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Mangesius J, Seppi T, Arnold CR, Mangesius S, Kerschbaumer J, Demetz M, Minasch D, Vorbach SM, Sarcletti M, Lukas P, Nevinny-Stickel M, Ganswindt U. Prognosis versus Actual Outcomes in Stereotactic Radiosurgery of Brain Metastases: Reliability of Common Prognostic Parameters and Indices. Curr Oncol 2024; 31:1739-1751. [PMID: 38668035 PMCID: PMC11049204 DOI: 10.3390/curroncol31040132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
This study aims to evaluate the clinical outcome of stereotactic radiosurgery as the sole treatment for brain metastases and to assess prognostic factors influencing survival. A total of 108 consecutive patients with 213 metastases were retrospectively analyzed. Treatment was determined with close-meshed MRI follow-up. Various prognostic factors were assessed, and several prognostic indices were compared regarding their reliability to estimate overall survival. Median overall survival was 15 months; one-year overall survival was 50.5%. Both one- and two-year local controls were 90.9%. The rate of new metastases after SRS was 49.1%. Multivariate analysis of prognostic factors revealed that the presence of extracranial metastases, male sex, lower KPI, and progressive extracranial disease were significant risk factors for decreased survival. Of all evaluated prognostic indices, the Basic Score for Brain Metastases (BSBMs) showed the best correlation with overall survival. A substantial survival advantage was found for female patients after SRS when compared to male patients (18 versus 9 months, p = 0.003). SRS of brain metastasis is a safe and effective treatment option when frequent monitoring for new metastases with MRI is performed. Common prognostic scores lack reliable estimation of survival times. Female sex should be considered as an additional independent positive prognostic factor influencing survival.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Danijela Minasch
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Samuel Moritz Vorbach
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Manuel Sarcletti
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Lukas
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
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2
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Rostampour N, Rezaeian S, Sarbakhsh P, Meola A, Choupani J, Doosti-Irani A, Nemati H, Almasi T, Badrigilan S, Chang SD. Efficacy of Stereotactic Radiosurgery as Single or Combined Therapy for Brain Metastasis: A Systematic Review and Meta-Analysis. Crit Rev Oncol Hematol 2023; 186:104015. [PMID: 37146702 DOI: 10.1016/j.critrevonc.2023.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/22/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023] Open
Abstract
To determine the efficacy of stereotactic radiosurgery (SRS) in treating patients with brain metastases (BMs), a network meta-analysis (NMA) of randomized controlled trials (RCTs) and a direct comparison of cohort studies were performed. Relevant literature regarding the effectiveness of SRS alone and in combination with whole-brain radiotherapy (WBRT) and surgery was retrieved using systematic database searches up to April 2019. The patterns of overall survival (OS), one-year OS, progression-free survival (PFS), one-year local brain control (LBC), one-year distant brain control (DBC), neurological death (ND), and complication rate were analyzed. A total of 18 RCTs and 37 cohorts were included in the meta-analysis. Our data revealed that SRS carried a better OS than SRS+WBRT (p= 0.048) and WBRT (p= 0.041). Also, SRS+WBRT demonstrated a significantly improved PFS, LBC, and DBC compared to WBRT alone and SRS alone. Finally, SRS achieved the same LBC as high as surgery, but intracranial relapse occurred considerably more frequently in the absence of WBRT. However, there were not any significant differences in ND and toxicities between SRS and other groups. Therefore, SRS alone may be a better alternative since increased patient survival may outweigh the increased risk of brain tumor recurrence associated with it.
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Affiliation(s)
- Nima Rostampour
- Department of Medical Physics, School of Medcine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Epidemiology and Biostatistics Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Antonio Meola
- Depratment of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jalal Choupani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Nemati
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Tinoosh Almasi
- Department of Medical Physics, School of Medcine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samireh Badrigilan
- Department of Medical Physics, School of Medcine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Steven D Chang
- Depratment of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
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Rades D, Johannwerner L, Werner EM, Cremers F, Yu NY. The First Survival Score for Patients Treated with Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost for Brain Metastases. BIOLOGY 2023; 12:biology12040585. [PMID: 37106785 PMCID: PMC10135994 DOI: 10.3390/biology12040585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
A modern approach for brain metastases includes whole-brain radiotherapy plus simultaneous boost (WBRT+SIB). We developed a survival score in 128 patients treated with WBRT+SIB. Three models, each including three prognostic groups, were created. Positive predictive values (PPVs) for death ≤6 and survival ≥6 months were calculated. On multivariate analyses, performance score (KPS) and the number of brain metastases were significantly associated with survival. On univariate analyses, age showed a strong trend, and extra-cerebral cranial metastases a trend. In Model 1 (KPS, number of lesions), compared groups had 6-month survival rates of 15%, 38% and 57%. In Model 2 (KPS, lesions, age), rates were 17%, 33% and 75%, and in Model 3 (KPS, lesions, age, extra-cerebral metastases), 14%, 34% and 78%. PPVs for death ≤6 and survival ≥6 months were 85% and 57% (Model 1), 83% and 75% (Model 2), and 86% and 78% (Model 3). Thus, all models were accurate in predicting death ≤ 6 months; poor-prognosis patients may not benefit from SIB. Models 2 and 3 were superior in predicting survival ≥ 6 months. Given that Model 3 requires more data (including extensive staging), Model 2 is considered favorable for many patients. If extra-cerebral metastases are already known or extensive staging has been performed, Model 3 can also be used.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Leonie Johannwerner
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Elisa M Werner
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
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4
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Liu J, Xu J, Ye W, Zhong W, Zhang X, Mao J, Wu D. Whole-Brain Radiotherapy Combined With Anlotinib for Multiple Brain Metastases From Non-small Cell Lung Cancer Without Targetable Driver Mutation: A Single-Arm, Phase II Study. Clin Med Insights Oncol 2022; 16:11795549221079185. [PMID: 35250325 PMCID: PMC8891900 DOI: 10.1177/11795549221079185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Existing evidence demonstrates that radiotherapy and antiangiogenic drugs have synergistic antitumour effects and may be a promising treatment option for patients with solid tumour. Thus, we performed a phase II trial to evaluate the efficacy and safety of whole-brain radiotherapy (WBRT) combined with anlotinib for multiple brain metastases (BMs) from non-small cell lung cancer (NSCLC) without targetable driver mutations. Methods: Patients with multiple BMs (⩾3) from NSCLC without targetable driver mutations who failed to respond to at least first-line chemotherapy were enrolled. Eligible patients received WBRT (30 Gy/10 f, 5 f/week) and anlotinib (12 mg/day, day 1-14 of 21 days per cycle, 2 cycles) until disease progression or treatment intolerance. The primary endpoint was intracranial objective response rate (iORR) and secondary endpoints included intracranial progression-free survival (iPFS), disease control rate (DCR), overall survival (OS), and safety. Results: Between April 2019 and March 2021, 21 patients were enrolled in the trial, of which 12 were aged ⩾60 years (57.1%), 13 were men (61.9%), 7 had an Eastern Cooperative Oncology Group Performance Status score of 0 to 1 (81.0%), 18 had adenocarcinoma (85.7%), and 11 had ⩾6 BMs (52.4%). Of the 21 evaluable patients, the iORR was 66.7% (1 complete response + 13 partial response [PR]), and 28.6% (7PR) had extracerebral lesions. The DCRs for intracerebral and extracerebral lesions were 90.5% and 81.0%, respectively. The iPFS and OS were 10.3 months (95% confidence interval [CI]: 0-24.8 months) and 13.4 months (95% CI: 0-27.9 months), respectively. The most frequently observed toxicities were loss of appetite (61.9%), hypertension (52.4%), fatigue (47.6%), diarrhoea (28.6%), vomiting (19.0%), dizziness (42.9%), and headache (33.3%). None of the patients developed grade 4 or higher grade adverse reactions. Conclusions: Anlotinib combined with WBRT is effective and well tolerated in patients with multiple BMs (⩾3) from NSCLC without targetable driver mutations. Therefore, further validation studies are required. Clinical trial registration number: ChiCTR 1900027769
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Affiliation(s)
- Jianjiang Liu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Jun Xu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Wanli Ye
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Wangyan Zhong
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Xiaoyu Zhang
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Jiwei Mao
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
| | - Dongping Wu
- Department of Radiation Oncology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China
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5
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Lad M, Gupta R, Raman A, Parikh N, Gupta R, Chandra A, Para A, Aghi MK, Moore J. Trends in physician reimbursements and procedural volumes for radiosurgery versus open surgery in brain tumor care: an analysis of Medicare data from 2009 to 2018. J Neurosurg 2021; 136:97-108. [PMID: 34330094 DOI: 10.3171/2020.11.jns202284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given its minimally invasive nature and effectiveness, stereotactic radiosurgery (SRS) has become a mainstay for the multimodal treatment of intracranial neoplasm. However, no studies have evaluated recent trends in the use of SRS versus those of open resection for the management of brain tumor or trends in the involvement of neurosurgeons in SRS (which is primarily delivered by radiation oncologists). Here, the authors used publicly available Medicare data from 2009 to 2018 to elucidate trends in the treatment of intracranial neoplasm and to compare reimbursements between these approaches. METHODS By using CPT Professional 2019, the authors identified 10 open resection and 9 SRS codes (4 for neurosurgery and 5 for radiation oncology) for the treatment of intracranial neoplasm. Medicare payments (inflation adjusted) and allowed services (number of reimbursed procedures) for each code were abstracted from the Centers for Medicare and Medicaid Services Part B National Summary Data File (2009-2018). Payments per procedure and procedures per 100,000 Medicare enrollees were analyzed with linear regression and compared with tests for equality of slopes (α = 0.05). The average payment per procedure over the study period was compared by using the 2-tailed Welsh unequal variances t-test, and more granular comparisons were conducted by using ANOVA with post hoc Tukey honestly significant difference (HSD) tests. RESULTS From 2009 to 2018, the number of SRS treatments per 100,000 Medicare enrollees for intracranial neoplasm increased by 3.97 cases/year (R2 = 0.99, p < 0.001), while comparable open resections decreased by 0.34 cases/year (R2 = 0.85, p < 0.001) (t16 = 7.5, p < 0.001). By 2018, 2.6 times more SRS treatments were performed per 100,000 enrollees than open resections (74.9 vs 28.7 procedures). However, neurosurgeon involvement in SRS treatment declined over the study period, from 23.4% to 11.5% of SRS treatments; simultaneously, the number of lesions treated per session increased from 1.46 to 1.84 (R2 = 0.98, p < 0.001). Overall, physician payments from 2013 to 2018 averaged $1816.08 (95% CI $1788.71-$1843.44) per SRS treatment and $1565.59 (95% CI $1535.83-$1595.34) per open resection (t10 = 15.9, p < 0.001). For neurosurgeons specifically, reimbursements averaged $1566 per open resection, but this decreased to $1031-$1198 per SRS session; comparatively, radiation oncologists were reimbursed even less (average $359-$898) per SRS session (p < 0.05 according to the Tukey HSD test for all comparisons). CONCLUSIONS Over a decade, the number of open resections for intracranial neoplasm in Medicare enrollees declined slightly, while the number of SRS procedures increased greatly. This latter expansion is largely attributable to radiation oncologists; meanwhile, neurosurgeons have shifted their involvement in SRS toward sessions for the management of multiple lesions.
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Affiliation(s)
- Meeki Lad
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Radhika Gupta
- 2Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Alex Raman
- 3University of California at Los Angeles
| | | | - Raghav Gupta
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey.,4Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ankush Chandra
- 5Vivian L. Smith Department of Neurosurgery, University of Texas at Houston Medical Center, Houston, Texas.,6Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Ashok Para
- 1Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Manish K Aghi
- 6Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Justin Moore
- 7Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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6
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Mangesius J, Seppi T, Bates K, Arnold CR, Minasch D, Mangesius S, Kerschbaumer J, Lukas P, Ganswindt U, Nevinny-Stickel M. Hypofractionated and single-fraction radiosurgery for brain metastases with sex as a key predictor of overall survival. Sci Rep 2021; 11:8639. [PMID: 33883632 PMCID: PMC8060341 DOI: 10.1038/s41598-021-88070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022] Open
Abstract
Overall survival (OS) of patients with brain metastases treated with hypofractionated (HFSRT) or single-fraction (SRS) radiosurgery depends on several prognostic factors. The aim of this study was to investigate the potential of sex as an independent predictor of OS and evaluate the predictive accuracy of common prognostic scores. Retrospective analysis of 281 consecutive patients receiving radiosurgery of brain metastases was performed. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare OS between SRS and HFSRT and by sex, before and after propensity-score matching (PSM) on key baseline prognostic covariates. Prognostic scores were evaluated using Harrell's concordance index. Median OS was 11 months after both SRS and HFSRT. After PSM, median OS was 12 months after SRS (95% CI: 7.5-16.5) and 9 months after HFSRT (95% CI: 5.0-13.0; p = 0.77). Independent prognostic factors were sex, primary tumor, KPI, and systemic disease status. Median OS was 16 months for women and 7 months for male patients (p < 0.001). After excluding sex specific tumors, PSM revealed a median OS of 16 months for women and 8 months for male patients (p < 0.01). Evaluation of prognostic indices showed BSBM to be the most accurate (Harrell's C = 0.68), followed by SIR (0.61), GPA (0.60), RPA (0.58), and Rades et al. (0.57). OS after HFSRT and SRS did not differ, although PSM revealed a non-significant advantage for SRS. Female sex was found to be a major independent positive prognostic factor for survival, and thus should be considered in the personalized decision-making of brain metastases treatment.
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Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Katie Bates
- Department for Medical Statistics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Danijela Minasch
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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7
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Donofrio CA, Cavalli A, Gemma M, Riccio L, Donofrio A, Panni P, Ferrari da Passano C, Del Vecchio A, Bolognesi A, Soffietti R, Mortini P. Cumulative intracranial tumour volume prognostic assessment: a new predicting score index for patients with brain metastases treated by stereotactic radiosurgery. Clin Exp Metastasis 2020; 37:499-508. [PMID: 32430649 DOI: 10.1007/s10585-020-10037-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
Brain metastases (BM) represent the most common intracranial malignancy in adults. Limitations of existing prognostic models reduce their predictivity and clinical applicability. The aim of this study is to validate the cumulative intracranial tumour volume prognostic assessment (CITVPA) as a new prognostic score system for patients with BM treated by Stereotactic Radiosurgery (SRS). Between January 2001 and December 2015, 1894 patients underwent Gamma Knife SRS treatment. The CITVPA model was implemented and validated as follows: the CITV cut-offs were identified thanks to a receiver-operating characteristic (ROC) curve analysis; the survival predictive factors were selected through a Cox proportional hazard model; its prognostic power was compared to RPA, SIR and GPA through the Harrel concordance index (HCI). According to the ROC curve analysis, the CITV cut-off values were set at 1.5 and 4.0 cc. Based on the multivariate analysis, the CITVPA model included: age (OR 1.010, 95% CI 1.005-1.015, p < 0.001), KPS (OR 0.960, 95% CI 0.956-0.965, p < 0.001), extracranial metastases (OR 1.287, 95% CI 1.154-1.437, p < 0.001), BM number (OR 1.193, 95% CI 1.047-1.360, p = 0.008), and CITV (OR 1.028, 95% CI 1.020-1.036, p < 0.001). A score between 0 and 1 was attributed to each prognosticator; a global CITVPA score ranging from 0 to 5 was assigned with higher results corresponding to worse outcomes. The CITVPA (HCI = 0.64) exhibited a significantly (p < 0.001) higher prognostic power compared to RPA (HCI = 0.55), SIR (HCI = 0.55) and GPA (HCI = 0.61). The CITVPA represents a reliable prognostic system for patients with BM treated by SRS. However, further prospective and multicentric studies are necessary before its applicability in clinical practice.
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Affiliation(s)
- Carmine Antonio Donofrio
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Andrea Cavalli
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Gemma
- Service of Anaesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Italy
| | - Lucia Riccio
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alessandra Donofrio
- Department of Radiation Oncology, Brescia University, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Pietro Panni
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Camillo Ferrari da Passano
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | | | - Angelo Bolognesi
- Service of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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8
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Loi M, Caini S, Scoccianti S, Bonomo P, De Vries K, Francolini G, Simontacchi G, Greto D, Desideri I, Meattini I, Nuyttens J, Livi L. Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 153:103043. [PMID: 32650217 DOI: 10.1016/j.critrevonc.2020.103043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Local failure (LF) following stereotactic radiosurgery (SRS) of brain metastases (BM) may be treated with a second course of SRS (SRS2), though this procedure may increase the risk of symptomatic radionecrosis (RN). METHODS A literature search was conducted according to PRISMA to identify studies reporting LF, overall survival (OS) and RN rates following SRS2. Meta-analysis was performed to identify predictors of RN. RESULTS Analysis included 11 studies (335 patients,389 metastases). Pooled 1-year LF was 24 %(CI95 % 19-30 %): heterogeneity was acceptable (I2 = 21.4 %). Median pooled OS was 14 months (Confidence Interval 95 %, CI95 % 8.8-22.0 months). Cumulative crude RN rate was 13 % (95 %CI 8 %-19 %), with acceptable heterogeneity (I2 = 40.3 %). Subgroup analysis showed higher RN incidence in studies with median patient age ≥59 years (13 % [95 %CI 8 %-19 %] vs 7 %[95 %CI 3 %-12 %], p = 0.004) and lower incidence following prior Whole Brain Radiotherapy (WBRT, 19 %[95 %CI 13 %-25 %] vs 7%[95 %CI 3 %-13 %], p = 0.004). CONCLUSIONS SRS2 is an effective strategy for in-site recurrence of BM previously treated with SRS.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy.
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Pierluigi Bonomo
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Kim De Vries
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Joost Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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9
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Editorial commentary to " 18F-Fluorocholine PET uptake correlates with pathologic evidence of recurrent tumor after stereotactic radiosurgery for brain metastases" by Grkovski and colleagues. Eur J Nucl Med Mol Imaging 2019; 47:1340-1341. [PMID: 31872279 DOI: 10.1007/s00259-019-04651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Graber JJ, Cobbs CS, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors. Neurosurgery 2019; 84:E168-E170. [PMID: 30629225 DOI: 10.1093/neuros/nyy543] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
Abstract
TARGET POPULATION These recommendations apply to adult patients with new or recurrent solitary or multiple brain metastases from solid tumors as detailed in each section. QUESTION 1 Should patients with newly diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities? RECOMMENDATIONS Level 3: SRS is recommended as an alternative to surgical resection in solitary metastases when surgical resection is likely to induce new neurological deficits, and tumor volume and location are not likely to be associated with radiation-induced injury to surrounding structures. Level 3: SRS should be considered as a valid adjunctive therapy to supportive palliative care for some patients with brain metastases when it might be reasonably expected to relieve focal symptoms and improve functional quality of life in the short term if this is consistent with the overall goals of the patient. QUESTION 2 What is the role of SRS after open surgical resection of brain metastasis? RECOMMENDATION Level 3: After open surgical resection of a solitary brain metastasis, SRS should be used to decrease local recurrence rates. QUESTION 3 What is the role of SRS alone in the management of patients with 1 to 4 brain metastases? RECOMMENDATIONS Level 3: For patients with solitary brain metastasis, SRS should be given to decrease the risk of local progression. Level 3: For patients with 2 to 4 brain metastases, SRS is recommended for local tumor control, instead of whole brain radiotherapy, when their cumulative volume is < 7 mL. QUESTION 4 What is the role of SRS alone in the management of patients with more than 4 brain metastases? RECOMMENDATION Level 3: The use of stereotactic radiosurgery alone is recommended to improve median overall survival for patients with more than 4 metastases having a cumulative volume < 7 mL. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-treatment-adults-metastatic-brain-tumors/chapter_4.
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Affiliation(s)
- Jerome J Graber
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Department of Neurology, Swedish Neuroscience Institute, University of Washington Department of Neurology, Alvord Brain Tumor Center, Seattle, Washington
| | - Charles S Cobbs
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, Washington
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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Brun L, Dupic G, Chassin V, Verrelle P, Lapeyre M, Biau J. [Radionecrosis following stereotactic radiotherapy of a 3-cm brain metastasis: Can we improve the dosimetric results?]. Cancer Radiother 2018; 22:423-428. [PMID: 30078613 DOI: 10.1016/j.canrad.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/13/2017] [Accepted: 12/01/2017] [Indexed: 10/28/2022]
Abstract
Stereotactic radiotherapy is a major issue in the management of brain metastases. Radionecrosis is a major concern, especially for large lesions. Optimizing dosimetric parameters is essential to allow optimal local control rate while minimizing potential toxicity. We report the case of a 30-mm brain metastases treated with stereotactic radiotherapy after initial whole brain radiotherapy, complicated with symptomatic radionecrosis. A dose of 24Gy in three fractions on the 80% isodose were delivered using a dynamic conformal arc technique (Novalis TX®). We realized a dosimetric comparison with: (i) optimization of initial conformal arc plan, (ii) volumetric modulated arctherapy with coplanar arcs and (iii) volumetric modulated arctherapy with coplanar and non-coplanar arcs. The optimal dose planning in terms of planning target volume coverage (99.2%) and normal brain sparing (V24Gy=0.4cm3, V18Gy=6.5cm3, V10Gy=25.4cm3, V5=83.9cm3) was obtained with volumetric modulated arctherapy with coplanar and non-coplanar arcs. Volumetric modulated arctherapy-based stereotactic irradiation with coplanar and non-coplonar arcs seems an interesting option for the treatment of large brain metastases to optimize dosimetric parameters.
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Affiliation(s)
- L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - G Dupic
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - V Chassin
- Département de physique médicale, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - P Verrelle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Université Clermont Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand, France; Inserm, U1240 imagerie moléculaire et stratégies théranostiques (Imost), 58, rue Montalembert, 63005 Clermont-Ferrand, France.
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12
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Hatiboglu MA, Akdur K, Sawaya R. Neurosurgical management of patients with brain metastasis. Neurosurg Rev 2018; 43:483-495. [DOI: 10.1007/s10143-018-1013-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/19/2018] [Accepted: 07/15/2018] [Indexed: 12/18/2022]
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13
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Yang Y, Pei X, Yang M. Combination of apatinib and continuous nutritional support for a gastric cancer patient with brain metastasis prolongs survival. J Clin Pharm Ther 2018; 43:726-729. [PMID: 29777533 DOI: 10.1111/jcpt.12708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 12/23/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Gastric cancer is the most common gastrointestinal malignant tumour in China, which rarely metastasizes into the central nervous system. However, brain metastasis leads to increased risk of death. CASE SUMMARY Here, we report a case of brain metastasis from gastric cancer, which was treated with apatinib and continual nutritional support, with a survival time of 2 years. WHAT IS NEW AND CONCLUSION The combination of apatinib and continual nutritional support may be an option for the treatment of brain metastasis from gastric cancer. A prospective study should be performed to confirm this.
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Affiliation(s)
- Y Yang
- Kunming Medical University, Yunnan, China.,Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China
| | - X Pei
- Department of Oncology, Lanzhou University Second Hospital, Gansu, China
| | - M Yang
- Department of Gastroenterology, Tianshui Qinzhou People's Hospital, Gansu, China
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Kim MS, Park SH, Park ES, Park JB, Kwon SC, Lyo IU, Sim HB. Quantitative analysis in peritumoral volumes of brain metastases treated with stereotactic radiotherapy. J Neuroradiol 2018; 45:310-315. [PMID: 29410152 DOI: 10.1016/j.neurad.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/24/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to verify changes in diffusion tensor imaging (DTI) factors in patients with brain metastases treated with stereotactic radiotherapy (SRT). We also investigated the impact of SRT on peritumoral volumes though the use of DTI. METHODS A total of 28 patients with brain metastases who had undergone SRT between March 2014 and December 2015 were enrolled. Magnetic resonance imaging with DTI factors, such as fractional anisotropy (FA) and apparent diffusion tensor (ADC) value, was performed 1 day before the procedure and 3 months after the procedure. DTI data from tumor lesions, edema volumes, and the volumes that received 12Gy were measured. RESULTS Tumor volume (P=0.001) and ADC values in the volumes that received 12Gy (P=0.018) and the edema volumes (P=0.003) significantly decreased after the procedure. Decreases in tumor volume were only correlated with decreases in edema volumes (P<0.001). Decreases in edema volumes were correlated with increases in FA values and decreases in ADC values of the volumes that received 12Gy [P=0.019 (FA)/0.002 (ADC)] and the edema volumes [P=0.011 (FA)/0.002 (ADC)]. CONCLUSIONS It was possible to quantify changes in peritumoral volumes in patients with brain metastases after SRT by using DTI. ADC values of peritumoral volumes decreased significantly after SRT. Therefore, it was confirmed through DTI that performing SRT on tumor lesions has a positive effect on the structure and function of peritumoral volumes.
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Affiliation(s)
- Min Soo Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
| | - Sung Ho Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea.
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojin sunhwando-ro, Dong-gu, 44033 Ulsan, Republic of Korea
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A New Scoring Tool to Assess Overall Survival in Patients With Intracerebral Metastases From Gynecological Cancers. Int J Gynecol Cancer 2018; 27:597-602. [PMID: 28187091 DOI: 10.1097/igc.0000000000000899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE This study aimed to facilitate individualized treatment strategies for intracerebral metastases from gynecological cancers by creating a specific overall survival (OS) score. METHODS/MATERIALS Fifty-six patients irradiated for cerebral metastases from gynecological cancers were included. Eleven factors were retrospectively analyzed for OS: age, Eastern Cooperative Oncology Group (ECOG) performance score, cancer type, histology, histologic grading, initial stage, number of lesions, extracerebral metastases, time between cancer diagnosis and brain metastases treatment, recursive partitioning analysis class, and type of treatment. Independent predictors of OS were incorporated in the score (better OS, 1 point; worse OS, 0 points). RESULTS On Cox proportional hazards analysis, performance score (hazards ratio, 1.98; 95% confidence interval, 1.30-3.23; P = 0.001), no extracerebral metastases (3.34; 1.46-8.96; P = 0.003), and recursive partitioning analysis class 1 (3.27; 1.97-5.65; P < 0.001) were significant. The following points were assigned: ECOG score 1 to 2 = 1 point, ECOG score 3 to 4 = 0 points, no extracerebral metastases = 1 point, extracerebral metastases = 0 points. Sum scores were 0 (n = 32), 1 (n = 15), or 2 points (n = 9). Six-month OS rates were 6%, 67%, and 100%, respectively (P < 0.001). CONCLUSIONS A predictive tool including 3 groups with significantly different OS probabilities was designed for patients with cerebral metastases from gynecological cancers. This tool will aid in choosing individual treatments.
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Murovic J, Ding V, Han SS, Adler JR, Chang SD. Impact of CyberKnife Radiosurgery on Overall Survival and Various Parameters of Patients with 1-3 versus ≥ 4 Brain Metastases. Cureus 2017; 9:e1798. [PMID: 29282442 PMCID: PMC5741273 DOI: 10.7759/cureus.1798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction This study’s objective is to compare the overall survivals (OSs) and various parameters of patients with 1-3 versus ≥ 4 brain metastases post-CyberKnife radiosurgery (CKRS) (Accuray, Sunnyvale, California) alone. Methods Charts of 150 patients, from 2009-2014, treated with only CKRS for brain metastases were reviewed retrospectively for overall survival (OS) and patient, tumor, and imaging characteristics. Parameters included demographics, Eastern Cooperative Oncology Group (ECOG) performance scores, number and control of extracranial disease (ECD) sites, cause of death (COD), histology, tumor volume (TV), and post-CKRS whole brain radiotherapy (WBRT). The imaging characteristics assessed were time of complete response (CR), partial response (PR), stable imaging or local failure (LF), and distal brain failure (DBF). Patients and their data were divided into those with 1-3 (group 1) versus ≥ 4 brain metastases (group 2). For each CR and LF patient, absolute neutrophil count (ANC), absolute lymphocyte count (ALC)), and ANC/ALC ratio (NLR) were obtained, when available, at the time of CKRS. Results Both group 1 and group 2 had a median OS of 13 months. The patient median age for the 115 group 1 patients versus the 35 group 2 patients was 62 versus 56 years. Group 1 had slightly more males and group 2, females. The predominant ECOG score for each group was 1 and the number of ECD sites was one and two, respectively. Uncontrolled ECD occurred in the majority of both group 1 and group 2 patients. The main COD was ECD in both groups. The prevalent tumor histology for groups 1 and 2 was non-small cell lung carcinoma. Median TVs were 1.08 cc versus 1.42 cc for groups 1 and 2, respectively. The majority of patients in both groups did not undergo post-CKRS WBRT. Imaging outcomes were LC (CR, PR, or stable imaging) in 93 (80.9%) and 26 (74.3%) group 1 and 2 patients, of whom 32 (27.8%) and six (17.1%) had CR; 38 (33.0%) and 18 (51.4%), PR and 23 (20.0%) and two (5.7%), stable imaging; LF was the outcome in 22 (19.1%) and nine (25.7%) patients, and DBF occurred in 62 (53.9%) and 21 (60.0%), respectively. Uni- and multivariable analyses showed the independent parameters of a lower ECOG score, a greater number of ECD sites and uncontrolled ECD were significantly associated with greater mortality risk with and without accounting for other covariates. At CKRS, 19 group 1 and 2 CR patients had a mean ANC of 5.88 K/µL and a mean ALC of 1.31 K/µL and 13 (68%) of 19 had NLRs ≤ five, while 11 with LFs had a mean ANC of 5.22 K/µL and a mean ALC of 0.93 K/µL and seven (64%) had NLRs > five. An NLR ≤ five and high ALC was associated with a CR and an NLR > five and a low ALC with an LF. Conclusions Median OS post-CKRS was 13 months for both patients with 1-3 brain metastases and with ≥ 4. This is the only study in the literature to evaluate OS in patients with 1-3 and ≥ 4 brain metastases who were treated with CKRS alone. For groups 1 and 2 patients combined, 119 (79.3%) had LC and 38 (25.3%) had CR. The ANC, ALC, and NLR values are likely predictive of CR and LF outcomes
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Affiliation(s)
- Judith Murovic
- Department of Neurosurgery, Stanford University School of Medicine
| | - Victoria Ding
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine
| | - Summer S Han
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine
| | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine
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Yuan X, Liu WJ, Li B, Shen ZT, Shen JS, Zhu XX. A Bayesian network meta-analysis of whole brain radiotherapy and stereotactic radiotherapy for brain metastasis. Medicine (Baltimore) 2017; 96:e7698. [PMID: 28834873 PMCID: PMC5571995 DOI: 10.1097/md.0000000000007698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/04/2017] [Accepted: 07/06/2017] [Indexed: 11/26/2022] Open
Abstract
This study was conducted to compare the effects of whole brain radiotherapy (WBRT) and stereotactic radiotherapy (SRS) in treatment of brain metastasis.A systematical retrieval in PubMed and Embase databases was performed for relative literatures on the effects of WBRT and SRS in treatment of brain metastasis. A Bayesian network meta-analysis was performed by using the ADDIS software. The effect sizes included odds ratio (OR) and 95% confidence interval (CI). A random effects model was used for the pooled analysis for all the outcome measures, including 1-year distant control rate, 1-year local control rate, 1-year survival rate, and complication. The consistency was tested by using node-splitting analysis and inconsistency standard deviation. The convergence was estimated according to the Brooks-Gelman-Rubin method.A total of 12 literatures were included in this meta-analysis. WBRT + SRS showed higher 1-year distant control rate than SRS. WBRT + SRS was better for the 1-year local control rate than WBRT. SRS and WBRT + SRS had higher 1-year survival rate than the WBRT. In addition, there was no difference in complication among the three therapies.Comprehensively, WBRT + SRS might be the choice of treatment for brain metastasis.
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Affiliation(s)
- Xi Yuan
- Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Command, Medical School of Nanjing University
| | - Wen-Jie Liu
- Blood Purification Center, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Bing Li
- Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Command, Medical School of Nanjing University
| | - Ze-Tian Shen
- Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Command, Medical School of Nanjing University
| | - Jun-shu Shen
- Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Command, Medical School of Nanjing University
| | - Xi-Xu Zhu
- Department of Radiation Oncology, Nanjing General Hospital of Nanjing Military Command, Medical School of Nanjing University
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Shi Y, Sun Y, Yu J, Ding C, Ma Z, Wang Z, Wang D, Wang Z, Wang M, Wang Y, Lu Y, Ai B, Feng J, Liu Y, Liu X, Liu J, Wu G, Qu B, Li X, Li E, Li W, Song Y, Chen G, Chen Z, Chen J, Yu P, Wu N, Wu M, Xiao W, Xiao J, Zhang L, Zhang Y, Zhang Y, Zhang S, Song X, Luo R, Zhou C, Zhou Z, Zhao Q, Hu C, Hu Y, Nie L, Guo Q, Chang J, Huang C, Han B, Han X, Li G, Huang Y, Shi Y. [China Experts Consensus on the Diagnosis and Treatment of Brain Metastases of Lung Cancer (2017 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:1-13. [PMID: 28103967 PMCID: PMC5973287 DOI: 10.3779/j.issn.1009-3419.2017.01.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yuankai Shi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Yan Sun
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Jinming Yu
- Shandong Province Cancer Hospital, 250117 Jinan, China
| | - Cuimin Ding
- The Fourth Hospital of Hebei Medical University, 050000 Shijiazhuang, China
| | - Zhiyong Ma
- Henan Province Cancer Hospital, 450008 Zhengzhou, China
| | - Ziping Wang
- Beijing Cancer Hospital, 100142 Beijing, China
| | - Dong Wang
- Daping Hospital, Third Military Medical University, 400042 Chongqing, China
| | - Zheng Wang
- National Center for Geriatric Medicine/Beijing Hospital, 100730 Beijing, China
| | - Mengzhao Wang
- Peking Union Medical College Hospital, 100730 Beijing, China
| | - Yan Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - You Lu
- West China Hospital of Sichuan University, 610041 Chengdu, China
| | - Bin Ai
- National Center for Geriatric Medicine/Beijing Hospital, 100730 Beijing, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital, 210009 Nanjing, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, 110001 Shenyang, China
| | - Xiaoqing Liu
- The 307th Hospital of Chinese People's Liberation Army, 100071 Beijing, China
| | - Jiwei Liu
- The First Affiliated Hospital of Dalian Medical University, 116011 Dalian, China
| | - Gang Wu
- Huazhong University of Science and Technology Union Hospital, 430022 Wuhan, China
| | - Baolin Qu
- Chinese People's Liberation Army General Hospital, 100853 Beijing, China
| | - Xueji Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Enxiao Li
- The First Affiliated Hospital of Xi 'an Jiaotong University, 710061 Xi'an, China
| | - Wei Li
- The First Hospital of Jilin University, 130021 Changchun, China
| | - Yong Song
- Nanjing General Hospital, 210002 Nanjing, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, 150081 Harbin, China
| | - Zhengtang Chen
- Xinqiao Hospital of Third Military medical University, 400037 Chongqing, China
| | - Jun Chen
- The Second Hospital of Dalian Medical University, 116027 Dalian, China
| | - Ping Yu
- Sichuan Cancer Hospital, 610047 Chengdu, China
| | - Ning Wu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Milu Wu
- Qinghai University Affiliated Cancer Hospital, 810000 Xining, China
| | - Wenhua Xiao
- The First Affiliated Hospital of Chinese People's Liberation Army General Hospital, 100048 Beijing, China
| | - Jianping Xiao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Li Zhang
- Peking Union Medical College Hospital, 100730 Beijing, China
| | - Yang Zhang
- The Second Hospital of Dalian Medical University, 116027 Dalian, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, 310022 Hangzhou, China
| | - Shucai Zhang
- Beijing Chest Hospital, Capital Medical University, 101149 Beijing, China
| | - Xia Song
- Shanxi Province Cancer Hospital, 030013 Taiyuan, China
| | - Rongcheng Luo
- TCM-Integrated Cancer Center of Southern Medical University, 510315 Guangzhou, China
| | - Caicun Zhou
- Tongji University Affiliated Shanghai Pulmonary Hospital, 200433 Shanghai, China
| | - Zongmei Zhou
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China
| | - Qiong Zhao
- The First Affiliated Hospital, Zhejiang University, 310003 Hangzhou, China
| | - Chengping Hu
- Xiangya Hospital Central South University, 410008 Changsha, China
| | - Yi Hu
- Chinese People's Liberation Army General Hospital, 100853 Beijing, China
| | - Ligong Nie
- Peking University First Hospital, 100034 Beijing, China
| | - Qisen Guo
- The Fourth Hospital of Hebei Medical University, 050000 Shijiazhuang, China
| | - Jianhua Chang
- Fudan Universitay Shanghai Cancer Center, 200032 Shanghai, China
| | - Cheng Huang
- Fujian Cancer Hospital, 350014 Fuzhou, China
| | - Baohui Han
- Shanghai Chest Hospital, Shanghai Jiaotong University, 200030 Shanghai, China
| | - Xiaohong Han
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Gong Li
- General Hospital of Armed Police, 100039 Beijing, China
| | - Yu Huang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
| | - Youwu Shi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, 100021 Beijing, China
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Rades D, Janssen S, Dziggel L, Blanck O, Bajrovic A, Veninga T, Schild SE. A matched-pair study comparing whole-brain irradiation alone to radiosurgery or fractionated stereotactic radiotherapy alone in patients irradiated for up to three brain metastases. BMC Cancer 2017; 17:30. [PMID: 28061768 PMCID: PMC5219794 DOI: 10.1186/s12885-016-2989-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background This matched-pair study was initiated to validate the results of a retrospective study of 186 patients published in 2007 that compared whole-brain irradiation (WBI) alone and radiosurgery (RS) alone for up to three brain metastases. Methods One-hundred-fifty-two patients receiving WBI alone for up to three brain metastases were matched with 152 patients treated with RS of fractionated stereotactic radiotherapy (FSRT) alone 1:1 for each of eight factors (age, gender, Eastern Oncology Cooperative Group (ECOG)-performance score, nature of tumor, brain metastases number, extra-cerebral spread, period from cancer detection to irradiation of brain metastases, and recursive partitioning analysis (RPA)-class. Groups were analyzed regarding intracerebral control (IC) and overall survival (OS). Results On univariate analysis of IC, type of irradiation did not significantly affect outcomes (p = 0.84). On Cox regression, brain metastases number (p < 0.001), nature of tumor (p < 0.001) and period from cancer detection to irradiation of brain metastases (p = 0.013) were significantly associated with IC. On univariate analysis of OS, type of irradiation showed no significant association with outcomes (p = 0.63). On multivariate analyses, OS was significantly associated with ECOG performance score (p = 0.011), nature of tumor (p = 0.035), brain metastases number (p = 0.048), extra-cerebral spread (p = 0.002) and RPA-class (p < 0.001). Conclusion In this matched-pair study, RS/FSRT alone was not superior to WBI alone regarding IC and OS. These results can be considered a revision of the findings from our retrospective previous study without matched-pair design, where RS alone resulted in significantly better IC than WBI alone on multivariate analysis.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany.
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany.,Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Liesa Dziggel
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center Northern Germany, Güstrow, Germany
| | - Amira Bajrovic
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Theo Veninga
- Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
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Kothari N, Mellon E, Hoffe SE, Frakes J, Shridhar R, Pimiento J, Meredith K, Tran ND, Saeed N, Almhanna K. Outcomes in patients with brain metastasis from esophageal carcinoma. J Gastrointest Oncol 2016; 7:562-9. [PMID: 27563446 DOI: 10.21037/jgo.2016.03.12] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Brain metastases from esophageal carcinoma have historically been rare and associated with poor prognosis. With improvements in systemic disease control, the incidence of brain metastases is expected to rise. To better inform management decisions, we sought to identify factors associated with survival in patients with brain metastasis from esophageal cancer. METHODS We retrospectively identified 49 patients with brain metastasis from stage I-IV primary esophageal cancer treated with surgery, radiation, or a combination of modalities at our tertiary referral center between 1998 and 2015. Medical records were reviewed to collect demographic and clinical information. RESULTS Median age at diagnosis of the primary esophageal cancer was 60 years. Forty-one (84%) patients were male and forty patients (82%) had adenocarcinoma. Median overall survival (MS) following esophageal cancer diagnosis was 24 months (range, 3-71 months), and median survival after the identification of brain metastases was 5 months (range, 1-52 months). On univariate analysis, only patients with poor Karnofsky performance status (KPS <70), recursive partitioning analysis (RPA) classification (III), or 3 or more brain metastases were found to have worsened survival after the diagnosis of brain metastases (all P<0.01). Factors not associated with survival were age, gender, histology (adenocarcinoma vs. other), palliative-intent treatment of the primary tumor, time to diagnosis of brain metastases from initial diagnosis, uncontrolled primary tumor at time of brain metastasis diagnosis, or extracranial metastases. On multivariate analysis (MVA, KPS excluded), patients with RPA class I (MS, 14.6 months) or II (MS, 5.0 months) disease had significantly improved overall survival compared to class III disease (MS, 1.6 months, P<0.01). Also on MVA, patients with 1 (MS, 10.7 months) or 2 (MS, 4.7 months) brain metastases had significantly improved overall survival compared to patients with 3 or more brain metastases (MS, 0.3 months, P<0.01). For the 36 patients with 1-2 brain metastases and KPS ≥70, MS was 11.1 months. CONCLUSIONS While the prognosis for esophageal cancer metastatic to brain remains poor overall, we found that patients with good performance status and limited number of brain lesions have superior survival. Aggressive management may further improve outcomes in these patients.
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Affiliation(s)
- Nishi Kothari
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Eric Mellon
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jessica Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Jose Pimiento
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ken Meredith
- Department of Gastrointestinal Oncology, First Physicians Group, Sarasota, FL, USA
| | - Nam D Tran
- Department of Neuro-oncology. H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nadia Saeed
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Khaldoun Almhanna
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Wernicke AG, Yondorf MZ, Parashar B, Nori D, Clifford Chao KS, Boockvar JA, Pannullo S, Stieg P, Schwartz TH. The cost-effectiveness of surgical resection and cesium-131 intraoperative brachytherapy versus surgical resection and stereotactic radiosurgery in the treatment of metastatic brain tumors. J Neurooncol 2016; 127:145-53. [DOI: 10.1007/s11060-015-2026-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
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Seidel C, Hambsch P, Hering K, Bresch A, Rohde S, Kortmann RD, Gaudino C. Analysis of frequency of deep white matter metastasis on cerebral MRI. J Neurooncol 2015; 123:135-9. [DOI: 10.1007/s11060-015-1773-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/02/2015] [Indexed: 12/17/2022]
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Simeonova AO, Fleckenstein K, Wertz H, Frauenfeld A, Boda-Heggemann J, Lohr F, Wenz F. Are three doses of stereotactic ablative radiotherapy (SABR) more effective than 30 doses of conventional radiotherapy? Transl Lung Cancer Res 2015; 1:45-53. [PMID: 25806154 DOI: 10.3978/j.issn.2218-6751.10.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/24/2011] [Indexed: 12/29/2022]
Abstract
In early stage non-small cell lung cancer (NSCLC) definitive radiation therapy is an appropriate alternative to surgery. Recent studies show, that in such patients hypofractionation schedules (for example 3 times 18 Gy or 5 times 12 Gy), can be safely applied, without causing severe toxicities and achieving high local control rates of up to 90% and more. In the last couple of years a lot of knowledge about the cancer biology, technical aspects, clinical outcomes and toxicities has been accumulated from different clinical trials. The purpose of this review is to summarize recent outcomes and developments in stereotactic radiation therapy for patients with early stage NSCLC.
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Affiliation(s)
- Anna O Simeonova
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hansjörg Wertz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anian Frauenfeld
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Management of Cerebral Brain Metastasis. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sharpton SR, Oermann EK, Moore DT, Schreiber E, Hoffman R, Morris DE, Ewend MG. The volumetric response of brain metastases after stereotactic radiosurgery and its post-treatment implications. Neurosurgery 2014; 74:9-15; discussion 16; quiz 16. [PMID: 24077581 DOI: 10.1227/neu.0000000000000190] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Changes in tumor volume are seen on magnetic resonance imaging within weeks after stereotactic radiosurgery (SRS), but it remains unclear what clinical outcomes early radiological changes portend. OBJECTIVE We hypothesized that rapid, early reduction in tumor volume post-SRS is associated with prolonged local control and favorable clinical outcome. METHODS A retrospective review of patients treated with CyberKnife SRS for brain metastases at the University of North Carolina from 2007 to 2009 was performed. Patients with at least 1 radiological follow-up, minimal initial tumor volume of 0.1 cm, no previous focal radiation, and no recent whole-brain radiation therapy were eligible for inclusion. RESULTS Fifty-two patients with 100 metastatic brain lesions were analyzed and had a median follow-up of 15.6 months (range, 2-33 months) and a median of 2 (range, 1-8) metastatic lesions. In treated metastases in which there was a significant tumor volume reduction by 6 or 12 weeks post-SRS, there was no local progression for the duration of the study. Furthermore, patients with metastases that did not reduce in volume by 6 or 12 weeks post-SRS were more likely to require corticosteroids (P = .01) and to experience progression of neurological symptoms (P = .003). CONCLUSION Significant volume reductions of brain metastases measured at either 6 or 12 weeks post-SRS were strongly associated with prolonged local control. Furthermore, early volume reduction was associated with less corticosteroid use and stable neurological symptoms.
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Affiliation(s)
- Suzanne R Sharpton
- *Department of Internal Medicine, University of California San Francisco, San Francisco, California; ‡Department of Neurological Surgery, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North California; §Department of Biostatistics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North California; ¶Radiation Oncology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North California
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Schüttrumpf LH, Niyazi M, Nachbichler SB, Manapov F, Jansen N, Siefert A, Belka C. Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases. Radiat Oncol 2014; 9:105. [PMID: 24885624 PMCID: PMC4036428 DOI: 10.1186/1748-717x-9-105] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/22/2014] [Indexed: 11/30/2022] Open
Abstract
Background In the present study factors affecting survival and toxicity in cerebral metastasized patients treated with stereotactic radiosurgery (SRS) were analyzed with special focus on radiation necrosis. Patients and methods 340 patients with 1–3 cerebral metastases having been treated with SRS were retrospectively analyzed. Radiation necrosis was diagnosed by MRI und PET imaging. Univariate and multivariate analysis using a Cox proportional hazards regression model and log-rank test were performed to determine the prognostic value of treatment-related and individual factors for outcome and SRS-related complications. Results Median overall survival was 282 days and median follow-up 721 days. 44% of patients received WBRT during the course of disease. Concerning univariate analysis a significant difference in overall survival was found for Karnofsky Performance Status (KPS ≤ 70: 122 days; KPS > 70: 342 days), for RPA (recursive partitioning analysis) class (RPA class I: 1800 days; RPA class II: 281 days; RPA class III: 130 days), irradiated volume (≤2.5 ml: 354 days; > 2.5 ml: 234 days), prescribed dose (≤18 Gy: 235 days; > 18 Gy: 351 days), gender (male: 235 days; female: 327 days) and whole brain radiotherapy (+WBRT: 341 days/-WBRT: 231 days). In multivariate analysis significance was confirmed for KPS, RPA class and gender. MRI and clinical symptoms suggested radiation necrosis in 21 patients after SRS +/− whole brain radiotherapy (WBRT). In five patients clinically relevant radiation necrosis was confirmed by PET imaging. Conclusions SRS alone or in combination with WBRT represents a feasible option as initial treatment for patients with brain metastases; however a significant subset of patients may develop neurological complications. Performance status, RPA class and gender were identified to predict improved survival in cerebral metastasized patients.
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Affiliation(s)
| | | | | | | | | | | | - Claus Belka
- Department of Radiation Oncology, University of Munich, Marchioninistr 15, Munich 81377, Germany.
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Hyun MK, Hwang JS, Kim JH, Choi JE, Jung SY, Bae JM. Survival outcomes after whole brain radiation therapy and/or stereotactic radiosurgery for cancer patients with metastatic brain tumors in Korea: a systematic review. Asian Pac J Cancer Prev 2014; 14:7401-7. [PMID: 24460310 DOI: 10.7314/apjcp.2013.14.12.7401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To compare survival outcomes after whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and WBRT plus SRS combination therapy in Korea, by performing a quantitative systematic review. MATERIALS AND METHODS We searched 10 electronic databases for reports on Korean patients treated with WBRT or SRS for brain metastases published prior to July 2010. Independent reviewers screened all articles and extracted the data. When a Kaplan-Meier survival curve was available, median survival time and standard errors were calculated. Summary estimates for the outcomes in each study were calculated using the inverse variance random-effects method. RESULTS Among a total of 2,761 studies, 20 studies with Korean patients (n=1,053) were identified. A combination of 12 studies (n=566) with WBRT outcomes showed a median survival time of 6.0 months (95%CI: 5.9-6.2), an overall survival rate of 5.6% (95%CI: 1-24), and a 6-month survival rate of 46.5% (95%CI: 37.2-56.1). For nine studies (n=412) on SRS, the median survival was 7.9 months (95%CI: 5.1-10.8), and the 6-month survival rate was 63.1% (95%CI: 49.8-74.8). In six studies (n=75) using WBRT plus SRS, the median survival was 10.7 months (95%CI: 4.7-16.6), and the overall and 6-month survival rates were 16.8% (95%CI: 6.2-38.2) and 85.7% (95%CI: 28.3-96.9), respectively. CONCLUSIONS WBRT plus SRS showed better 1-year survival outcome than of WBRT alone for Korean patients with metastatic brain tumors. However, the results of this analysis have to be interpreted cautiously, because the risk factors of patients were not adjusted in the included studies.
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Affiliation(s)
- Min Kyung Hyun
- National Evidence-based Healthcare Collaborating Agency, Korea E-mail :
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Davis JN, Medbery C, Sharma S, Danish A, Mahadevan A. The RSSearch™ Registry: patterns of care and outcomes research on patients treated with stereotactic radiosurgery and stereotactic body radiotherapy. Radiat Oncol 2013; 8:275. [PMID: 24274599 DOI: 10.1186/1748-717x-8-275] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/16/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The RSSearch™ Registry is a multi-institutional, observational, ongoing registry established to standardize data collection from patients treated with stereotactic radiosurgery (SRS) and/or stereotactic body radiotherapy (SBRT). This report describes the design, patient demographics, lesion characteristics, and SRS/SBRT treatment patterns in RSSearch™. Illustrative patient-related outcomes are also presented for two common treatment sites--brain metastases and liver metastases. MATERIALS AND METHODS Thirty-nine US centers participated in RSSearch™. Patients screened for SRS/SBRT were eligible to be enrolled. Descriptive analyses were performed to assess patient characteristics, physician treatment practices, and clinical outcomes. Kaplan-Meier analysis was used to determine overall survival (OS), local progression-free (LPFS), and distant disease-free survival (DDFS). RESULTS From January, 2008-January, 2013, 11,457 patients were enrolled. The median age was 67 years (range 7-100 years); 51% male and 49% female. Forty-six percent had no prior treatment, 22% had received chemotherapy, 19% radiation therapy and 17% surgery. There were 11,820 lesions from 65 treatment locations; 54% extracranial and 46% intracranial. The most common treatment locations were brain/cranial nerve/spinal cord, lung, prostate and liver. Metastatic lesions accounted for the majority of cases (41.6%), followed by primary malignant (32.9%), benign (10.9%), recurrent (9.4%), and functional diseases (4.3%). SRS/SBRT was used with a curative intent in 39.8% and palliative care in 44.8% of cases. The median dose for all lesions was 30 Gy (range < 1-96.7 Gy) delivered in a median number of 3 fractions. The median dose for lesions in the brain/cranial nerve/spinal cord, lung, liver, pancreas and prostate was 24, 54, 45, 29 and 36.25 Gy, respectively. In a subset analysis of 799 patients with 952 brain metastases, median OS was 8 months. For patients with a Karnofsky performance score (KPS) > 70, OS was 11 months vs. 4 months for KPS ≤ 70. Six-month and 12-month local control was 79% and 61%, respectively for patients with KPS ≤ 70, and 85% and 74%, respectively for patients with KPS > 70. In a second subset analysis including 174 patients with 204 liver metastases, median OS was 22 months. At 1-year, LPFS and DDFS rates were 74% and 53%, respectively. LPFS CONCLUSION This study demonstrates that collective patterns of care and outcomes research for SRS/SBRT can be performed and reported from data entered by users in a common database. The RSSearch™ dataset represents SRS/SBRT practices in a real world setting, providing a useful resource for expanding knowledge of SRS/SBRT treatment patterns and outcomes and generating robust hypotheses for randomized clinical studies.
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Affiliation(s)
| | | | | | | | - Anand Mahadevan
- Department of Radiation Oncology, Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, MA, USA.
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Ruzevick J, Kleinberg L, Rigamonti D. Imaging changes following stereotactic radiosurgery for metastatic intracranial tumors: differentiating pseudoprogression from tumor progression and its effect on clinical practice. Neurosurg Rev 2013; 37:193-201; discussion 201. [PMID: 24233257 DOI: 10.1007/s10143-013-0504-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 08/18/2013] [Accepted: 08/24/2013] [Indexed: 02/07/2023]
Abstract
Stereotactic radiosurgery has become standard adjuvant treatment for patients with metastatic intracranial lesions. There has been a growing appreciation for benign imaging changes following radiation that are difficult to distinguish from true tumor progression. These imaging changes, termed pseudoprogression, carry significant implications for patient management. In this review, we discuss the current understanding of pseudoprogression in metastatic brain lesions, research to differentiate pseudoprogression from true progression, and clinical implications of pseudoprogression on treatment decisions.
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Affiliation(s)
- Jacob Ruzevick
- Department of Neurological Surgery, The Johns Hopkins University School of Medicine, Phipps Building, Room 126, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
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Antoni D, Noël G. [Radiotherapy of brain metastases according to the GPA score (Graded Prognostic Assessment)]. Cancer Radiother 2013; 17:424-7. [PMID: 23973456 DOI: 10.1016/j.canrad.2013.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 05/28/2013] [Accepted: 06/10/2013] [Indexed: 11/25/2022]
Abstract
The management of patients with brain metastases remains a difficult and controversial subject. For years, the standard treatment has been whole-brain radiation therapy alone, but its validity is now under question because of improvements in surgery and the development of radiosurgery or novel targeted therapies and also because whole-brain radiation therapy is responsible for long term neurocognitive toxicity. Therefore it is important to assess diagnosis-specific prognostic factors and indexes when scheduling treatments. The GPA score (Graded Prognostic Assessment), established for various histologic tumor types, includes five prognostic factors: age, Karnofsky Performance Status, presence of extracranial metastases, number of brain metastases and also genetic subtype for breast cancer. We propose an adaptation of the management of brain metastases according to the GPA score.
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Affiliation(s)
- D Antoni
- Département universitaire de radiothérapie, centre de lutte contre le cancer Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, BP 42, 67065 Strasbourg cedex, France.
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Kim HJ, Huh JW, Jung TY, Kim IY, Kim HR, Jung S, Kim YJ. Clinical outcome with gamma-knife surgery or surgery for brain metastases from colorectal cancer. J Clin Neurosci 2013; 20:1417-21. [PMID: 23910824 DOI: 10.1016/j.jocn.2012.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/24/2012] [Accepted: 12/01/2012] [Indexed: 01/08/2023]
Abstract
The aim of this study was to investigate the clinical outcomes after gamma knife surgery (GKS) or surgery as the first treatment for brain metastases in colorectal cancer (CRC). Of the 4350 patients diagnosed with CRC at our institution identified from 1987 to 2009, 27 patients who underwent GKS (GKS group) and 11 who underwent surgery (surgery group) were included. The oncologic outcomes were compared between the two groups. Local control was significantly better in the surgery group than in the GKS group (90% versus [vs.] 71.4%, respectively; p=0.006). The rate of symptom relief after 3 months was significantly higher in the surgery group than in the GKS group (72.7 vs.18.5%, respectively; p=0.005). The median survival after GKS was 5.6 months and surgery was 16.2 months. In multivariate analysis, controlled primary tumor (p=0.038) and solitary metastasis (p=0.028) were correlated with prolonged overall survival, whereas surgery (p=0.034) was associated with longer local control. Surgery for brain metastasis from CRC is more advantageous in local control and neurologic symptom palliation than GSK. In multivariate analysis, overall survival was associated with controlled primary tumor and solitary metastasis.
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Affiliation(s)
- Hun Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
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Friedman WA. Expanding indications for stereotactic radiosurgery in the treatment of brain metastases. Neurosurgery 2013; 60 Suppl 1:9-12. [PMID: 23839345 DOI: 10.1227/01.neu.0000430329.25516.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 2013; 40:48-59. [PMID: 23810288 DOI: 10.1016/j.ctrv.2013.05.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/22/2022]
Abstract
Chemotherapy has made substantial progress in the therapy of systemic cancer, but the pharmacological efficacy is insufficient in the treatment of brain metastases. Fractionated whole brain radiotherapy (WBRT) has been a standard treatment of brain metastases, but provides limited local tumor control and often unsatisfactory clinical results. Stereotactic radiosurgery using Gamma Knife, Linac or Cyberknife has overcome several of these limitations, which has influenced recent treatment recommendations. This present review summarizes the current literature of single session radiosurgery concerning survival and quality of life, specific responses, tumor volumes and numbers, about potential treatment combinations and radioresistant metastases. Gamma Knife and Linac based radiosurgery provide consistent results with a reproducible local tumor control in both single and multiple brain metastases. Ideally minimum doses of ≥18Gy are applied. Reported local control rates were 90-94% for breast cancer metastases and 81-98% for brain metastases of lung cancer. Local tumor control rates after radiosurgery of otherwise radioresistant brain metastases were 73-90% for melanoma and 83-96% for renal cell cancer. Currently, there is a tendency to treat a larger number of brain metastases in a single radiosurgical session, since numerous studies document high local tumor control after radiosurgical treatment of >3 brain metastases. New remote brain metastases are reported in 33-42% after WBRT and in 39-52% after radiosurgery, but while WBRT is generally applied only once, radiosurgery can be used repeatedly for remote recurrences or new metastases after WBRT. Larger metastases (>8-10cc) should be removed surgically, but for smaller metastases Gamma Knife radiosurgery appears to be equally effective as surgical tumor resection (level I evidence). Radiosurgery avoids the impairments in cognition and quality of life that can be a consequence of WBRT (level I evidence). High local efficacy, preservation of cerebral functions, short hospitalization and the option to continue a systemic chemotherapy are factors in favor of a minimally invasive approach with stereotactic radiosurgery.
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Likhacheva A, Pinnix CC, Parikh N, Allen PK, Guha-Thakurta N, McAleer M, Sulman EP, Mahajan A, Shiu A, Luo D, Chiu M, Brown PD, Prabhu SS, Chang EL. Validation of Recursive Partitioning Analysis and Diagnosis-Specific Graded Prognostic Assessment in patients treated initially with radiosurgery alone. J Neurosurg 2013. [PMID: 23205787 DOI: 10.3171/2012.3.gks1289] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Brain metastases present a therapeutic challenge because patients with metastatic cancers live longer now than in the recent past due to systemic therapies that, while effective, may not penetrate the blood-brain barrier. In the present study the authors sought to validate the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA), a new prognostic index that takes into account the histological characteristics of the primary tumor, and the Radiation Therapy Ontology Group Recursive Partitioning Analysis (RPA) system by using a single-institution database of patients who were treated initially with stereotactic radiosurgery (SRS) alone for brain metastases. METHODS Investigators retrospectively identified adult patients who had undergone SRS at a single institution, MD Anderson Cancer Center, for initial treatment of brain metastases between 2003 and 2010 but excluded those who had undergone craniotomy and/or whole-brain radiation therapy at an earlier time; the final number was 251. The Leksell Gamma Knife was used to treat 223 patients, and a linear accelerator was used to treat 28 patients. The patient population was grouped according to DS-GPA scores as follows: 0-0.5 (7 patients), 1 (33 patients), 1.5 (25 patients), 2 (63 patients), 2.5 (14 patients), 3 (68 patients), and 3.5-4 (41 patients). The same patients were also grouped according to RPA classes: 1 (24 patients), 2 (216 patients), and 3 (11 patients). The most common histological diagnoses were non-small cell lung cancer (34%), melanoma (29%), and breast carcinoma (16%). The median number of lesions was 2 (range 1-9) and the median total tumor volume was 0.9 cm(3) (range 0.3-22.9 cm(3)). The median radiation dose was 20 Gy (range 14-24 Gy). Stereotactic radiosurgery was performed as the sole treatment (62% of patients) or combined with a salvage treatment consisting of SRS (22%), whole-brain radiation therapy (12%), or resection (4%). The median duration of follow-up was 9.4 months. RESULTS In this patient group the median overall survival was 11.1 months. The DS-GPA prognostic index divided patients into prognostically significant groups. Median survival times were 2.8 months for DS-GPA Scores 0-0.5, 3.9 months for Score 1, 6.6 months for Score 1.5, 12.9 months for Score 2, 11.9 months for Score 2.5, 12.2 months for Score 3, and 31.4 months for Scores 3.5-4 (p < 0.0001). In the RPA groups, the median overall survival times were 38.8 months for Class 1, 9.4 months for Class 2, and 2.8 months for Class 3 (p < 0.0001). Neither the RPA class nor the DS-GPA score was prognostic for local tumor control or new lesion-free survival. A multivariate analysis revealed that patient age > 60 years, Karnofsky Performance Scale score ≤ 80%, and total lesion volume > 2 cm(3) were significant adverse prognostic factors for overall survival. CONCLUSIONS Application of the DS-GPA to a database of patients with brain metastases who were treated with SRS appears to be valid and offers additional prognostic refinement over that provided by the RPA. The DS-GPA may also allow for improved selection of patients to undergo initial SRS alone and should be studied further.
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Affiliation(s)
- Anna Likhacheva
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Antoni D, Kehrli P, Clavier JB, Lahlou MA, Lefebvre F, Noel G. Outcome Improvement in RPA I or II Patients With 1 or 2 Brain Metastases by Combined Surgery and Radiotherapy. World J Oncol 2013; 4:37-45. [PMID: 29147328 PMCID: PMC5649917 DOI: 10.4021/wjon626w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the role of surgery and postoperative radiotherapy in the management of brain metastases (BM): a retrospective analysis for overall survival (OS), local and brain control (LC and BC) of a series of 329 patients with recursive partitioning analysis (RPA) I or II with 1 or 2 BM in a single institution. Methods Patients were treated either with combined surgical resection and whole brain radiation therapy (WBRT) in 104 cases (31.6%) or with WBRT alone in 225 cases (68.4%). Ninety-five patients (91.4%) who underwent surgery and WBRT and 147 (65.3%) who underwent WBRT alone benefited from a radiation boost to the metastatic site. Results The median OS was higher for patients RPA I compared to RPA II: 21.3 and 5.9 months (P < 0.0001), as well as for the surgical group compared to the radiation group: 20.2 vs 5.3 months (P < 0.0001), respectively. After the multivariate analysis, the improved OS was significantly associated with control of primary tumor (P = 0.0002) after surgical resection and with type of primary tumor (P = 0.002), absence of extracranial metastases (ECM) (P = 0.006), and high Karnofsky performance status (90 - 100 vs 70 - 80) (P = 0.003) after radiotherapy alone. The 12-, 24- and 36-months LC rates were 91.1%, 91.1% and 83.9%, respectively, after surgical resection and 81.2%, 63.1% and 57.3%, respectively, after radiotherapy alone (P = 0.005). In a univariate analysis, improved LC for the surgical group was also associated with the absence of ECM (P = 0.01) and for the radiation group, with a radiation boost (P = 0.01). The BC rates at 12, 24 and 36 months were 73.2%, 66.9% and 56%, respectively, in the surgical group and 75.7%, 49.6% and 42.4%, respectively, in the radiation group (P = 0.2). In our univariate analysis, improved BC after surgical resection was associated with control of primary tumor (P = 0.02). For patients in the radiation group, gender (P = 0.03) and a radiation boost (P = 0.0003) were significant prognostic factors in a univariate analysis. In our multivariate analysis, only the radiation boost was significant (P = 0.001). Conclusions Surgical resection followed by WBRT leads to a better outcome compared to WBRT alone for RPA I or II patients with 1 or 2 BM.
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Affiliation(s)
- Delphine Antoni
- Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de l'hopital, 67065 Strasbourg cedex, France
| | - Pierre Kehrli
- Neurosurgical Department, Hopital de Hautepierre, 1, Avenue Moliere, 67098 Strasbourg cedex, France
| | - Jean-Baptiste Clavier
- Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de l'hopital, 67065 Strasbourg cedex, France
| | - Mohamed Amine Lahlou
- Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de l'hopital, 67065 Strasbourg cedex, France.,Neurosurgical Department, Hopital de Hautepierre, 1, Avenue Moliere, 67098 Strasbourg cedex, France
| | - Francois Lefebvre
- Laboratory of Biostatistics, Faculte de Medecine, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - Georges Noel
- Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de l'hopital, 67065 Strasbourg cedex, France
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Menis J, Fontanella C, Follador A, Fasola G, Aprile G. Brain metastases from gastrointestinal tumours: Tailoring the approach to maximize the outcome. Crit Rev Oncol Hematol 2013; 85:32-44. [DOI: 10.1016/j.critrevonc.2012.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/30/2012] [Accepted: 04/11/2012] [Indexed: 12/18/2022] Open
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Chao ST, Koyfman SA, Woody N, Angelov L, Soeder SL, Reddy CA, Rybicki LA, Djemil T, Suh JH. Recursive Partitioning Analysis Index Is Predictive for Overall Survival in Patients Undergoing Spine Stereotactic Body Radiation Therapy for Spinal Metastases. Int J Radiat Oncol Biol Phys 2012; 82:1738-43. [DOI: 10.1016/j.ijrobp.2011.02.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 01/28/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Rades D, Schild SE. Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlenther Onkol 2012; 188:702-6. [PMID: 22418589 DOI: 10.1007/s00066-012-0093-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND About 40% of patients with brain metastases have a very limited number of lesions and may be candidates for radiosurgery. Radiosurgery alone is superior to whole-brain radiotherapy (WBRT) alone for control of treated and new brain metastases. In patients with a good performance status, radiosurgery also resulted in better survival. However, the question is whether the results of radiosurgery alone can be further improved with additional WBRT. METHODS Information for this review was compiled by searching the PubMed and MEDLINE databases. Very important published meeting abstracts were also considered. RESULTS Based on both retrospective and prospective studies, the addition of WBRT to radiosurgery improved control of treated and new brain metastases but not survival. However, because a recurrence within the brain has a negative impact on neurocognitive function, it is important to achieve long-term control of brain metastases. CONCLUSION The addition of WBRT provides significant benefits. Further randomized studies including adequate assessment of neurocognitive function and a follow-up period of at least 2 years are needed to help customize the treatment for individual patients.
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Affiliation(s)
- D Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Rades D, Panzner A, Dziggel L, Haatanen T, Lohynska R, Schild SE. Dose-escalation of whole-brain radiotherapy for brain metastasis in patients with a favorable survival prognosis. Cancer 2011; 118:3852-9. [PMID: 22170514 DOI: 10.1002/cncr.26680] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/19/2011] [Accepted: 10/06/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with brain metastases who have a favorable survival prognosis may benefit from intensive treatments, including neurosurgery and radiosurgery. However, many patients cannot receive such treatments, and whole-brain radiotherapy (WBRT) alone is their only option. The most common WBRT schedule is 30 grays (Gy) in 10 fractions. In this retrospective study, the authors investigated whether these patients benefit from a dose escalation beyond 30 Gy. METHODS Data from 109 patients who received 30 Gy in 10 fractions were compared with 75 patients who received 40 Gy in 20 fractions. All patients had a favorable survival prognosis. Both groups were compared for local control (LC) and overall survival (OS). Subgroup analyses were performed for patients who had less radiosensitive tumors (N = 27) and for other patients (N = 157). RESULTS The LC rate at 1 year was 28% after 30 Gy and 44% after 40 Gy (P = .064). On multivariate analysis, the 40 Gy dose was associated with improved LC (P = .047). The survival rate at 1 year was 50% after 30 Gy and 61% after 40 Gy (P = .007). On multivariate analysis, the 40 Gy dose was associated with improved OS (P = .008). On subgroup analysis of patients who had less radiosensitive tumors, the 1-year LC rate was 7% after 30 Gy and 38% after 40 Gy (P = .031); and the 1-year OS rate was 40% and 73%, respectively (P = .008). On subgroup analysis of patients who had other tumor types, the 1-year LC rate was 31% after 30 Gy and 45% after 40 Gy (P = .26); and the 1-year OS rate was 52% and 59%, respectively (P = .08). CONCLUSIONS Escalation of the WBRT dose beyond 30 Gy resulted in better outcomes, particularly for patients who had less radiosensitive tumors.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, Lubeck, Germany.
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Abstract
Stereotactic radiosurgery (SRS) should be considered in the comprehensive treatment paradigm for all patients with brain metastases. This technique has proven benefits for local tumor control in individuals with as many as 4 lesions, and when combined with structured radiographic follow-up, will likely preserve a better quality of life for appropriately selected patients. Institutions and physicians treating patients with brain metastases should have the capability of safely performing SRS and individual cases should be prospectively reviewed by multidisciplinary teams to provide the best comprehensive care.
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The role of surgery, radiosurgery and whole brain radiation therapy in the management of patients with metastatic brain tumors. Int J Surg Oncol 2011; 2012:952345. [PMID: 22312545 PMCID: PMC3263703 DOI: 10.1155/2012/952345] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 10/03/2011] [Indexed: 01/30/2023] Open
Abstract
Brain tumors constitute the most common intracranial tumor. Management of brain metastases has become increasingly complex as patients with brain metastases are living longer and more treatment options develop. The goal of this paper is to review the role of stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), and surgery, in isolation and in combination, in the contemporary treatment of brain metastases. Surgery and SRS both offer management options that may help to optimize therapy in selected patients. WBRT is another option but can lead to late toxicity and suboptimal local control in longer term survivors. Improved prognostic indices will be critical for selecting the best therapies. Further prospective trials are necessary to continue to elucidate factors that will help triage patients to the proper brain-directed therapy for their cancer.
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Elaimy AL, Mackay AR, Lamoreaux WT, Fairbanks RK, Demakas JJ, Cooke BS, Lee CM. Clinical outcomes of stereotactic radiosurgery in the treatment of patients with metastatic brain tumors. World Neurosurg 2011; 75:673-83. [PMID: 21704935 DOI: 10.1016/j.wneu.2010.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/06/2010] [Accepted: 12/01/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a form of radiation therapy that delivers a focused, highly conformal dose of radiation to a single volume, while minimizing damage to the adjacent nervous tissue. The efficacy of SRS has been examined in the treatment of patients diagnosed with brain metastases due to the fact that it is capable of targeting any region in the brain and can irradiate multiple tumors in the same treatment setting in a noninvasive fashion. METHODS Modern literature was reviewed for studies on SRS in the treatment of patients with brain metastases. RESULTS After assessing patient age, Karnofsky Performance Score (KPS), control of primary cancer, presence of extracranial metastases, number of brain metastases, location of brain metastases, and size of brain metastases, SRS offers suitable patients a viable, less invasive treatment option. In patients with 1 to 4 brain metastases who have a KPS ≥70, the addition of SRS to whole-brain radiation therapy (WBRT) produces increased levels of survival and local tumor control when compared with patients treated with WBRT alone. The available evidence suggests that specific patients treated with SRS alone exhibit superior levels of survival and tumor control when compared with patients treated with WBRT alone. Further evidence in the form of a randomized trial is needed to confirm this observation. Questions remain regarding survival and tumor control in patient groups treated with SRS with or without WBRT. Recently published randomized evidence reported a survival advantage in patients treated with SRS alone. These data differ from other previously published randomized evidence, as well as several prospective and retrospective studies, which reported nonsignificant survival differences. Contrasting evidence also exists pertaining to local and distant tumor control, which warrants further investigation into this matter. The available evidence suggests that in patients with 1 to 2 brain metastases, both SRS alone and SRS with WBRT offer equivalent levels of survival when compared with patients treated with surgery with WBRT. Research has been conducted that reports a survival advantage in patients with 1 to 3 brain metastases that were treated with SRS with WBRT. CONCLUSIONS SRS can be an advantageous course of treatment in specific patient groups when utilized alone, after surgery, with WBRT, or in combination with either or both of the treatment modalities. Although treatment approaches have been refined, many questions remain unanswered and further clinical evidence is needed to guide physicians in their future treatment decisions regarding treating patients in specific clinical scenarios.
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Bilimagga RS, Nirmala S, Rishi KS, Janaki M, Ponni A, Rajeev A, Kalyan S. Role of palliative radiotherapy in brain metastases. Indian J Palliat Care 2011; 15:71-5. [PMID: 20606860 PMCID: PMC2886217 DOI: 10.4103/0973-1075.53588] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Brain metastases are a common manifestation of systemic cancer and exceed primary brain tumors in number and are a significant cause of neurologic problems. They affect 20-40% of all cancer patients. Aggressive management of brain metastases is effective in both symptom palliation and prolonging the life. Radiotherapy has a major role to play in the management of brain metastases. AIM: The aim of the study was to know the outcome of palliative radiotherapy in symptomatic brain metastases in terms of improvement in their performance status. Materials and Methods: This is a retrospective study of 63 patients diagnosed to have brain metastases and treated with palliative whole brain radiotherapy to a dose of 30 Gy in 10 fractions over two weeks between June 1998 and June 2007. Diagnosis was done in most of the cases with computed tomography scan and in a few with magnetic resonance imaging. Improvement in presenting symptoms has been assessed in terms of improvement in their performance status by using the ECOG scale. Results: Fifty-four patients completed the planned treatment. Eight patients received concurrent Temozolamide; 88% of patients had symptom relief at one month follow-up; 39/54 patients had a follow-up of just one to three months. Hence survival could not be assessed in this study. Conclusion: External beam radiotherapy in the dose of 30 Gy over two weeks achieved good palliation in terms improvement in their performance status in 88% of patients. Addition of concurrent and adjuvant Timozolamide may improve the results.
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Affiliation(s)
- Ramesh S Bilimagga
- Department of Radiotherapy, M. S. Ramaiah Medical College, Bangalore - 560 054, India
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Siomin V, Lin JL, Marko NF, Barnett GH, Toms SA, Chao ST, Angelov L, Vogelbaum MA, Navaratne K, Suh JH, Weil RJ. Stereotactic Radiosurgical Treatment of Brain Metastases to the Choroid Plexus. Int J Radiat Oncol Biol Phys 2011; 80:1134-42. [DOI: 10.1016/j.ijrobp.2010.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/06/2010] [Accepted: 03/17/2010] [Indexed: 12/13/2022]
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Comparison of Stereotactic Brachytherapy (125Iodine Seeds) with Stereotactic Radiosurgery (LINAC) for the Treatment of Singular Cerebral Metastases. Strahlenther Onkol 2010; 187:7-14. [DOI: 10.1007/s00066-010-2168-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/16/2010] [Indexed: 11/25/2022]
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Abd-El-Barr MM, Rahman M, Rao G. Investigational therapies for brain metastases. Neurosurg Clin N Am 2010; 22:87-96, vii. [PMID: 21109153 DOI: 10.1016/j.nec.2010.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contrary to the incidence of primary cancers, the incidence of brain metastasis has been increasing. This increase is likely because of the effects of an aging population, improved neuroimaging surveillance, and better control of systemic cancer, allowing time for brain metastasis to occur. Unlike systemic cancers, for which chemotherapy is the mainstay of treatment, the therapeutic strategies available to treat brain metastasis have traditionally been limited to surgical resection, whole brain radiation therapy, or stereotactic radiosurgery, either individually or in combination. It is important to put the treatment in the context of the prognosis for patients with brain metastases.
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Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, University of Florida, Box 100265, Gainesville, FL 32610, USA
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Nishikawa T, Ueba T, Kawashima M, Kajiwara M, Iwata R, Kato M, Miyamatsu N, Yamashita K. Early detection of metachronous brain metastases by biannual brain MRI follow-up may provide patients with non-small cell lung cancer with more opportunities to have radiosurgery. Clin Neurol Neurosurg 2010; 112:770-4. [DOI: 10.1016/j.clineuro.2010.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 04/27/2010] [Accepted: 06/10/2010] [Indexed: 11/17/2022]
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The efficacy of gamma knife radiosurgery for advanced gastric cancer with brain metastases. J Neurooncol 2010; 103:513-21. [DOI: 10.1007/s11060-010-0405-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 09/06/2010] [Indexed: 10/18/2022]
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