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Jermain PR, Muir B, McEwen M, Niu Y, Pang D. Accurate machine-specific reference and small-field dosimetry for a self-shielded neuro-radiosurgical system. Med Phys 2024; 51:4423-4433. [PMID: 38695760 DOI: 10.1002/mp.17111] [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: 01/05/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The newly available ZAP-X stereotactic radiosurgical system is designed for the treatment of intracranial lesions, with several unique features that include a self-shielding, gyroscopic gantry, wheel collimation, non-orthogonal kV imaging, short source-axis distance, and low-energy megavoltage beam. Systematic characterization of its radiation as well as other properties is imperative to ensure its safe and effective clinical application. PURPOSE To accurately determine the radiation output of the ZAP-X with a special focus on the smaller diameter cones and an aim to provide useful recommendations on quantification of small field dosimetry. METHODS Six different types of detectors were used to measure relative output factors at field sizes ranging from 4 to 25 mm, including the PTW microSilicon and microdiamond diodes, Exradin W2 plastic scintillator, Exradin A16 and A1SL ionization chambers, and the alanine dosimeter. The 25 mm cone served as the reference field size. Absolute dose was determined with both TG-51-based dosimetry using a calibrated PTW Semiflex ion chamber and measurements using alanine dosimeters. RESULTS The average radiation output factors (maximum deviation from the average) measured with the microDiamond, microSilicon, and W2 detectors were: for the 4 mm cone, 0.741 (1.0%); for the 5 mm cone: 0.817 (1.0%); for the 7.5 mm cone: 0.908 (1.0%); for the 10 mm cone: 0.946 (0.4%); for the 12.5 mm cone: 0.964 (0.2%); for the 15 mm cone: 0.976 (0.1%); for the 20 mm cone: 0.990 (0.1%). For field sizes larger than 10 mm, the A1SL and A16 micro-chambers also yielded consistent output factors within 1.5% of those obtained using the microSilicon, microdiamond, and W2 detectors. The absolute dose measurement obtained with alanine was within 1.2%, consistent with combined uncertainties, compared to the PTW Semiflex chamber for the 25 mm reference cone. CONCLUSION For field sizes less than 10 mm, the microSilicon diode, microDiamond detector, and W2 scintillator are suitable devices for accurate small field dosimetry of the ZAP-X system. For larger fields, the A1SL and A16 micro-chambers can also be used. Furthermore, alanine dosimetry can be an accurate verification of reference and absolute dose typically measured with ion chambers. Use of multiple suitable detectors and uncertainty analyses were recommended for reliable determination of small field radiation outputs.
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Affiliation(s)
- Peter R Jermain
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Bryan Muir
- Metrology Research Centre, National Research Council, Ottawa, Ontario, Canada
| | - Malcolm McEwen
- Metrology Research Centre, National Research Council, Ottawa, Ontario, Canada
| | - Ying Niu
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Dalong Pang
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
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Albano L, Losa M, Garbin E, Pompeo E, Barzaghi LR, Mortini P. Efficacy and safety of radiosurgery in acromegaly. Best Pract Res Clin Endocrinol Metab 2024:101898. [PMID: 38806304 DOI: 10.1016/j.beem.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Stereotactic radiosurgery (SRS) more and more frequently plays a crucial role in the treatment of acromegaly. We provide a systematic review of the literature and meta-analysis, according to PRISMA, on SRS for the management of growth hormone (GH)-secreting pituitary adenomas, including several radiosurgical techniques, with the aim of describing efficacy and safety of this treatment. A weighted random effects model was used to calculate pooled outcome estimates. From 346 abstract reviews, 27 retrospective studies were included. Despite the variability in hormonal remission criteria and the heterogeneity between treatment guidelines among included studies, most of them reported an endocrine remission rate between 40% and 60%. Random effects meta-analysis for overall endocrine remission and 5-year probability of remission estimate after SRS were 46% (95% CI: 39-53%) and of 48% (95% CI: 38-57%), respectively. Random effects meta-analysis for new hypopituitarism estimate after SRS was 23% (95% CI: 17-29%). Furthermore, incidence of radiation induced optic neuropathy after SRS ranged between 0% and 6% This meta-analysis confirms and quantifies safety and effectiveness of SRS to achieve endocrine remission after surgical management in acromegaly.
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Affiliation(s)
- Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Marco Losa
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Garbin
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Lina Raffaella Barzaghi
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Pietro Mortini
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Albano L, Losa M, Barzaghi LR, Barrile E, Bindal SK, Wei Z, Pompeo E, Villanacci F, Del Vecchio A, Flickinger JC, Niranjan A, Mortini P, Lunsford LD. Single Versus Fractionated Gamma Knife Radiosurgery for Nonfunctioning Pituitary Adenomas Close to the Optic Pathway: A Multicenter Propensity Score Matched Study. Neurosurgery 2024:00006123-990000000-01062. [PMID: 38376150 DOI: 10.1227/neu.0000000000002886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Gamma Knife radiosurgery (GKRS), typically administered in a single session (S-GKRS), is an effective treatment for nonfunctioning pituitary adenoma (NFPA). For lesions close to the optic pathway, the use of hypofractionated radiosurgery is growing. This study seeks to compare the results of S-GKRS vs fractionated-GKRS (F-GKRS) for NFPAs adjacent to the optic pathway. METHODS Two cohorts of patients with residual or recurrent NFPAs in contact to the optic pathway were retrospectively included in this study: (1) a group of patients who underwent a 3-day course of F-GKRS in Europe and (2) a group of patients treated with S-GKRS in the United States. A propensity score matching (ratio 1:1) was carried out to obtain and compare 2 homogeneous groups of patients with NFPA. RESULTS A total of 84 patients were included for analysis (42 in the S-GKRS cohort and 42 in the F-GKRS group). The 2 cohorts did not differ for age, sex, number of previous surgical procedure, tumor volume, and follow-up. The mean follow-up was 60.2 ± 37.0 months and 62.4 ± 37.4 months for F-GKRS and S-GKRS cohort, respectively (P = .38). The overall tumor control at last follow-up was achieved in 95.2% and 92.9% of patients in F-GKRS and S-GKRS, respectively (P = .64). The 1-year, 3-year, 5-year, and 7-year progression-free survival rate after F-GKRS was 100%, 97.1%, 97.1%, and 91%, respectively. In the S-GKRS sample, progression-free survival rates were 100%, 100%, 92.5%, and 92.5% at 1, 3, 5, and 7 years after treatment, respectively. Two patients (4.7%) from the F-GKRS cohort and 2 (4.7%) from the S-GKRS cohort sustained visual worsening after radiosurgery (P = 1.0). CONCLUSION In the management of NFPAs adjacent to the optic pathway both F-GKRS and S-GKRS had comparable outcomes and risks at 7 years. Future prospective studies including larger cohorts with longer follow-up are needed to confirm our results.
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Affiliation(s)
- Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Elena Barrile
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Shray K Bindal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Edoardo Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Federico Villanacci
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - John C Flickinger
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Image-Guided Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Dharnipragada R, Dusenbery K, Watanabe Y, Ferreira C, Chen CC. Comparison of Gamma Knife (GK) and Linear Accelerator (LINAC) radiosurgery of brain metastasis resection cavity: a systematic review and proportional meta-analysis. Clin Exp Metastasis 2024; 41:1-8. [PMID: 37943360 DOI: 10.1007/s10585-023-10240-8] [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: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) to the resection cavity is essential in the treatment of brain metastasis (BM) amenable to surgical resection. The two most common platforms for SRS delivery include Gamma Knife (GK) and LINAC. Here we collated the available peer-reviewed literature and performed a meta-analysis on clinical outcomes after GK or LINAC resection cavity SRS. METHODS Following PRISMA Guidelines, a search on PUBMED and MEDLINE was performed to include all studies evaluating each post-operative SRS modality. Local control, overall survival, radiation necrosis, and leptomeningeal disease were evaluated from the available data. A proportional meta-analysis was performed via R using the metafor package to pool the outcomes of studies and a moderator effect to assess the significance between groups. RESULTS We identified 21 GK studies (n = 2009) and 28 LINAC studies (n = 2219). The radiosurgery doses employed were comparable between GK and LINAC studies. The pooled estimate of 1-year local control, 1-year overall survival, and risk of leptomeningeal disease were statistically comparable between GK and LINAC (81.7 v 85.8%; 61.4 v 62.7%; 10.6 v 12.5%, respectively). However, the risk of radiation necrosis (RN) was higher for LINAC resection cavity SRS (5.4% vs. 10%, p = 0.036). The volume of the resection cavity was a significant modifying factor for RN in both modalities (p = 0.007) with a 0.5% and 0.7% increase in RN risk with every 1 cm3 increase in tumor volume for GK and LINAC, respectively. CONCLUSIONS Our meta-analysis suggests that GK and LINAC SRS of resection cavity achieve comparable 1-year local control and survival. However, resection cavity treated with GK SRS was associated with lowered RN risk relative to those treated with LINAC SRS.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
- University of Minnesota Medical School, University of Minnesota Twin-Cities, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota Twin Cities, Minneapolis, MN, 55455, USA
| | - Yoichi Watanabe
- Department of Radiation Oncology, University of Minnesota Twin Cities, Minneapolis, MN, 55455, USA
| | - Clara Ferreira
- Department of Radiation Oncology, University of Minnesota Twin Cities, Minneapolis, MN, 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
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Beckers C, Pruschy M, Vetrugno I. Tumor hypoxia and radiotherapy: A major driver of resistance even for novel radiotherapy modalities. Semin Cancer Biol 2024; 98:19-30. [PMID: 38040401 DOI: 10.1016/j.semcancer.2023.11.006] [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: 09/19/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
Hypoxia in solid tumors is an important predictor of poor clinical outcome to radiotherapy. Both physicochemical and biological processes contribute to a reduced sensitivity of hypoxic tumor cells to ionizing radiation and hypoxia-related treatment resistances. A conventional low-dose fractionated radiotherapy regimen exploits iterative reoxygenation in between the individual fractions, nevertheless tumor hypoxia still remains a major hurdle for successful treatment outcome. The technological advances achieved in image guidance and highly conformal dose delivery make it nowadays possible to prescribe larger doses to the tumor as part of single high-dose or hypofractionated radiotherapy, while keeping an acceptable level of normal tissue complication in the co-irradiated organs at risk. However, we insufficiently understand the impact of tumor hypoxia to single high-doses of RT and hypofractionated RT. So-called FLASH radiotherapy, which delivers ionizing radiation at ultrahigh dose rates (> 40 Gy/sec), has recently emerged as an important breakthrough in the radiotherapy field to reduce normal tissue toxicity compared to irradiation at conventional dose rates (few Gy/min). Not surprisingly, oxygen consumption and tumor hypoxia also seem to play an intriguing role for FLASH radiotherapy. Here we will discuss the role of tumor hypoxia for radiotherapy in general and in the context of novel radiotherapy treatment approaches.
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Affiliation(s)
- Claire Beckers
- Laboratory for Applied Radiobiology, Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Pruschy
- Laboratory for Applied Radiobiology, Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Irene Vetrugno
- Laboratory for Applied Radiobiology, Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Vera-Chang MN, Danforth JM, Stuart M, Goodarzi AA, Brand M, Richardson RB. Profound DNA methylomic differences between single- and multi-fraction alpha irradiations of lung fibroblasts. Clin Epigenetics 2023; 15:174. [PMID: 37891670 PMCID: PMC10612361 DOI: 10.1186/s13148-023-01564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Alpha (α)-radiation is a ubiquitous environmental agent with epigenotoxic effects. Human exposure to α-radiation at potentially harmful levels can occur repetitively over the long term via inhalation of naturally occurring radon gas that accumulates in enclosed spaces, or as a result of a single exposure from a nuclear accident. Alterations in epigenetic DNA methylation (DNAm) have been implicated in normal aging and cancer pathogenesis. Nevertheless, the effects of aberrations in the methylome of human lung cells following exposure to single or multiple α-irradiation events on these processes remain unexplored. RESULTS We performed genome-wide DNAm profiling of human embryonic lung fibroblasts from control and irradiated cells using americium-241 α-sources. Cells were α-irradiated in quadruplicates to seven doses using two exposure regimens, a single-fraction (SF) where the total dose was given at once, and a multi-fraction (MF) method, where the total dose was equally distributed over 14 consecutive days. Our results revealed that SF irradiations were prone to a decrease in DNAm levels, while MF irradiations mostly increased DNAm. The analysis also showed that the gene body (i.e., exons and introns) was the region most altered by both the SF hypomethylation and the MF hypermethylation. Additionally, the MF irradiations induced the highest number of differentially methylated regions in genes associated with DNAm biomarkers of aging, carcinogenesis, and cardiovascular disease. The DNAm profile of the oncogenes and tumor suppressor genes suggests that the fibroblasts manifested a defensive response to the MF α-irradiation. Key DNAm events of ionizing radiation exposure, including changes in methylation levels in mitochondria dysfunction-related genes, were mainly identified in the MF groups. However, these alterations were under-represented, indicating that the mitochondria undergo adaptive mechanisms, aside from DNAm, in response to radiation-induced oxidative stress. CONCLUSIONS We identified a contrasting methylomic profile in the lung fibroblasts α-irradiated to SF compared with MF exposures. These findings demonstrate that the methylome response of the lung cells to α-radiation is highly dependent on both the total dose and the exposure regimen. They also provide novel insights into potential biomarkers of α-radiation, which may contribute to the development of innovative approaches to detect, prevent, and treat α-particle-related diseases.
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Affiliation(s)
- Marilyn N Vera-Chang
- Radiobiology and Health Branch, Chalk River Laboratories, Canadian Nuclear Laboratories, Chalk River, ON, K0J 1J0, Canada
| | - John M Danforth
- Departments of Biochemistry and Molecular Biology and Oncology, Cumming School of Medicine, Robson DNA Science Centre, Charbonneau Cancer Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Marilyne Stuart
- Environment and Waste Technologies Branch, Chalk River Laboratories, Canadian Nuclear Laboratories, Chalk River, ON, K0J 1J0, Canada
| | - Aaron A Goodarzi
- Departments of Biochemistry and Molecular Biology and Oncology, Cumming School of Medicine, Robson DNA Science Centre, Charbonneau Cancer Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Marjorie Brand
- Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
| | - Richard B Richardson
- Radiobiology and Health Branch, Chalk River Laboratories, Canadian Nuclear Laboratories, Chalk River, ON, K0J 1J0, Canada.
- McGill Medical Physics Unit, Cedars Cancer Centre-Glen Site, Montreal, QC, H4A 3J1, Canada.
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Dinh CT, Chen S, Nourbakhsh A, Padgett K, Johnson P, Goncalves S, Bracho O, Bas E, Bohorquez J, Monje PV, Fernandez-Valle C, Elsayyad N, Liu X, Welford SM, Telischi F. Single Fraction and Hypofractionated Radiation Cause Cochlear Damage, Hearing Loss, and Reduced Viability of Merlin-Deficient Schwann Cells. Cancers (Basel) 2023; 15:2818. [PMID: 37345155 PMCID: PMC10216287 DOI: 10.3390/cancers15102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Vestibular schwannomas (VS) are benign intracranial tumors caused by loss of function of the merlin tumor suppressor. We tested three hypotheses related to radiation, hearing loss (HL), and VS cell survival: (1) radiation causes HL by injuring auditory hair cells (AHC), (2) fractionation reduces radiation-induced HL, and (3) single fraction and equivalent appropriately dosed multi-fractions are equally effective at controlling VS growth. We investigated the effects of single fraction and hypofractionated radiation on hearing thresholds in rats, cell death pathways in rat cochleae, and viability of human merlin-deficient Schwann cells (MD-SC). METHODS Adult rats received cochlear irradiation with single fraction (0 to 18 Gray [Gy]) or hypofractionated radiation. Auditory brainstem response (ABR) testing was performed for 24 weeks. AHC viabilities were determined using immunohistochemistry. Neonatal rat cochleae were harvested after irradiation, and gene- and cell-based assays were conducted. MD-SCs were irradiated, and viability assays and immunofluorescence for DNA damage and cell cycle markers were performed. RESULTS Radiation caused dose-dependent and progressive HL in rats and AHC losses by promoting expression of apoptosis-associated genes and proteins. When compared to 12 Gy single fraction, hypofractionation caused smaller ABR threshold and pure tone average shifts and was more effective at reducing MD-SC viability. CONCLUSIONS Investigations into the mechanisms of radiation ototoxicity and VS radiobiology will help determine optimal radiation regimens and identify potential therapies to mitigate radiation-induced HL and improve VS tumor control.
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Affiliation(s)
- Christine T. Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Si Chen
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Aida Nourbakhsh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
| | - Kyle Padgett
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Perry Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Stefania Goncalves
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
| | - Olena Bracho
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
| | - Esperanza Bas
- Department of Research Pharmacy, Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
| | - Jorge Bohorquez
- Department of Biomedical Engineering, University of Miami, Miami, FL 33146, USA
| | - Paula V. Monje
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Cristina Fernandez-Valle
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL 32827, USA;
| | - Nagy Elsayyad
- Allina Health Cancer Institute—Radiation Oncology, St. Paul, MN 55102, USA
| | - Xuezhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Scott M. Welford
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Fred Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA (O.B.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL 33146, USA
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Li B, Bai F, Yao X, Xu L, Zhao L. Clinical value of styrofoam fixation in intracranial tumor radiotherapy. Front Oncol 2023; 13:1131006. [PMID: 37051532 PMCID: PMC10083371 DOI: 10.3389/fonc.2023.1131006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
ObjectiveTo analyze the application value of two postural fixation techniques.(styrofoam combined with head mask and fixed headrest combined with head mask) in intracranial tumor radiotherapy via cone beam computed tomography (CBCT).MethodsThis study included 104 patients with intracranial tumors undergoing radiotherapy. The patients were divided into two groups: Group A (54 cases with styrofoam fixation) and Group B (50 cases with fixed headrest fixation). The positional deviation in 3D space between the two groups was compared using CBCT. The set-up errors were expressed as median (25th percentile, 75th percentile)or M(p25, p75) since the set-up errors in all directions were not normally distributed,The Mann-Whitney U test was performed.ResultsThe age and gender of patients in the two groups were not significantly different. The set-up errors of A in lateral (X), longitudinal (Y), vertical (Z), and yaw(Rtn) axes were 1.0 (0,1) mm, 1.0 (0,1) mm, 1.0 (0,2) mm, and 0.4 (0.1, 0.8) degrees, respectively while the set-up errors of B were 1.0 (0,1) mm, 1.0 (1,2) mm, 1.0 (0,2) mm, and 0.5 (0.15,0.9) degrees, respectively. Moreover, patients in the styrofoam group had significantly smaller set-up errors in the Y-axis than patients in the headrest group (p=0.001). However, set-up errors in the X, Z, and Rtn axes were not significantly different between the two groups. The expansion boundaries of the target area in the X, Y, and Z directions were 1.77 mm, 2.45 mm, and 2.47 mm, respectively. The outer expansion boundaries of the headrest group were 2.03 mm, 3.88 mm, and 2.57 mm in X, Y, and Z directions, respectively. The set-up times of groups A and B were (32.71 ± 5.21) seconds and (46.57 ± 6.68) seconds, respectively (p=0.014). Patients in group A had significantly better comfort satisfaction than patients in group B (p=0.001).ConclusionStyrofoam plus head thermoplastic mask body fixation technique has a higher positional accuracy in intracranial tumor radiotherapy than headrest plus head thermoplastic mask fixation. Besides, styrofoam plus head thermoplastic mask body fixation technique is associated with improved positioning efficiency, and better comfort than headrest plus head thermoplastic mask fixation, and thus can be effectively applied for intracranial tumor radiotherapy positioning.
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Zhang Q, Hamilton D, Conway P, Xie SJ, Haghighi N, Lasocki A. Radiation necrosis and therapeutic outcomes in patients treated with linear accelerator-based hypofractionated stereotactic radiosurgery for intact intracranial metastases. J Med Imaging Radiat Oncol 2023; 67:308-319. [PMID: 36847751 DOI: 10.1111/1754-9485.13519] [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: 01/11/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Balancing disease control and treatment-related toxicities can be challenging when treating higher-risk brain metastases (BMs) that are larger in size or eloquent anatomical locations. Hypofractionated stereotactic radiosurgery (hfSRS) is expected to offer superior or equal efficacy with lower toxicity profile compared with single-fraction SRS (sfSRS). We report the efficacy and toxicity profiles of hfSRS in a consecutive cohort of patients to support this predicted benefit from hfSRS for high-risk BMs. METHODS We retrospectively analysed 185 consecutive individual lesions from 152 patients with intact BMs treated with hfSRS between 1 July 2016 and 31 October 2019 and followed up to 30 April 2022 with serial brain magnetic resonance imaging (MRI). The primary endpoint was the event of radiation necrosis (RN). Local control (LC) rate and distant brain failure (DBF) were reported as secondary outcomes. Kaplan-Meier method was used to report the cumulative incidence of RN and overall survival and the incidence of DBF. Potential risk factors for RN were assessed using univariable Cox regression analysis. RESULTS The median follow-up was 38.0 months, and the median survival post-SRS was 9.5 months. The cumulative incidence rate of RN was 13.2% (95% CI: 7.0-24.7%), and 18.1% of patients with confirmed RN were symptomatic. Higher mean dose delivered to planning target volume (PTV) (HR 1.22, 95% CI: 1.05-1.42, P = 0.01), higher mean BED10 (biological equivalent dose assuming a tissue α / β $$ \alpha /\beta $$ ratio of 10) (HR 1.12, 95% CI: 1.04-1.2, P < 0.001), and higher mean BED2 (HR 1.02, 95% CI: 1-1.04, P = 0.04) delivered to the lesion was associated with increased risk of RN. LC rate was 86% and the cumulative incidence of DBF was 36% with a median onset of 28.4 months. CONCLUSIONS Our results support the predicted radiobiological benefit of the use of hfSRS in high-risk BMs to limit treatment-related toxicity with low risk for symptomatic RN comparable with lower risk population receiving sfSRS while achieving satisfactory local disease control.
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Affiliation(s)
- Qichen Zhang
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Icon Cancer Centre Gold Coast University Hospital, Queensland, Gold Coast, Australia
| | - Daniel Hamilton
- Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,MetaMelb Research Group, School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Conway
- Icon Cancer Centre Richmond, Victoria, Melbourne, Australia
| | - Sophia Jing Xie
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Victoria, Melbourne, Australia
| | - Neda Haghighi
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Arian Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Vetlova ER, Banov SM, Golanov AV, Pronin IN, Antipina NA, Galkin MV. [Results of hypofractionated stereotactic radiotherapy for resected and intact large brain metastases]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:67-75. [PMID: 38054229 DOI: 10.17116/neiro20238706167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Post-resection or isolated hypofractionated stereotactic radiotherapy (HF-SRT) is a therapeutic option for large brain metastases (>2 cm, LBMs). OBJECTIVE To compare the results of post-resection or isolated HF-SRT in patients with LBMs. MATERIAL AND METHODS A prospective study included 115 patients with 129 intact LBMs and 133 patients with 149 resected LBMs who underwent HF-SRT. Median baseline focal size was 22.5 and 28 mm, median target volume - 8.3 and 23.7 cm3, respectively. RESULTS Median follow-up was 13.9 months, median overall survival - 19.1 months. After 12 months, local recurrences developed in 17 and 31% of patients, respectively (p=0.0078). Local recurrence after 12 months developed in 23% of patients with residual tumor in postoperative cavity compared to 16% of patients after total resection (p=0.0073). After 12 months, incidence of leptomeningeal progression was 27 and 11%, respectively (p=0.033), incidence of symptomatic radiation-induced necrosis - 4 and 23%, respectively (p=0.0006). CONCLUSION Post-resection HF-SRT demonstrated better local control and less severe symptomatic radiation-induced necrosis compared to patients with intact LBMs. Incidence of leptomeningeal progression is significantly higher after resection of LBMs.
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Affiliation(s)
- E R Vetlova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S M Banov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
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11
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Carpenter DJ, Fairchild AT, Adamson JD, Fecci PE, Sampson JH, Herndon JE, Torok JA, Mullikin TC, Kim GJ, Reitman ZJ, Kirkpatrick JP, Floyd SR. Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery. Adv Radiat Oncol 2022; 8:101166. [PMID: 36845614 PMCID: PMC9943776 DOI: 10.1016/j.adro.2022.101166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Hypofractionated stereotactic radiosurgery (HF-SRS) with or without surgical resection is potentially a preferred treatment for larger or symptomatic brain metastases (BMs). Herein, we report clinical outcomes and predictive factors following HF-SRS. Methods and Materials Patients undergoing HF-SRS for intact (iHF-SRS) or resected (rHF-SRS) BMs from 2008 to 2018 were retrospectively identified. Linear accelerator-based image-guided HF-SRS consisted of 5 fractions at 5, 5.5, or 6 Gy per fraction. Time to local progression (LP), time to distant brain progression (DBP), and overall survival (OS) were calculated. Cox models assessed effect of clinical factors on OS. Fine and Gray's cumulative incidence model for competing events examined effect of factors on LP and DBP. The occurrence of leptomeningeal disease (LMD) was determined. Logistic regression examined predictors of LMD. Results Among 445 patients, median age was 63.5 years; 87% had Karnofsky performance status ≥70. Fifty-three % of patients underwent surgical resection, and 75% received 5 Gy per fraction. Patients with resected BMs had higher Karnofsky performance status (90-100, 41 vs 30%), less extracranial disease (absent, 25 vs 13%), and fewer BMs (multiple, 32 vs 67%). Median diameter of the dominant BM was 3.0 cm (interquartile range, 1.8-3.6 cm) for intact BMs and 4.6 cm (interquartile range, 3.9-5.5 cm) for resected BMs. Median OS was 5.1 months (95% confidence interval [CI], 4.3-6.0) following iHF-SRS and 12.8 months (95% CI, 10.8-16.2) following rHF-SRS (P < .01). Cumulative LP incidence was 14.5% at 18 months (95% CI, 11.4-18.0%), significantly associated with greater total GTV (hazard ratio, 1.12; 95% CI, 1.05-1.20) following iFR-SRS, and with recurrent versus newly diagnosed BMs across all patients (hazard ratio, 2.28; 95% CI, 1.01-5.15). Cumulative DBP incidence was significantly greater following rHF-SRS than iHF-SRS (P = .01), with respective 24-month rates of 50.0 (95% CI, 43.3-56.3) and 35.7% (95% CI, 29.2-42.2). LMD (57 events total; 33% nodular, 67% diffuse) was observed in 17.1% of rHF-SRS and 8.1% of iHF-SRS cases (odds ratio, 2.46; 95% CI, 1.34-4.53). Any radionecrosis and grade 2+ radionecrosis events were observed in 14 and 8% of cases, respectively. Conclusions HF-SRS demonstrated favorable rates of LC and radionecrosis in postoperative and intact settings. Corresponding LMD and RN rates were comparable to those of other studies.
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Affiliation(s)
- David J. Carpenter
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina,Corresponding author: Scott Floyd, MD, PhD
| | | | - Justus D. Adamson
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Peter E. Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - John H. Sampson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - James E. Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jordan A. Torok
- Department of Radiation Oncology, St. Clair Hospital Cancer Center, Pittsburgh, Pennsylvania
| | - Trey C. Mullikin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Grace J. Kim
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Zachary J. Reitman
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - John P. Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina,Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Scott R. Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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12
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Gong X, Ding J, Knisely JPS, Wang E, Pan L, Wang B, Zhang N, Wu H, Dai J, Yu T, Tang X. Dose-staged Gamma Knife radiosurgery for meningiomas: A retrospective study in a single center. Front Neurol 2022; 13:893480. [PMID: 36313491 PMCID: PMC9606413 DOI: 10.3389/fneur.2022.893480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to study the efficiency and safety of a dose-staged Gamma Knife radiosurgery strategy for large meningiomas or meningiomas close to important nerve structures.MethodsThis study evaluates the outcome of a prospectively accrued series of 71 consecutive patients with meningiomas treated with staged dose-fractionated Gamma Knife radiosurgery. The average peripheral doses for the first and second fractions were 9.0 ± 0.9 Gy (8–12 Gy) and 8.6 ± 0.7 Gy (range, 7–10 Gy), respectively. The interval between fractions was 6.1 ± 1.9 months (range, 3–12 months). The median follow-up time was 36 months (12–96 months).ResultsDuring the follow-up period after the second fraction, 97.2% achieved tumor control in our series. A total of 2 patients exhibited local recurrence at 30 and 60 months after the second fraction, respectively. No treatment-related complications or new long-term neurological dysfunctions were reported. MRIs observed slightly or moderately increased peritumoral edema in six patients, but no specific neurological complaints are attributed to this finding.ConclusionThis study investigates the efficiency and safety of dose-staged Gamma Knife radiosurgery as an alternative option for meningiomas that were large in volume, adjacent to crucial structures, or in patients with contraindications to craniotomy.
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Affiliation(s)
- Xiu Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianbo Ding
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
- *Correspondence: Jianbo Ding
| | - Jonathan P. S. Knisely
- Department of Radiation Oncology, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, United States
| | - Enmin Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Li Pan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Binjiang Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nan Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hanfeng Wu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
| | - Jiazhong Dai
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tonggang Yu
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
| | - Xuqun Tang
- Department of Neurosurgery, Shanghai Gamma Hospital, Shanghai, China
- Department of Neurosurgery, Gamma Knife Center of Huashan Hospital, Shanghai, China
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13
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Goeckeritz J, Cerillo J, Sanghadia C, Hosseini M, Clark A, Pierre K, Lucke-Wold B. Principles of Lung Cancer Metastasis to Brain. JOURNAL OF SKELETON SYSTEM 2022; 1:https://www.mediresonline.org/article/principles-of-lung-cancer-metastasis-to-brain. [PMID: 36745145 PMCID: PMC9893877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is a disease associated with significant morbidity and mortality on a global setting. This form of cancer commonly gives raise to metastatic lesions the brain, which can further worsen outcomes. In this focused review, we discuss an overview of lung cancers that metastasize to the brain: known risk factors; means of detection and diagnosis; and options for treatment including a comparison between surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy. These interventions are still being assessed by clinical trials and continue to be modified through evidence-based practice.
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Affiliation(s)
| | - John Cerillo
- College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL
| | | | | | - Alec Clark
- College of Medicine, University of Central Florida, Orlando, FL
| | - Kevin Pierre
- Department of Radiology, University of Florida, Gainesville, FL
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14
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Alvi MA, Asher AL, Michalopoulos GD, Grills IS, Warnick RE, McInerney J, Chiang VL, Attia A, Timmerman R, Chang E, Kavanagh BD, Andrews DW, Walter K, Bydon M, Sheehan JP. Factors associated with progression and mortality among patients undergoing stereotactic radiosurgery for intracranial metastasis: results from a national real-world registry. J Neurosurg 2022; 137:985-998. [PMID: 35171833 DOI: 10.3171/2021.10.jns211410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) has been increasingly employed in recent years to treat intracranial metastatic lesions. However, there is still a need for optimization of treatment paradigms to provide better local control and prevent progressive intracranial disease. In the current study, the authors utilized a national collaborative registry to investigate the outcomes of patients with intracranial metastatic disease who underwent SRS and to determine factors associated with lesion treatment response, overall progression, and mortality. METHODS The NeuroPoint Alliance SRS registry was queried for all patients with intracranial metastatic lesions undergoing single- or multifraction SRS at participating institutions between 2016 and 2020. The main outcomes of interest included lesion response (lesion-level analysis), progression using Response Assessment for Neuro-Oncology criteria, and mortality (patient-level analysis). Kaplan-Meier analysis was used to report time to progression and overall survival, and multivariable Cox proportional hazards analysis was used to investigate factors associated with lesion response, progression, and mortality. RESULTS A total of 501 patients (1447 intracranial metastatic lesions) who underwent SRS and had available follow-up were included in the current analyses. The most common primary tumor was lung cancer (49.5%, n = 248), followed by breast (15.4%, n = 77) and melanoma (12.2%, n = 61). Most patients had a single lesion (44.9%, n = 225), 29.3% (n = 147) had 2 or 3 lesions, and 25.7% (n = 129) had > 3 lesions. The mean sum of baseline measurements of the lesions according to Response Evaluation Criteria in Solid Tumors (RECIST) was 35.54 mm (SD 25.94). At follow-up, 671 lesions (46.4%) had a complete response, 631 (43.6%) had a partial response (≥ 30% decrease in longest diameter) or were stable (< 30% decrease but < 20% increase), and 145 (10%) showed progression (> 20% increase in longest diameter). On multivariable Cox proportional hazards analysis, melanoma-associated lesions (HR 0.48, 95% CI 0.34-0.67; p < 0.001) and larger lesion size (HR 0.94, 95% CI 0.93-0.96; p < 0.001) showed lower odds of lesion regression, while a higher biologically effective dose was associated with higher odds (HR 1.001, 95% CI 1.0001-1.00023; p < 0.001). A total of 237 patients (47.3%) had overall progression (local failure or intracranial progressive disease), with a median time to progression of 10.03 months after the index SRS. Factors found to be associated with increased hazards of progression included male sex (HR 1.48, 95% CI 1.108-1.99; p = 0.008), while administration of immunotherapy (before or after SRS) was found to be associated with lower hazards of overall progression (HR 0.62, 95% CI 0.460-0.85; p = 0.003). A total of 121 patients (23.95%) died during the follow-up period, with a median survival of 19.4 months from the time of initial SRS. A higher recursive partitioning analysis score (HR 21.3485, 95% CI 1.53202-3.6285; p < 0.001) was found to be associated with higher hazards of mortality, while single-fraction treatment compared with hypofractionated treatment (HR 0.082, 95% CI 0.011-0.61; p = 0.015), administration of immunotherapy (HR 0.385, 95% CI 0.233-0.64; p < 0.001), and presence of single compared with > 3 lesions (HR 0.427, 95% CI 0.187-0.98; p = 0.044) were found to be associated with lower risk of mortality. CONCLUSIONS The comparability of results between this study and those of previously published clinical trials affirms the value of multicenter databases with real-world data collected without predetermined research purpose.
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Affiliation(s)
- Mohammed Ali Alvi
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 3Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Giorgos D Michalopoulos
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Inga S Grills
- 4Department of Neurological Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Ronald E Warnick
- 5Department of Neurosurgery, The Jewish Hospital, Cincinnati, Ohio
| | - James McInerney
- 6Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Veronica L Chiang
- 7Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Albert Attia
- 8Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Timmerman
- 9Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Eric Chang
- 10Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian D Kavanagh
- 11Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - David W Andrews
- 12Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kevin Walter
- 13Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York; and
| | - Mohamad Bydon
- 1Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jason P Sheehan
- 14Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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15
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Umekawa M, Shinya Y, Hasegawa H, Kawashima M, Shin M, Katano A, Minamitani M, Kashio A, Kondo K, Saito N. Stereotactic radiosurgery ensures an effective and safe long-term control of Koos grade IV vestibular schwannomas: a single-center, retrospective, cohort study. J Neurooncol 2022; 159:201-209. [PMID: 35729368 DOI: 10.1007/s11060-022-04058-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Stereotactic radiosurgery (SRS) is a standard treatment modality for vestibular schwannomas (VSs). However, there is a paucity of data on tumor control and neurological preservation for larger VSs. We aimed to investigate the long-term effectiveness of SRS for Koos grade IV compared with I-III VSs. METHODS We included 452 patients with VSs (50 Koos grade IV and 402 Koos grade I‒III) who were treated with SRS at our institution from 1990 to 2021. Tumor control and functional preservation were calculated using the Kaplan-Meier method and compared between groups with the log-rank test. RESULTS The median post-SRS follow-up period was 68 months. Progression-free survival rates were 91% at 5 and 10 years for Koos grade IV VSs, and 95% and 92%, respectively, for Koos grade I‒III VSs (p = 0.278). In Koos grade IV VSs, functional preservation rates of the facial and trigeminal nerves were both 96% at 5 years (both 98% for Koos grade I‒III VSs; facial, p = 0.410; trigeminal, p = 0.107). Hearing preservation rates were 61% at 5 years for Koos grade IV VSs and 78% for Koos grade I-III VSs (p = 0.645). Symptomatic transient tumor expansion was more common with Koos grade IV VSs (8.0% vs. 2.5%, p = 0.034), although all related symptoms diminished in accordance with tumor shrinkage. CONCLUSION SRS may contribute to long-term tumor control and adequate neurological preservation in the treatment of Koos grade IV VSs, comparable to those in the treatment of Koos grade I‒III VSs.
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Affiliation(s)
- Motoyuki Umekawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan.
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Mariko Kawashima
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Masanari Minamitani
- Department of Radiology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Akinori Kashio
- Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
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16
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Yan M, Zalay O, Kennedy T, Owen TE, Purzner J, Taslimi S, Purzner T, Alkins R, Moideen N, Fung AS, Moraes FY. Outcomes of Hypofractionated Stereotactic Radiotherapy for Small and Moderate-Sized Brain Metastases: A Single-Institution Analysis. Front Oncol 2022; 12:869572. [PMID: 35444935 PMCID: PMC9014302 DOI: 10.3389/fonc.2022.869572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) is the standard treatment for limited intracranial metastases. With the advent of frameless treatment delivery, fractionated stereotactic radiotherapy (FSRT) has become more commonly implemented given superior control and toxicity rates for larger lesions. We reviewed our institutional experience of FSRT to brain metastases without size restriction. Methods We performed a retrospective review of our institutional database of patients treated with FSRT for brain metastases. Clinical and dosimetric details were abstracted. All patients were treated in 3 or 5 fractions using LINAC-based FSRT, did not receive prior cranial radiotherapy, and had at least 6 months of MRI follow-up. Overall survival was estimated using the Kaplan–Meier method. Local failure and radionecrosis cumulative incidence rates were estimated using a competing risks model with death as the competing risk. Univariable and multivariable analyses using Fine and Gray’s proportional subdistribution hazards regression model were performed to determine covariates predictive of local failure and radionecrosis. Results We identified 60 patients and 133 brain metastases treated at our institution from 2016 to 2020. The most common histologies were lung (53%) and melanoma (25%). Most lesions were >1 cm in diameter (84.2%) and did not have previous surgical resection (88%). The median duration of imaging follow-up was 9.8 months. The median survival for the whole cohort was 20.5 months. The local failure at 12 months was 17.8% for all lesions, 22.1% for lesions >1 cm, and 13.7% for lesions ≤1 cm (p = 0.36). The risk of radionecrosis at 12 months was 7.1% for all lesions, 13.2% for lesions >1 cm, and 3.2% for lesions ≤1 cm (p = 0.15). Conclusions FSRT is safe and effective in the treatment of brain metastases of any size with excellent local control and toxicity outcomes. Prospective evaluation against single-fraction SRS is warranted for all lesion sizes.
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Affiliation(s)
- Michael Yan
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Osbert Zalay
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Thomas Kennedy
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Timothy E Owen
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - James Purzner
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Teresa Purzner
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Ryan Alkins
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Nikitha Moideen
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Andrea S Fung
- Department of Oncology, Division of Medical Oncology and Hematology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
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17
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Cho A, Medvedeva K, Kranawetter B, Untersteiner H, Hirschmann D, Lepilina O, Baulin A, Buschmann M, Ertl A, Marik W, Dorfer C, Rössler K, Gatterbauer B, Ilyalov S, Frischer JM. How to dose-stage large or high-risk brain metastases: an alternative two-fraction radiosurgical treatment approach. J Neurosurg 2022; 137:1666-1675. [DOI: 10.3171/2022.2.jns212440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE
The authors sought to evaluate clinical outcome in patients with large, high-risk brain metastases (BMs) treated with different dose strategies by use of two-fraction dose-staged Gamma Knife radiosurgery (GKRS).
METHODS
A retrospective analysis was performed with data from 142 patients from two centers who had been treated with two-fraction dose-staged GKRS between June 2015 and January 2020. Depending on the changes in marginal dose between the first (GKRS1) and second (GKRS2) GKRS treatments, the study population was divided into three treatment groups: dose escalation, dose maintenance, and dose de-escalation.
RESULTS
The 142 study patients underwent two-fraction dose-staged GKRS treatments for 166 large, high-risk BMs. The median tumor volume of 7.4 cm3 decreased significantly from GKRS1 to GKRS2 (4.4 cm3; p < 0.001), and to the last follow-up (1.8 cm3; p < 0.001). These significant differences in BM volume reduction were achieved in all three treatment groups. However, differences according to the primary tumor histology were apparent: while dose maintenance seemed to be the most effective treatment strategy for BMs from lung cancer or melanoma, dose escalation was the most beneficial treatment option for BMs from breast, gastrointestinal, or genitourinary cancer. Of note, the vast majority of patients who underwent dose-staged BM treatment did not show any significant postradiosurgical complications.
CONCLUSIONS
In patients with large, high-risk BMs, dose-staged GKRS treatment represents an effective local treatment method with acceptable complication risks. Different dose-strategy options are available that may be chosen according to the primary tumor histology and treatment volume but may also be tailored to the findings at GKRS2.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | | | | | | | | | - Martin Buschmann
- Department of Neurosurgery, Medical University of Vienna, Austria
- Department of Radiation Oncology, Medical University of Vienna; and
| | - Adolf Ertl
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Austria
| | | | | | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, Austria
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18
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Simon M, Papp J, Csiki E, Kovács Á. Plan Quality Assessment of Fractionated Stereotactic Radiotherapy Treatment Plans in Patients With Brain Metastases. Front Oncol 2022; 12:846609. [PMID: 35345445 PMCID: PMC8957100 DOI: 10.3389/fonc.2022.846609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose The treatment options available in the management of brain metastases includes fractionated stereotactic radiotherapy (FSRT) and stereotactic radiosurgery (SRS) treatments. FSRT treatments have proved to be useful mainly in the treatment of larger volumes. This study aims to evaluate the FSRT treatment technique used in our department based on various plan quality indices. Methods and Materials 24 treatment plans of 23 patients were analyzed. Volumetric modulated arc therapy (VMAT) plans were generated in line with the department protocol. The following parameters were extracted: Radiation Therapy Oncology Group conformity index (RTOG CI), Paddick conformity index (Paddick CI), gradient index (GI), quality index (Q), homogeneity index (HI), and V24.4 volume as a parallel index of V12 used at SRS plan evaluation. Results Plan conformity was acceptable, RTOG CI mean was 0.942; Paddick CI mean was 0.824. The mean GI value was 6.146. The mean of HI and Q indices were 1.263 and 0.94, respectively. V24.4 mean was 33.434 cm3. All plans achieved clinically acceptable organs-at-risk (OAR) constraints. PTV volumes were clustered into either 10 cm3 or 15 cm3 bins depending on the plan quality metric we used. The mean values show a balanced distribution of plan indices along the various PTV bins. Discussion Our results based on the derived indices show that our FSRT approach can achieve clinically acceptable treatment plans. Furthermore, the clustering of PTV volumes show that these plan quality metrics remain acceptable for a wide spectrum of PTV volumes.
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Affiliation(s)
- Mihály Simon
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, University of Pécs Faculty of Health Sciences, Pécs, Hungary
| | - Judit Papp
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, University of Pécs Faculty of Health Sciences, Pécs, Hungary
| | - Emese Csiki
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Árpád Kovács
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, University of Pécs Faculty of Health Sciences, Pécs, Hungary
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19
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Köseer AS, Loureiro LR, Jureczek J, Mitwasi N, González Soto KE, Aepler J, Bartsch T, Feldmann A, Kunz-Schughart LA, Linge A, Krause M, Bachmann M, Arndt C, Dubrovska A. Validation of CD98hc as a Therapeutic Target for a Combination of Radiation and Immunotherapies in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:1677. [PMID: 35406454 PMCID: PMC8997111 DOI: 10.3390/cancers14071677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 02/07/2023] Open
Abstract
Most patients with head and neck squamous cell carcinomas (HNSCC) are diagnosed at a locally advanced stage and show heterogeneous treatment responses. Low SLC3A2 (solute carrier family 3 member 2) mRNA and protein (CD98hc) expression levels are associated with higher locoregional control in HNSCC patients treated with primary radiochemotherapy or postoperative radiochemotherapy, suggesting that CD98hc could be a target for HNSCC radiosensitization. One of the targeted strategies for tumor radiosensitization is precision immunotherapy, e.g., the use of chimeric antigen receptor (CAR) T cells. This study aimed to define the potential clinical value of new treatment approaches combining conventional radiotherapy with CD98hc-targeted immunotherapy. To address this question, we analyzed the antitumor activity of the combination of fractionated irradiation and switchable universal CAR (UniCAR) system against radioresistant HNSCC cells in 3D culture. CD98hc-redirected UniCAR T cells showed the ability to destroy radioresistant HNSCC spheroids. Also, the infiltration rate of the UniCAR T cells was enhanced in the presence of the CD98hc target module. Furthermore, sequential treatment with fractionated irradiation followed by CD98hc-redirected UniCAR T treatment showed a synergistic effect. Taken together, our obtained data underline the improved antitumor effect of the combination of radiotherapy with CD98hc-targeted immunotherapy. Such a combination presents an attractive approach for the treatment of high-risk HNSCC patients.
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Affiliation(s)
- Ayşe Sedef Köseer
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
| | - Liliana R. Loureiro
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Justyna Jureczek
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Tumor Immunology, University Cancer Center (UCC), University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Nicola Mitwasi
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Karla Elizabeth González Soto
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Julia Aepler
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Tabea Bartsch
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Anja Feldmann
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
| | - Leoni A. Kunz-Schughart
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- OncoRay–National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01307 Dresden, Germany
| | - Annett Linge
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- OncoRay–National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01307 Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mechthild Krause
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- OncoRay–National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01307 Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, 01307 Dresden, Germany
| | - Michael Bachmann
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Tumor Immunology, University Cancer Center (UCC), University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Claudia Arndt
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01328 Dresden, Germany; (J.J.); (N.M.); (K.E.G.S.); (J.A.); (T.B.)
- Mildred Scheel Early Career Center, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Anna Dubrovska
- National Center for Tumor Diseases (NCT), Partner Site Dresden: German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf (HZDR), 01307 Dresden, Germany; (A.S.K.); (L.R.L.); (A.F.); (L.A.K.-S.); (A.L.); (M.K.); (M.B.)
- German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- OncoRay–National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, 01307 Dresden, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology-OncoRay, 01307 Dresden, Germany
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20
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Piras A, Boldrini L, Menna S, Sanfratello A, D'Aviero A, Cusumano D, Di Cristina L, Messina M, Spada M, Angileri T, Daidone A. Five-Fraction Stereotactic Radiotherapy for Brain Metastases: A Single-Institution Experience on Different Dose Schedules. Oncol Res Treat 2022; 45:408-414. [PMID: 35172322 DOI: 10.1159/000522645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
Introduction The most common intracranial neoplasm diagnosed in adults are brain metastases (BrM). The benefit in terms of clinical control and toxicity for stereotactic radiotherapy (SRT)has been investigated for patients with low load of brain metastases. Aim of this single-institution experience was to investigate the best dose schedule for five-fraction stereotactic radiotherapy (FFSRT). Methods A retrospective analysis of patients treated for BrM with different dose schedules of FFSRT was performed. Local Control and clinical outcomes were evaluated with Magnetic resonance imaging (MRI) at 3, 6 and 9 months. Toxicity data were also collected. Results A total of 41 patients treated from November 2016 to September 2020 were enrolled in the analysis. Non Small Cell Lung cancer (51,2%) and breast cancer (24,3%) represented the most frequent primitive tumors. Treatment was performed on 5 consecutive days with prescribed dose ranging from 30 to 40 Gy, prescribed to the 95% isodose line that covered at least 98% of the GTV. Statistically significant differences (p=0.025) with higher LC control rates for dose schedules > 6Gy for fractions. Toxicity rates were not found to be higher than G1. Conclusion The results of this retrospective analysis suggest that FFSRT for BrM seems to be safe and feasible. Our results also underline that a total dose lower than 30 Gy in 5 fractions should not be used due to the expected minor LC.
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Affiliation(s)
- Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Luca Boldrini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sebastiano Menna
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Roma, Italy
| | | | - Andrea D'Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Davide Cusumano
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Roma, Italy
| | | | - Marco Messina
- UOC Oncologia Medica, Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
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21
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Kirkpatrick JP. Answering the Big Clinical Questions in Brain Metastasis Management. Front Oncol 2022; 11:834122. [PMID: 35118002 PMCID: PMC8805701 DOI: 10.3389/fonc.2021.834122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
Management of brain metastases is challenging, both because of the historically guarded prognosis and evolving, more efficacious treatment paradigms for metastatic cancer. This perspective addresses several of the important difficult questions that practitioners treating patients with brain tumors face in the clinic. Successfully answering these questions requires knowledge of the clinical evidence, thoughtful discussion of the patient’s goals of care and collaboration in a multi-disciplinary setting.
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Affiliation(s)
- John P. Kirkpatrick
- Department of Radiation Oncology, Duke Cancer Institute, Durham, NC, United States
- Department of Neurosurgery, Duke Cancer Institute, Durham, NC, United States
- *Correspondence: John P. Kirkpatrick,
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22
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Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study. Adv Radiat Oncol 2021; 6:100760. [PMID: 34934856 PMCID: PMC8655418 DOI: 10.1016/j.adro.2021.100760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose To examine the effectiveness and safety of single-isocenter multitarget stereotactic radiosurgery using a volume-adapted dosing strategy in patients with 4 to 10 brain metastases. Methods and Materials Adult patients with 4 to 10 brain metastases were eligible for this prospective trial. The primary endpoint was overall survival. Secondary endpoints were local recurrence, distant brain failure, neurologic death, and rate of adverse events. Exploratory objectives were neurocognition, quality of life, dosimetric data, salvage rate, and radionecrosis. Dose was prescribed in a single fraction per RTOG 90-05 or as 5 Gy × 5 fractions for lesions ≥3 cm diameter, lesions involving critical structures, or single-fraction brain V12Gy >20 mL. Results Forty patients were treated with median age of 61 years, Karnofsky performance status 90, and 6 brain metastases. Twenty-two patients survived longer than expected from the time of protocol SRS, with 1 living patient who has not reached that milestone. Median overall survival was 8.1 months with a 1-year overall survival of 35.7%. The 1-year local recurrence rate was 5% (10 of 204 of evaluable lesions) in 12.5% (4 of 32) of the patients. Distant brain failure was observed in 19 of 32 patients with a 1-year rate of 35.8%. Grade 1-2 headache was the most common complaint, with no grade 3-5 treatment-related adverse events. Radionecrosis was observed in only 5 lesions, with a 1-year rate of 1.5%. Rate of neurologic death was 20%. Neurocognition and quality of life did not significantly change 3 months after SRS compared with pretreatment. Conclusions These results suggest that volume-adapted dosing single-isocenter multitarget stereotactic radiosurgery is an effective and safe treatment for patients with 4 to 10 brain metastases.
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Rahman R, Sulman E, Haas-Kogan D, Cagney DN. Update on Radiation Therapy for Central Nervous System Tumors. Hematol Oncol Clin North Am 2021; 36:77-93. [PMID: 34711456 DOI: 10.1016/j.hoc.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation therapy has long been a critical modality of treatment of patients with central nervous system tumors, including primary brain tumors, brain metastases, and meningiomas. Advances in radiation technology and delivery have allowed for more precise treatment to optimize patient outcomes and minimize toxicities. Improved understanding of the molecular underpinnings of brain tumors and normal brain tissue response to radiation will allow for continued refinement of radiation treatment approaches to improve clinical outcomes for brain tumor patients. With continued advances in precision and delivery, radiation therapy will continue to be an important modality to achieve optimal outcomes of brain tumor patients.
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Affiliation(s)
- Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA
| | - Erik Sulman
- Department of Radiation Oncology, New York University Grossman School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, 75 Francis Street, ASB1-L2, Boston, MA 02115, USA.
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Myrehaug S, Hudson J, Soliman H, Ruschin M, Tseng CL, Detsky J, Husain Z, Keith J, Atenafu EG, Maralani P, Heyn C, Das S, Lipsman N, Sahgal A. Hypofractionated Stereotactic Radiation Therapy for Intact Brain Metastases in 5 Daily Fractions: Effect of Dose on Treatment Response. Int J Radiat Oncol Biol Phys 2021; 112:342-350. [PMID: 34537313 DOI: 10.1016/j.ijrobp.2021.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Multileaf collimator (MLC) linear accelerator (Linac)-based hypofractionated stereotactic radiation therapy (HSRT) is increasingly used not only for large brain metastases or those adjacent to critical structures but also for those metastases that would otherwise be considered for single-fraction radiosurgery (SRS). However, data on outcomes in general are limited, and there is a lack of understanding regarding optimal dosing. Our aim was to report mature image-based outcomes for MLC-Linac HSRT with a focus on clinical and dosimetric factors associated with local failure (LF). METHODS AND MATERIALS A total of 220 patients with 334 brain metastases treated with HSRT were identified. All patients were treated using a 5-fraction daily regimen and were followed with clinical evaluation and volumetric magnetic resonance imaging every 2 to 3 months. Overall survival and progression-free survival were calculated using the Kaplan-Meier method, with LF determined using Fine and Gray's competing risk method. Predictive factors were identified using Cox regression multivariate analysis. RESULTS Median follow-up was 10.8 months. Median size of treated metastasis was 1.9 cm; 60% of metastases were <2 cm in size. The median total dose was 30 Gy in 5 fractions; 36% of the cohort received <30 Gy. The median time to LF and 12-month cumulative incidence of LF was 8.5 months and 23.8%, respectively. Median time to death and 12-month overall survival rates were 11.8 months and 48.2%, respectively. Fifty-two metastases (15.6%) had an adverse radiation effect, of which 32 (9.5%) were symptomatic necrosis. Multivariable analysis identified worse LF in patients who received a total dose of <30 Gy (hazard ratio, 1.62; P = .03), with LF at 6 and 12 months of 13% and 33% for patients treated with <30 Gy versus 5% and 19% for patients treated with >30 Gy. Exploratory analysis demonstrated a dose-response effect observed in all histologic types, including among breast cancer subtypes. CONCLUSION Optimal local control is achieved with HSRT of ≥30 Gy in 5 daily fractions, independent of tumor volume and histology, with an acceptable risk of radiation necrosis.
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Affiliation(s)
- Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada.
| | - John Hudson
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Mark Ruschin
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, Ontario, Canada
| | - Pejman Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Sunit Das
- Department of Neurosurgery, St. Michaels Hospital, Ontario, Canada
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
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Thielhelm TP, Goncalves S, Welford SM, Mellon EA, Cohen ER, Nourbakhsh A, Fernandez-Valle C, Telischi F, Ivan ME, Dinh CT. Understanding the Radiobiology of Vestibular Schwannomas to Overcome Radiation Resistance. Cancers (Basel) 2021; 13:4575. [PMID: 34572805 PMCID: PMC8467596 DOI: 10.3390/cancers13184575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Vestibular schwannomas (VS) are benign tumors arising from cranial nerve VIII that account for 8-10% of all intracranial tumors and are the most common tumors of the cerebellopontine angle. These tumors are typically managed with observation, radiation therapy, or microsurgical resection. Of the VS that are irradiated, there is a subset of tumors that are radioresistant and continue to grow; the mechanisms behind this phenomenon are not fully understood. In this review, the authors summarize how radiation causes cellular and DNA injury that can activate (1) checkpoints in the cell cycle to initiate cell cycle arrest and DNA repair and (2) key events that lead to cell death. In addition, we discuss the current knowledge of VS radiobiology and how it may contribute to clinical outcomes. A better understanding of VS radiobiology can help optimize existing treatment protocols and lead to new therapies to overcome radioresistance.
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Affiliation(s)
- Torin P Thielhelm
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Stefania Goncalves
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Scott M Welford
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Erin R Cohen
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Aida Nourbakhsh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Cristina Fernandez-Valle
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL 32816, USA
| | - Fred Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Christine T Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Palmiero AN, Fabian D, Randall ME, Clair W, Pokhrel D. Predicting the effect of indirect cell kill in the treatment of multiple brain metastases via single-isocenter/multitarget volumetric modulated arc therapy stereotactic radiosurgery. J Appl Clin Med Phys 2021; 22:94-103. [PMID: 34498359 PMCID: PMC8504608 DOI: 10.1002/acm2.13400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/11/2021] [Accepted: 08/04/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Due to spatial uncertainty, patient setup errors are of major concern for radiosurgery of multiple brain metastases (m‐bm) when using single‐isocenter/multitarget (SIMT) volumetric modulated arc therapy (VMAT) techniques. However, recent clinical outcome studies show high rates of tumor local control for SIMT‐VMAT. In addition to direct cell kill (DCK), another possible explanation includes the effects of indirect cell kill (ICK) via devascularization for a single dose of 15 Gy or more and by inducing a radiation immune intratumor response. This study quantifies the role of indirect cell death in dosimetric errors as a function of spatial patient setup uncertainty for stereotactic treatments of multiple lesions. Material and Methods Nine complex patients with 61 total tumors (2‐16 tumors/patient) were planned using SIMT‐VMAT with geometry similar to HyperArc with a 10MV‐FFF beam (2400 MU/min). Isocenter was placed at the geometric center of all tumors. Average gross tumor volume (GTV) and planning target volume (PTV) were 1.1 cc (0.02–11.5) and 1.9 cc (0.11–18.8) with an average distance to isocenter of 5.4 cm (2.2–8.9). The prescription was 20 Gy to each PTV. Plans were recalculated with induced clinically observable patient setup errors [±2 mm, ±2o] in all six directions. Boolean structures were generated to calculate the effect of DCK via 20 Gy isodose volume (IDV) and ICK via 15 Gy IDV minus the 20 Gy IDV. Contributions of each IDV to the PTV coverage were analyzed along with normal brain toxicity due to the patient setup uncertainty. Induced uncertainty and minimum dose covering the entire PTV were analyzed to determine the maximum tolerable patient setup errors to utilize the ICK effect for radiosurgery of m‐bm via SIMT‐VMAT. Results Patient setup errors of 1.3 mm /1.3° in all six directions must be maintained to achieve PTV coverage of the 15 Gy IDV for ICK. Setup errors of ±2 mm/2° showed clinically unacceptable loss of PTV coverage of 29.4 ± 14.6% even accounting the ICK effect. However, no clinically significant effect on normal brain dosimetry was observed. Conclusions Radiosurgery of m‐bm using SIMT‐VMAT treatments have shown positive clinical outcomes even with small residual patient setup errors. These clinical outcomes, while largely due to DCK, may also potentially be due to the ICK. Potential mechanisms, such as devascularization and/or radiation‐induced intratumor immune enhancement, should be explored to provide a better understanding of the radiobiological response of stereotactic radiosurgery of m‐bm using a SIMT‐VMAT plan.
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Affiliation(s)
- Allison N Palmiero
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Denise Fabian
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Marcus E Randall
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - William Clair
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
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Skourou C, Hickey D, Rock L, Houston P, Sturt P, O' Sullivan S, Faul C, Paddick I. Treatment of multiple intracranial metastases in radiation oncology: a contemporary review of available technologies. BJR Open 2021; 3:20210035. [PMID: 34877458 PMCID: PMC8611687 DOI: 10.1259/bjro.20210035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
The use of stereotactic radiosurgery to treat multiple intracranial metastases, frequently concurrently, has become increasingly common. The ability to accurately and safely deliver stereotactic radiosurgery treatment to multiple intracranial metastases (MIM) relies heavily on the technology available for targeting, planning, and delivering the dose. A number of platforms are currently marketed for such applications, each with intrinsic capabilities and limitations. These can be broadly categorised as cobalt-based, linac-based, and robotic. This review describes the most common representative technologies for each type along with their advantages and current limitations as they pertain to the treatment of multiple intracranial metastases. Each technology was used to plan five clinical cases selected to represent the clinical breadth of multiple metastases cases. The reviewers discuss the different strengths and limitations attributed to each technology in the case of MIM as well as the impact of disease-specific characteristics (such as total number of intracranial metastases, their size and relative proximity) on plan and treatment quality.
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Affiliation(s)
| | | | | | | | | | | | - Clare Faul
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK
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Kang SM, Kim JM, Cheong JH, Ryu JI, Won YD, Kim YS, Han MH. Effect of osteoporotic conditions on the development of peritumoral brain edema after LINAC-based radiation treatment in patients with intracranial meningioma. Radiat Oncol 2021; 16:160. [PMID: 34425881 PMCID: PMC8383364 DOI: 10.1186/s13014-021-01890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Disruption of the tumor-brain barrier in meningioma is a crucial factor in peritumoral brain edema (PTBE). We previously reported the possible effect of osteoporosis on the integrity of the arachnoid trabeculae because both the bone and the arachnoid trabeculae are composed of type 1 collagen. We hypothesized that osteoporotic conditions may be associated with PTBE occurrence after radiation treatment in patients with meningioma. METHODS A receiver operating characteristic curve analysis was used to identify the optimal cut-off values of mean skull Hounsfield unit for predicting osteopenia and osteoporosis in patients from our registry. Multivariate Cox regression analysis was used to determine whether possible osteoporosis independently predicted PTBE development in patients with meningioma after radiation. RESULTS A total of 106 intracranial meningiomas were included for the study. All patients received linear accelerator-based radiation therapy in our hospital over an approximate 6-year period. Multivariate Cox regression analysis identified that hypothetical osteoporosis was an independent predictive factor for the development of PTBE in patients with meningioma after linear accelerator-based radiation treatment (hazard ratio 5.20; 95% confidence interval 1.11-24.46; p = 0.037). CONCLUSIONS Our study suggests that possible osteoporotic conditions may affect PTBE development after linear accelerator-based radiation treatment for intracranial meningioma. However, due to the study's small number of patients, these findings need to be validated in future studies with larger cohorts, before firm recommendations can be made.
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Affiliation(s)
- Sang Mook Kang
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Jae Min Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Jin Hwan Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Yu Deok Won
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, 471-701, Gyonggi-do, Korea.
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Unterberger A, Ng E, Pradhan A, Kondajji A, Kulinich D, Duong C, Yang I. Adjuvant radiotherapy for atypical meningiomas is associated with improved progression free survival. J Neurol Sci 2021; 428:117590. [PMID: 34358821 DOI: 10.1016/j.jns.2021.117590] [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: 03/31/2021] [Revised: 06/23/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the progression-free survival benefits of adjuvant radiotherapy (ART) following surgical resection compared to surgery alone in high-grade meningioma patients. METHODS We retrospectively identified 43 patients with atypical meningiomas, who underwent either radiotherapy post-surgical resection (Surgery+ART) or surgery alone (Surgery alone) at our institution between February 2007 to March 2019. GTR was achieved in 28 patients, and STR, in 11. Patient, meningioma, and treatment data were extracted from records and compared using Kaplan-Meier methodology, log-rank tests, and Cox proportional hazard models. Radiation complications were also evaluated. RESULTS Overall 32.6% (n = 14) of patients, 6 patients in the Surgery+ART group and 8 in the Surgery alone group, experienced recurrence. In the Surgery+ART group, the median PFS time was 46.5 months (CI: [35.8-50.6]), compared to 24.5 months (CI: [18.3-32.9]) in the Surgery alone group. 2-year PFS for Surgery+ART was 100% vs. 69.0% for Surgery alone, and the 5-year PFS rate was 70.6% and 39.2%, respectively (log-rank p-value = .004). CONCLUSIONS Our data revealed a significant PFS increase for those treated with adjuvant radiotherapy following surgery compared to surgery alone. Future prospective studies evaluating differing radiation modalities and dosages should be conducted.
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Affiliation(s)
- Ansley Unterberger
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Edwin Ng
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Anjali Pradhan
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Aditya Kondajji
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daniel Kulinich
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Courtney Duong
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Isaac Yang
- Departments of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA; Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA; Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
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Maggio I, Franceschi E, Tosoni A, Nunno VD, Gatto L, Lodi R, Brandes AA. Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas. CNS Oncol 2021; 10:CNS72. [PMID: 34015955 PMCID: PMC8162186 DOI: 10.2217/cns-2021-0003] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
Meningiomas are the most common primary intracranial tumors. The majority of meningiomas are benign, but they can present different grades of dedifferentiation from grade I to grade III (anaplastic/malignant) that are associated with different outcomes. Radiological surveillance is a valid option for low-grade asymptomatic meningiomas. In other cases, the treatment is usually surgical, aimed at achieving a complete resection. The use of adjuvant radiotherapy is the gold standard for grade III, is debated for grade II and is not generally indicated for radically resected grade I meningiomas. The use of systemic treatments is not standardized. Here we report a review of the literature on the clinical, radiological and molecular characteristics of meningiomas, available treatment strategies and ongoing clinical trials.
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Affiliation(s)
- Ilaria Maggio
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Enrico Franceschi
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Alicia Tosoni
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Vincenzo Di Nunno
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Lidia Gatto
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Raffaele Lodi
- IRCSS Istituto di Scienze Neurologiche di Bologna, Bologna 40139, Italy
| | - Alba A Brandes
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
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Efficacy and safety of hypofractionated stereotactic radiotherapy for brain metastases using three fractions: A single-centre retrospective study. Cancer Radiother 2021; 25:763-770. [PMID: 34083125 DOI: 10.1016/j.canrad.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Hypofractionated stereotactic radiotherapy (HFSRT) has become a standard of care for patients with a limited number of brain metastases (BM). An increasing number of linear accelerators (LA) are able to accurately perform HFSRT including VersaHD® (Elekta®) LA. The main aim of this study was to report clinical outcomes of BM treated by HFSRT using 3×7.7Gy on 70% isodose line in terms of local control (LC). PATIENTS AND METHODS Between November 2016 and October 2018, all patients suffering from histologically-proven primary with one or several newly diagnosed BM treated by HFSRT were retrospectively included and evaluated. Patients who had received prior treatment by neurosurgery or cerebral radiotherapy were excluded. RESULTS Among 44 patients, 61 BM were treated. With a median follow-up of 31.9 months, LC rates at 6 and 12 months were 93.2% and 90.9, respectively. Single-BM was independently predictive of LC (P=0.025) and overall survival (P=0.013). Acute toxicity rates were acceptable: 65.9% of patients had grade 1 and 2 and no acute grade 3 toxicity according to the NCI-CTCAE (version 5.0). Regarding delayed toxicity, one case (2.3%) of radionecrosis was confirmed by magnetic resonance spectroscopy. CONCLUSION In our single-centre retrospective analysis, BM treatment by HFSRT delivered in three fractions showed a 12-month LC rate of 90.9% without major toxicities, which suggests safety and efficiency of this technique. However, longer-term follow-up and prospective studies are still needed to confirm these results.
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Singhal S, Gill M, Srivastava C, Gupta D, Kumar A, Kaushik A, Semwal MK. Simplifying Tumor Volume Estimation from Linear Dimensions for Intra-Cranial Lesions Treated with Stereotactic Radiosurgery. J Med Phys 2021; 45:199-205. [PMID: 33953494 PMCID: PMC8074724 DOI: 10.4103/jmp.jmp_56_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022] Open
Abstract
Aims: This study aims to derive simple yet robust formula(s) for the calculation of cranial tumor volume using linear tumor dimensions in anterioposterior (AP), mediolateral (ML) and craniocaudal (CC) directions and also propose a reproducible methodology for tumor dimension measurements. Materials and Methods: Magnetic resonance images (MRI) of 337 patients planned for Gammaknife Stereotactic Radiosurgery for different types of brain tumors were analyzed using Leksell Gamma Plan (LGP) software. Tumor volume in three dimensional was outlined and maximum tumor diameters were measured in three orthogonal directions AP, ML, and CC on the MRI. Formulas were derived to calculate tumor volume from AP, ML, and CC diameters using linear regression technique. An agreement between the calculated volume and standard volume observed from LGP software was determined using Bland Altman (B-A) plot. A comparison was made between the volume calculated using traditionally used formula of ellipsoid, standard volume obtained from LGP software and volume calculated from formulas derived in the present study. Results: The tumors were divided into two categories based on their size for better volume prediction. The tumors having product of their diameters in the range 0–2.5cc were called “small tumors” and the formula proposed for their volume estimation (V = 1.513) × (AP × ML × CC) + 0.047 ) was found to predict the tumor volume with an average bias of 0.0005cc. For “large tumors,” having product of diameters in the range 2.5–36cc, the proposed formula (V = 0.444 × (AP × ML × CC) + 0.339 ) predicted the tumor volume with an average bias of 0.007cc. Conclusions: The two formulas proposed in the study are more accurate as compared to the commonly used formula that considers the tumors as ellipsoids. The methodology proposed in the study for measurement of linear tumor dimensions is simple and reproducible.
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Affiliation(s)
- Sakshi Singhal
- Division of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Maneet Gill
- Department of Neurosurgery, Army Hospital Research and Referral, Delhi, India
| | - Chinmaya Srivastava
- Department of Neurosurgery, Army Hospital Research and Referral, Delhi, India
| | - Darpan Gupta
- Department of Neurosurgery, Army Hospital Research and Referral, Delhi, India
| | - Ashok Kumar
- Department of Radiation Oncology, Army Hospital Research and Referral, Delhi, India
| | - Aruna Kaushik
- Division of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Manoj Kumar Semwal
- Department of Radiation Oncology, Army Hospital Research and Referral, Delhi, India
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Jiang Y, Martin J, Alkadhimi M, Shigemori K, Kinchesh P, Gilchrist S, Kersemans V, Smart S, Thompson JM, Hill MA, O'Connor MJ, Davies BR, Ryan AJ. Olaparib increases the therapeutic index of hemithoracic irradiation compared with hemithoracic irradiation alone in a mouse lung cancer model. Br J Cancer 2021; 124:1809-1819. [PMID: 33742147 PMCID: PMC8144220 DOI: 10.1038/s41416-021-01296-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/27/2020] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background The radiosensitising effect of the poly(ADP-ribose) polymerase inhibitor olaparib on tumours has been reported. However, its effect on normal tissues in combination with radiation has not been well studied. Herein, we investigated the therapeutic index of olaparib combined with hemithoracic radiation in a urethane-induced mouse lung cancer model. Methods To assess tolerability, A/J mice were treated with olaparib plus whole thorax radiation (13 Gy), body weight changes were monitored and normal tissue effects were assessed by histology. In anti-tumour (intervention) studies, A/J mice were injected with urethane to induce lung tumours, and were then treated with olaparib alone, left thorax radiation alone or the combination of olaparib plus left thorax radiation at 8 weeks (early intervention) or 18 weeks (late intervention) after urethane injection. Anti-tumour efficacy and normal tissue effects were assessed by visual inspection, magnetic resonance imaging and histology. Results Enhanced body weight loss and oesophageal toxicity were observed when olaparib was combined with whole thorax but not hemithorax radiation. In both the early and late intervention studies, olaparib increased the anti-tumour effects of hemithoracic irradiation without increasing lung toxicity. Conclusions The addition of olaparib increased the therapeutic index of hemithoracic radiation in a mouse model of lung cancer.
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Affiliation(s)
- Yanyan Jiang
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Jennifer Martin
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Maryam Alkadhimi
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Kay Shigemori
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Paul Kinchesh
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Stuart Gilchrist
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Veerle Kersemans
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Sean Smart
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - James M Thompson
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - Mark A Hill
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | | | | | - Anderson J Ryan
- CRUK & MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK.
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Lai J, Liu J, Zhao J, Li A, Liu S, Deng Z, Tan Q, Wang H, Jia Y, Lei K, Zhou L. Effective method to reduce the normal brain dose in single-isocenter hypofractionated stereotactic radiotherapy for multiple brain metastases. Strahlenther Onkol 2021; 197:592-600. [PMID: 33725135 DOI: 10.1007/s00066-021-01757-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Island blocking and dose leakage problems will lead to unnecessary irradiation to normal brain tissue (NBT) in hypofractionated stereotactic radiotherapy (HSRT) for multiple brain metastases (BM) with single-isocenter volumetric modulated arc therapy (VMAT). The present study aimed at investigating whether reducing the number of metastases irradiated by each arc beam could minimize these two problems. MATERIALS AND METHODS A total of 32 non-small-cell lung cancer (NSCLC) patients with multiple BM received HSRT (24-36 Gy/3 fractions) with single-isocenter VMAT, where each arc beam only irradiated partial metastases (pm-VMAT), were enrolled in this retrospective study. Conventional single-isocenter VMAT plans, where each arc beam irradiated whole metastases (wm-VMAT), was regenerated and compared with pm-VMAT plans. Furthermore, the clinical efficacy and toxicities were evaluated. RESULTS Pm-VMAT achieved similar target coverage as that with wm-VMAT, with better dose fall-off (P < 0.001) and NBT sparing (P < 0.001). However, pm-VMAT resulted in more monitor units (MU) and longer beam-on time (P < 0.001). The intracranial objective response rate and disease control rate for all patients were 75% and 100%, respectively. The local control rates at 1 year and 2 year were 96.2% and 60.2%, respectively. The median progression-free survival and overall survival were 10.3 months (95% confidence interval [CI] 6.8-13.2) and 18.5 months (95% CI 15.9-20.1), respectively. All treatment-related adverse events were grade 1 or 2, and 3 lesions (2.31%) from 2 patients (6.25%) demonstrated radiation necrosis after HSRT. CONCLUSION HSRT with pm-VMAT is effective and has limited toxicities for NSCLC patients with multiple BM. Pm-VMAT could provide better NBT sparing while maintaining target dose coverage.
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Affiliation(s)
- Jialu Lai
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Jia Liu
- Department of Oncology, Chengdu First People' Hospital, 18, Wanxiang North Road, 610041, Chengdu, Sichuan, China
| | - Jianling Zhao
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - An Li
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Shoupeng Liu
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Zhonghua Deng
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Qiaoyue Tan
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Haitao Wang
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Yuming Jia
- Department of Oncology, Yibin Second People' Hospital, 96, North Street, 644000, Yibin, Sichuan, China
| | - Kaijian Lei
- Department of Oncology, Yibin Second People' Hospital, 96, North Street, 644000, Yibin, Sichuan, China
| | - Lin Zhou
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China.
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Unterberger A, Nguyen T, Duong C, Kondajji A, Kulinich D, Yang I. Meta-analysis of adjuvant radiotherapy for intracranial atypical and malignant meningiomas. J Neurooncol 2021; 152:205-216. [PMID: 33635510 DOI: 10.1007/s11060-020-03674-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Meningiomas comprise 33% of all CNS tumors. The World Health Organization (WHO) describes meningiomas as benign (BM), atypical (AM), and malignant/anaplastic (MM). High-grade meningiomas such as AMs and MMs are more aggressive, recur more frequently, and portend a worse prognosis than BMs. Currently, the standard treatment for high-grade meningiomas, especially AMs, is ill-defined. In particular, the benefit to survival outcomes of adjuvant radiotherapy post-surgical resection remains unclear. In this study, we investigated the effect of adjuvant radiotherapy (ART) post-surgery on survival outcomes compared to surgery alone for high-grade meningiomas. METHODS PRISMA guidelines were a foundation for our literature review. We screened the PubMed database for studies reporting overall survival (OS), progression free survival (PFS), and tumor recurrence for intracranial, primary AM and MMs treated with surgery+ART or surgery alone. Fixed and random effect models compared tumor control rate for AM aforementioned groups. RESULTS Mean 5-year PFS was 76.9% for AM (surgery+ART) and 55.9% for AM (surgery alone) patients. Mean 5-year OS was 81.3% and 74% for AM (surgery+ART) and AM (surgery alone) groups, respectively. Overall, the mean 5-year PFS for aggregated high-grade meningiomas AM+MM (surgery+ART) was 67.6%. Fixed effect models revealed tumor control rate as 76% for AM (surgery+ART) and 69% for AM (surgery alone) groups. ART induced toxicity incidence ranged from 12.0% to 35.5% for AM and MM patients. CONCLUSIONS Our analysis suggests that (surgery+ART) may increase PFS, OS, and tumor control rates in high-grade meningiomas. However, further studies involving surgery+ ART should be conducted to fully evaluate the ideal radiosurgical candidate, modality, and dosage.
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Affiliation(s)
- Ansley Unterberger
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Thien Nguyen
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Courtney Duong
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Aditya Kondajji
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daniel Kulinich
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, USA. .,Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, USA. .,Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, USA. .,Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, USA. .,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
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Tosi U, Lavieri MET, An A, Maayan O, Guadix SW, DeRosa AP, Christos PJ, Pannullo S, Stieg PE, Brandmaier A, Knisely JPS, Ramakrishna R. Outcomes of stereotactic radiosurgery for large vestibular schwannomas: a systematic review and meta-analysis. Neurooncol Pract 2021; 8:405-416. [PMID: 34277019 DOI: 10.1093/nop/npab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Large vestibular schwannomas (VS) pose a treatment challenge for both microsurgery (MS) and stereotactic radiosurgery (SRS). Technical developments have allowed for safer irradiation of large tumors. It remains unclear if SRS can achieve appropriate tumor control and acceptable cranial nerve toxicities. In this study, we assess outcomes of irradiation for large VS. Methods PubMed MEDLINE, EMBASE, Web of Science, and Cochrane were searched for all the studies assessing SRS outcome in large VS. Primary endpoints included clinical and radiographic tumor control, need for salvage surgery, serviceable hearing, cranial nerve V and VII impairment, presence of hydrocephalus requiring shunting, and presence of vertigo/dizziness. Results Twenty-two studies were identified that met selection criteria for analysis from an initial pool of 1272 reports. They were evaluated according to treatment protocol: 1) single-dose SRS (13 studies, 483 patients), 2) combination of MS and SRS (7 studies, 182 patients), and 3) fractionated SRS (3 studies, 82 patients). Tumor control was achieved in 89%, 94%, and 91% of patients, respectively. Odds ratios (ORs) of post- over pretreatment serviceable hearing were 0.42 (P < .01), 0.47 (P = .05), and 0.60 (P = .22); for facial nerve impairment, these ORs were 1.08 (P = .69), 3.45 (P = .28), and 0.87 (P = .71), respectively. Conclusions The management of large VS remains challenging. All treatment modalities resulted in high tumor control rates and worsening of pretreatment hearing. None, however, caused significant facial nerve impairment, suggesting that management strategies incorporating focal irradiation can be successful.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Anjile An
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Omri Maayan
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Antonio P DeRosa
- Samuel J. Wood Library, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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Guedes de Castro D, Braun AC, Calsavara VF, Melo Gondim GR, Gobo Silva ML, Chen MJ, Fogaroli RC, Ramos H, Coelho TM, Scintini Herbst AC, Abdallah EA, Yu LS, Fidarova E, Zubizarreta E, Assis Pellizzon AC, Domingos Chinen LT. Prospective Assessment of the Association Between Circulating Tumor Cells and Control of Brain Disease After Focal Radiation Therapy of Breast Cancer Brain Metastases. Adv Radiat Oncol 2021; 6:100673. [PMID: 33912738 PMCID: PMC8071730 DOI: 10.1016/j.adro.2021.100673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Predicting the risk of early distant brain failure (DBF) is in demand for management decisions in patients who are candidates for local treatment of brain metastases. This study aimed to analyze the association between circulating tumor cells (CTCs) and brain disease control after stereotactic radiation therapy/radiosurgery (SRT) for breast cancer brain metastasis (BCBM). Methods and Materials We prospectively assessed CTCs before (CTC1) and 4 to 5 weeks after (CTC2) SRT and their relationship with the number of new lesions (NL) suggestive of BCBM before SRT. CTC were quantified and analyzed by immunocytochemistry to evaluate the expression of the proteins COX2, EGFR, ST6GALNAC5, NOTCH1, and HER2. Distant brain failure-free survival (DBFFS), the primary endpoint, diffuse DBFFS (D-DBFFS), and overall survival were estimated. Analysis for DBF within 6 months, with death as competing risk, was performed. Results Patients were included between 2016 and 2018. CTCs were detected in all 39 patients before and in 34 of 35 patients after SRT. After median follow-up of 16.6 months, median DBFFS, D-DBFFS, and overall survival were 15.3, 14.1, and 19.5 months, respectively. DBF at 6 months was 40% with CTC1 ≤0.5 and 8.82% with CTC1 >0.5 CTC/mL (P = .007), and D-DBF at 6 months was 40% with CTC1 ≤0.5 and 0 with CTC1 >0.5 CTC/mL (P = .005) and 25% with NL/CTC1 >6.8 and 2.65% with NL/CTC1 ≤6.8 (P = .063). On multivariate analysis, DBFFS was inferior with CTC1 ≤0.5 (hazard ratio, 8.27; 95% confidence interval, 2.12-32.3; P = .002), and D-DBFFS was inferior with CTC1 ≤0.5 (hazard ratio, 10.22; 95% confidence interval, 1.99-52.41; P = .005). Protein expression was not associated with outcomes. Conclusions These data suggest that CTC1 and NL/CTC1 may have a role as a biomarker of early diffuse DBF and as a subsequent guide between focal or whole-brain radiation therapy in patients with BCBM.
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Radiosurgery and stereotactic irradiation of multiple and contiguous brain metastases: A practical proposal of dose prescription methods and a literature review. Cancer Radiother 2020; 25:92-102. [PMID: 33390318 DOI: 10.1016/j.canrad.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE In literature, there are no guidelines on how to prescribe dose in the case of radiosurgery (SRS) or stereotactic irradiation of multiple and adjacent BM. Aim of this work is to furnish practical proposals of dosimetric methods for multiple neighboring BM, and to make a literature review about the SRS treatment of multiple BM, comparing radiotherapy techniques on the basis of different dosimetric parameters. MATERIALS AND METHODS A theoretical proposal of dosimetric approaches to prescribe dose in case of multiple contiguous BM is done. A literature review between 2010 and 2020 was performed on MEDLINE and Cochrane databases according to the PRISMA methodology, with the following keywords dose prescription, radiosurgery, multiple BM. Papers not reporting dosimetric solutions to irradiate multiple BM were excluded. RESULTS Only one article in the literature reports a practical modality of dose prescription for multiple adjacent BM. Thus, we proposed other five practical solutions to prescribe radiation dose in case of two or more neighboring BM, describing advantages and drawbacks of each method in terms of different dosimetric parameters. The literature review about dosimetric solutions to irradiate multiple BM led to 56 titles; 14 articles met the chosen criteria and we reported their results in terms of dosimetric indexes and low doses to the normal brain tissue. CONCLUSIONS The six dosimetric approaches here described can be used by physicians for multiple contiguous BM, depending on the clinical situation. These methods may be applied in clinical studies to better evaluate their usefulness in practice.
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Tashiro M, Souda H, Yoshida T, Sakurai H. Reconstruction of dose distributions for fine carbon-ion beams using iterative approximation toward carbon-knife. Phys Med Biol 2020; 65:225023. [PMID: 33053513 DOI: 10.1088/1361-6560/abc131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For the practical application of carbon-knife with fine carbon-ion beams, the quantification of the dose distribution is essential and requires a high spatial resolution. We propose a novel method to quantify dose distributions with a spatial resolution smaller than the dosimeter size. The proposed method innovates the iterative reconstruction technique. Using a diode dosimeter with a sensitive area of 1 mm2, two-dimensional dose-area-product (DAP) distributions were measured at a 0.1 mm step at the surface and near the Bragg peak depths for fine carbon-ion beams of ∼1 mm size at the full width at half maximum (FWHM). Then, the dose distributions were reconstructed with a spatial resolution of 0.1 × 0.1 mm2 from the measured DAP distributions. However, an unnaturally high noise was observed in the reconstructed dose distributions, which were considered to originate from the measurement reproducibility errors of the DAP distributions estimated to be 2.5%-3%. Therefore, a low-pass filtering process was implemented to reduce the errors on the reconstructed dose distributions. The optimum cut-off frequencies of the low-pass filter were estimated depending on the amplitude of the induced noise. Using the filtering process with the obtained optimum cut-off frequency, the dose distribution was quantified with an average error of approximately 3% or less with respect to the peak value, when the actual measurement had an error of 3%. In the reconstructed dose rate distributions, a steep penumbra P80-20 ∼ 0.2 mm was observed at the surface, and a dose rate at the center axis of ∼90 Gy s-1 and a beam size of ∼1.1 mm at FWHM near the Bragg peak were obtained. The proposed method is expected to be useful for the measurement-based determination of microbeam models for commissioning and dose distribution calculations toward carbon-knife applications.
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Affiliation(s)
- Mutsumi Tashiro
- Gunma University Heavy Ion Medical Center (GHMC), Maebashi, Gunma, Japan
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Tam AKY, Chan DYC, Lim K, Poon D, Kam M, Cheung M, Wong GKC. Long term treatment efficacy & complications of hypofractionated stereotactic radiosurgery in brain arteriovenous malformations. J Clin Neurosci 2020; 82:241-246. [PMID: 33246903 DOI: 10.1016/j.jocn.2020.10.057] [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: 05/04/2020] [Revised: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate long term treatment efficacy and complications of hypofractionated stereotactic radiosurgery (hfSRS) and identify factors that predict outcomes. METHODS A retrospective review was conducted on 34 consecutive patients who received hfSRS from 2008 to 2017. Demographic, clinical, angio-architectural characteristics, and radiosurgery data were extracted from the Clinical Data Analysis and Reporting System and our unit's iPlan (BrainLAB, Munich) system. Data was analysed using SPSS. RESULTS 5-year obliteration rate was 39.1%. Most patients (n = 29, 85.3%) recovered well with GOS of 4-5. 26.9% (n = 9) patients have at least one post-radiosurgery complication including hemorrhage, neurological deficits, radionecrosis. Neurological morbidity and mortality was 17.6% (n = 6). A higher modified radiosurgery arteriovenous malformation score (mRBAS) is associated with a lower 5-year obliteration rate (Rho = -0.486, p = 0.025). None of the bAVM were obliterated once mRBAS exceeds 5.35. As expected, a larger 20-Gy volume outside lesion is associated with more complications and poorer GOS. Interestingly, irradiated drainage vein volume indexed to AVM volume (iiDVV) correlates with increased risks of post-hfSRS haemorrhage (Rho = 0.472, p = 0.031) and reduced event-free survival (Rho = -0.472, p = 0.031). Once iiDVV exceeds 20%, a high rebleeding rate after hfSRS is anticipated (AUC under ROC 0.889). CONCLUSION Hypofractionated stereotactic radiosurgery is an alternative radiosurgery treatment for bAVM unsuitable for single-fraction SRS. mRBAS predicts obliteration rate and morbidity in hfSRS. Index irradiated drainage vein volume (iiDVV) is associated with event-free survival and rebleeding and should be minimized if feasible.
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Affiliation(s)
- Aurora K Y Tam
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - David Y C Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Kevin Lim
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Darren Poon
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Michael Kam
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Michael Cheung
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - George K C Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Park C, Howell EP, Mehta VA, Ramirez L, Price MJ, Floyd SR, Kirkpatrick JP, Torok J, Abd-El-Barr MM, Karikari IO, Goodwin CR. Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases. J Neurosurg Spine 2020; 34:293-302. [PMID: 33157523 DOI: 10.3171/2020.6.spine20349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic body radiation therapy (SBRT) offers efficient, noninvasive treatment of spinal neoplasms. Single-fraction (SF) high-dose SBRT has a relatively narrow therapeutic window, while hypofractionated delivery of SBRT may have an improved safety profile with similar efficacy. Because the optimal approach of delivery is unknown, the authors examined whether hypofractionated SBRT improves pain and/or functional outcomes and results in better tumor control compared with SF-SBRT. METHODS This is a single-institution retrospective study of adult patients with spinal metastases treated with SF- or three-fraction (3F) SBRT from 2008 to 2019. Demographics and baseline characteristics, radiographic data, and posttreatment outcomes at a minimum follow-up of 3 months are reported. RESULTS Of the 156 patients included in the study, 70 (44.9%) underwent SF-SBRT (median total dose 1700 cGy) and 86 (55.1%) underwent 3F-SBRT (median total dose 2100 cGy). At baseline, a higher proportion of patients in the 3F-SBRT group had a worse baseline profile, including severity of pain (p < 0.05), average use of pain medication (p < 0.001), and functional scores (p < 0.05) compared with the SF-SBRT cohort. At the 3-month follow-up, the 3F-SBRT cohort experienced a greater frequency of improvement in pain compared with the SF-SBRT group (p < 0.05). Furthermore, patients treated with 3F-SBRT demonstrated a higher frequency of improved Karnofsky Performance Scale (KPS) scores (p < 0.05) compared with those treated with SF-SBRT, with no significant difference in the frequency of improvement in modified Rankin Scale scores. Local tumor control did not differ significantly between the two cohorts. CONCLUSIONS Patients who received spinal 3F-SBRT more frequently achieved significant pain relief and an increased frequency of improvement in KPS compared with those treated with SF-SBRT. Local tumor control was similar in the two groups. Future work is needed to establish the relationship between fractionation schedule and clinical outcomes.
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Affiliation(s)
| | | | | | - Luis Ramirez
- 3Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, North Carolina
| | | | - Scott R Floyd
- 2Radiation Oncology, Duke University Medical Center; and
| | | | - Jordan Torok
- 2Radiation Oncology, Duke University Medical Center; and
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Chen H, Louie A, Higginson D, Palma D, Colaco R, Sahgal A. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy in the Management of Oligometastatic Disease. Clin Oncol (R Coll Radiol) 2020; 32:713-727. [DOI: 10.1016/j.clon.2020.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 01/29/2023]
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Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas. Rep Pract Oncol Radiother 2020; 25:919-926. [PMID: 33088227 DOI: 10.1016/j.rpor.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Background Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. Methods/Results We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Conclusions Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.
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Huntoon K, Toland AMS, Dahiya S. Meningioma: A Review of Clinicopathological and Molecular Aspects. Front Oncol 2020; 10:579599. [PMID: 33194703 PMCID: PMC7645220 DOI: 10.3389/fonc.2020.579599] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
Meningiomas are the most the common primary brain tumors in adults, representing approximately a third of all intracranial neoplasms. They classically are found to be more common in females, with the exception of higher grades that have a predilection for males, and patients of older age. Meningiomas can also be seen as a spectrum of inherited syndromes such as neurofibromatosis 2 as well as ionizing radiation. In general, the 5-year survival for a WHO grade I meningioma exceeds 80%; however, survival is greatly reduced in anaplastic meningiomas. The standard of care for meningiomas in a surgically-accessible location is gross total resection. Radiation therapy is generally saved for atypical, anaplastic, recurrent, and surgically inaccessible benign meningiomas with a total dose of ~60 Gy. However, the method of radiation, regimen and timing is still evolving and is an area of active research with ongoing clinical trials. While there are currently no good adjuvant chemotherapeutic agents available, recent advances in the genomic and epigenomic landscape of meningiomas are being explored for potential targeted therapy.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
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Tokarev A, Rak V, Stepanov V, Zuev S, Evdokimova O, Viktorova O, Rozhnova E. Fractionated Radiosurgical Treatment of Intracerebral Schwannoma: A Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2020; 82:90-94. [PMID: 33086422 DOI: 10.1055/s-0040-1712464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intracranial schwannomas (ICS) unrelated to the cranial nerves are extremely rare; around 70 cases have been reported worldwide. The available literature consists of case reports and small series that present variable characteristics distinguishing these lesions. Brain parenchyma schwannomas are typically benign tumors with currently unknown origins. Diagnosis of intraparenchymal schwannoma is almost never made preoperatively. The management of these tumors usually consists of gross total resection, chemotherapy, and radiotherapy in cases of recurrence. The authors present a case of fractionated Gamma Knife radiosurgical treatment of intracerebral schwannoma following partial microsurgical resection.
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Affiliation(s)
- Alexey Tokarev
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Viacheslav Rak
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Valentin Stepanov
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Sergey Zuev
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Olga Evdokimova
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Olga Viktorova
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
| | - Elizabeth Rozhnova
- Radiosurgery Center, Sklifosovsky Research Institute of Emergency Care, Москва, Russian Federation
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Optimal management in optic nerve sheath meningioma – A multicentre study and pooled data analysis. J Clin Neurosci 2020; 80:162-168. [DOI: 10.1016/j.jocn.2020.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/27/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
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Starkweather CK, Choi BD, Alvarez-Breckenridge C, Brastianos PK, Oh K, Wang N, Shih H, Nahed BV. Initial Approach to the Patient with Multiple Newly Diagnosed Brain Metastases. Neurosurg Clin N Am 2020; 31:505-513. [PMID: 32921347 DOI: 10.1016/j.nec.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Brain metastases are the most common intracranial tumor in adults, with increasing incidence owing to prolonged survival times. Roughly half of patients diagnosed with new brain metastases have greater than 1 brain metastasis at the time of diagnosis, raising the question of how to optimize patient care with multiple brain metastases. The authors review studies relevant to the care of patients with brain metastasis, with emphasis on those relevant to the care of patients with multiple brain metastases. They discuss evolving strategies involving multiple modalities and the benefit of surgical management in patients with a large symptomatic brain metastasis.
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Affiliation(s)
- Clara Kwon Starkweather
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Bryan D Choi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | | | | | - Kevin Oh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Helen Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L. Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience. Neurosurg Focus 2020; 46:E8. [PMID: 31153152 DOI: 10.3171/2019.3.focus1963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife radiosurgery (GKRS) has been successfully used for the treatment of intracranial meningiomas given its steep dose gradients and high-dose conformality. However, treatment of skull base meningiomas (SBMs) may pose significant risk to adjacent radiation-sensitive structures such as the cranial nerves. Fractionated GKRS (fGKRS) may decrease this risk, but until recently it has not been practical with traditional pin-based systems. This study reports the authors' experience in treating SBMs with fGKRS, using a relocatable, noninvasive immobilization system.METHODSThe authors performed a retrospective review of all patients who underwent fGKRS for SBMs between 2013 and 2018 delivered using the Extend relocatable frame system or the Icon system. Patient demographics, pre- and post-GKRS tumor characteristics, perilesional edema, prior treatment details, and clinical symptoms were evaluated. Volumetric analysis of pre-GKRS, post-GKRS, and subsequent follow-up visits was performed.RESULTSTwenty-five patients met inclusion criteria. Nineteen patients were treated with the Icon system, and 6 patients were treated with the Extend system. The mean pre-fGKRS tumor volume was 7.62 cm3 (range 4.57-13.07 cm3). The median margin dose was 25 Gy delivered in 4 (8%) or 5 (92%) fractions. The median follow-up time was 12.4 months (range 4.7-17.4 months). Two patients (9%) experienced new-onset cranial neuropathy at the first follow-up. The mean postoperative tumor volume reduction was 15.9% with 6 patients (27%) experiencing improvement of cranial neuropathy at the first follow-up. Median first follow-up scans were obtained at 3.4 months (range 2.8-4.3 months). Three patients (12%) developed asymptomatic, mild perilesional edema by the first follow-up, which remained stable subsequently.CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs.
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Affiliation(s)
- Krishna C Joshi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | | | - Baha'eddin Muhsen
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Jason Hsieh
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Hamid Borghei-Razavi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Samuel T Chao
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gene H Barnett
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - John H Suh
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gennady Neyman
- 3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and.,4Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Varun R Kshettry
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Pablo F Recinos
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
| | - Lilyana Angelov
- 1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.,3Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute; and
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49
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Zhao L, Zhao W, Hou Y, Wen C, Wang J, Wu P, Guo Z. An Overview of Managements in Meningiomas. Front Oncol 2020; 10:1523. [PMID: 32974188 PMCID: PMC7473392 DOI: 10.3389/fonc.2020.01523] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
Meningioma is the most frequent primary tumor of the central nervous system. Important advances have been achieved in the treatment of meningioma in recent decades. Although most meningiomas are benign and have a good prognosis after surgery, clinicians often face challenges when the morphology of the tumor is complicated or the tumor is close to vital brain structures. At present, the longstanding treatment strategies of meningioma are mainly surgery and radiotherapy. The effectiveness of systemic therapy, such as chemotherapy or targeted therapy, has not been confirmed by big data series, and some clinical trials are still in progress. In this review, we summarize current treatment strategies and future research directions for meningiomas.
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Affiliation(s)
- Lianhua Zhao
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, China
| | - Wei Zhao
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, China
| | - Yanwei Hou
- Department of Neurosurgery, Tianjin TEDA Hospital, Tianjin, China
| | - Cuixia Wen
- Department of Radiotherapy, Xuzhou Central Hospital, Xuzhou, China
| | - Jing Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Pei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zaiyu Guo
- Department of Neurosurgery, Tianjin TEDA Hospital, Tianjin, China
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50
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Lee D, Riestenberg RA, Haskell-Mendoza A, Bloch O. Brain Metastasis Recurrence Versus Radiation Necrosis: Evaluation and Treatment. Neurosurg Clin N Am 2020; 31:575-587. [PMID: 32921353 DOI: 10.1016/j.nec.2020.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to determine appropriate treatment. Stereotactic biopsy remains the gold standard for identifying RN. Initial treatment of RN often involves management of edema using corticosteroids, antiangiogenic therapies, and hyperbaric oxygen therapy. For refractory symptoms, surgical resection can be considered. Minimally invasive stereotactic laser ablation has the benefit of providing tissue diagnosis and treating RN or recurrent tumor with similar efficacy. Laser ablation should be considered for lesions in need of intervention where the diagnosis requires tissue confirmation.
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Affiliation(s)
- Dennis Lee
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Robert A Riestenberg
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Aden Haskell-Mendoza
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis School of Medicine, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
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