g
• Women in pregnancy, lactation period

• Aged 18-75 years
• Histologically or cytologically confirmed non-small cell lung cancer
• 1-10 metastases on contrast-enhanced MRI
• Radiotherapy for extracranial lesions is permitted
• Tyrosine kinase inhibitors (TKI) are permitted in patients with progression of intracranial metastases during previous TKI therapy
• Patients have measurable or evaluable lesions based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Normal function of organs and bone marrow within 14 days: Total bilirubin 1.5 times or less the upper limits of normal (ULN); AST and ALT 1.5 times or less the ULN; absolute neutrophil count≥ 500 cells/mm3; creatinine clearance rate(CCR) ≥45 mL/min; Platelet count≥50,000 cells/mm3; international normalized ratio(INR) ≤1.5#Prothrombin Time (PT)≤ 1.5 × ULN
• Informed-consent