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Ono T, Nemoto K. Re-Whole Brain Radiotherapy May Be One of the Treatment Choices for Symptomatic Brain Metastases Patients. Cancers (Basel) 2022; 14:cancers14215293. [PMID: 36358712 PMCID: PMC9657612 DOI: 10.3390/cancers14215293] [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: 09/07/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023] Open
Abstract
Generally, patients with multiple brain metastases receive whole brain radiotherapy (WBRT). Although, more than 60% of patients show complete or partial responses, many experience recurrence. Therefore, some institutions consider re-WBRT administration; however, there is insufficient information regarding this. Therefore, we aimed to review re-WBRT administration among these patients. Although most patients did not live longer than 12 months, symptomatic improvement was sometimes observed, with tolerable acute toxicities. Therefore, re-WBRT may be a treatment option for patients with symptomatic recurrence of brain metastases. However, physicians should consider this treatment cautiously because there is insufficient data on late toxicity, including radiation necrosis, owing to poor prognosis. A better prognostic factor for survival following radiotherapy administration may be the time interval of > 9 months between the first WBRT and re-WBRT, but there is no evidence supporting that higher doses lead to prolonged survival, symptom improvement, and tumor control. Therefore, 20 Gy in 10 fractions or 18 Gy in five fractions may be a reasonable treatment method within the tolerable total biological effective dose 2 ≤ 150 Gy, considering the biologically effective dose for tumors and normal tissues.
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Affiliation(s)
- Takashi Ono
- Correspondence: ; Tel.: +81-23-628-5386; Fax: +81-23-628-5389
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Soni YS, Rich BJ, Kwon D, Zhao W, John DL, Seldon C, Meshman J, Benveniste R, Komotar RJ, de la Fuente M, Guillermo Prieto MDP, Azzam G, Mellon EA, Benjamin CG, Diwanji T. Factors associated with the use of salvage whole brain radiation therapy versus salvage stereotactic radiosurgery after initial stereotactic radiosurgery for brain metastases. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:85-94. [PMID: 36275132 PMCID: PMC9489072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/29/2022] [Indexed: 01/03/2023]
Abstract
Objectives Patients undergoing stereotactic radiosurgery (SRS) for brain metastases require additional radiation for relapse. Our objective is to determine the factors associated with salvage SRS versus whole brain radiation therapy (WBRT) for salvage of first intracranial failure (ICF) after upfront SRS. Method We identified a cohort of 110 patients with brain metastases treated with SRS in the definitive or postoperative setting followed by subsequent salvage WBRT or SRS at least one month after initial SRS. Clinical and demographic characteristics were retrospectively recorded. Results 78 Patients received SRS and 32 patients received WBRT at the time of first ICF. On multivariate analysis (MVA) factors associated with decreased use of salvage SRS were male gender (p=0.044) and local progression (p<0.001). Conclusions Local progression and male gender were the strongest factors associated with selection of salvage WBRT. Possible etiologies of this difference could be provider or patient driven, but warrant further exploration.
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Affiliation(s)
- Yash S. Soni
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Benjamin J. Rich
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deukwoo Kwon
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Wei Zhao
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny L. John
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Meshman
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo J. Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Macarena de la Fuente
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Gregory Azzam
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric A. Mellon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carolina G. Benjamin
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA, Department of Radiation Oncology, Mid-Atlantic Permanente Medical Group, Halethorpe, MD, USA
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Li M, Song Y, Li L, Qin J, Deng H, Zhang T. Reirradiation of Whole Brain for Recurrent Brain Metastases: A Case Report of Lung Cancer With 12-Year Survival. Front Oncol 2021; 11:780581. [PMID: 34900735 PMCID: PMC8660684 DOI: 10.3389/fonc.2021.780581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
Whole brain radiotherapy (WBRT) for brain metastases (BMs) was considered to be dose limited. Reirradiation of WBRT for recurrent BM has always been challenged. Here, we report a patient with multiple BMs of non-small-cell lung cancer (NSCLC), who received two courses of WBRT at the interval of 5 years with the cumulative administration dose for whole brain as 70 Gy and a boost for the local site as 30 Gy. Furthermore, after experiencing relapse in the brain, he underwent extra gamma knife (GK) radiotherapy for local brain metastasis for the third time after 5 years. The overall survival was 12 years since he was initially diagnosed with NSCLC with multiple brain metastases. Meanwhile, each time of radiotherapy brought a good tumor response to brain metastasis. Outstandingly, during the whole survival, he had a good quality of life (QoL) with Karnofsky Performance Score (KPS) above 80. Even after the last GK was executed, he had just a mild neurocognitive defect. In conclusion, with the cautious evaluation of a patient, we suggest that reirradiation of WBRT could be a choice, and the cumulative radiation dose of the brain may be individually modified.
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Affiliation(s)
- Minmin Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanbo Song
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longhao Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Qin
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongbin Deng
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Maranzano E, Terenzi S, Anselmo P, Casale M, Arcidiacono F, Loreti F, Di Marzo A, Draghini L, Italiani M, Trippa F. A prospective phase II trial on reirradiation of brain metastases with radiosurgery. Clin Transl Radiat Oncol 2019; 17:1-6. [PMID: 31061900 PMCID: PMC6487370 DOI: 10.1016/j.ctro.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022] Open
Abstract
Reirradiation with radiosurgery of brain metastases is feasible and safe. Good KPS and controlled systemic disease are most important selection criteria. An accurate patient selection is essential to avoid brain toxicity. If diameter is ≤ 2 cm and dose ≤ 20 Gy local control is high without late toxicity.
Purpose In our previous published trial on radiosurgery (SRS) of recurrent brain metastases (BM) after whole brain radiotherapy (WBRT), Karnofsky performance status (KPS) and administered dose conditioned outcome and late toxicity, respectively. Brain radionecrosis was registered in 6% of patients. With the aim to obtain similar satisfactory outcomes and limit toxicity, we started a phase II trial in which reirradiation of BM with SRS were done using a tighter patient selection. Materials and methods Patients with BM recurring after WBRT were recruited for reirradiation with SRS. Only patients with good KPS (≥70), good neurologic functional score (NFS 0-1) and lesions with a diameter ≤20 mm were considered eligible for retreatment. Dose exceeding 20 Gy was never administered. Results The 59 patients reirradiated had 109 BM with a diameter range of 6–20 mm. Median interval between prior WBRT and SRS was 15 months and median SRS administered dose was 18 Gy (range 10–20 Gy). Complete and partial response (CR, PR) was obtained in 42% of patients with 2 years of control rate of 81%. Median overall survival (OS) after reirradiation was 14 months. No radionecrosis was detected. Conclusions Analysis of our current trial compared with results of our previous data suggests that a tighter patient selection (KPS ≥ 70; NFS 0-1, BM with ≤20 mm of diameter) and SRS dose ≤20 Gy allowed a high OS rate, a good percentage of CR and PR which last for >2 years, and no brain radionecrosis.
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Affiliation(s)
| | - Sara Terenzi
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Paola Anselmo
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | | | | | - Fabio Loreti
- Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy
| | | | - Lorena Draghini
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Marco Italiani
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
| | - Fabio Trippa
- Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy
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Suzuki R, Wei X, Allen PK, Welsh JW, Cox JD, Komaki R, Lin SH. Outcomes of re-irradiation for brain recurrence after prophylactic or therapeutic whole-brain irradiation for small cell lung Cancer: a retrospective analysis. Radiat Oncol 2018; 13:258. [PMID: 30594213 PMCID: PMC6310962 DOI: 10.1186/s13014-018-1205-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Small cell lung cancer (SCLC) can recur in the brain after whole-brain irradiation (WBI). We documented outcomes after treatment of such recurrences and sought predictors of local control and overall survival (OS). Materials and methods Eighty-five patients with SCLC and brain recurrence after prophylactic or therapeutic WBI in 1998–2015 were identified and data were extracted from the medical records. Survival was estimated with the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards modeling was used to identify factors associated with OS or further brain progression. Results Brain recurrence was treated by stereotactic radiosurgery (SRS) in 33 patients (39%), repeat WBI in 14 (16%), chemotherapy-only in 16 (19%), and observation in 22 (26%). Median OS time after brain recurrence (OSrec) was 4.3 months for all patients; 6-month OSrec rates were 58% after SRS, 21% after repeat WBI, 50% after chemotherapy-only, and 5% after observation (P < 0.001). Inferior OSrec was associated with poor performance status (ECOG score ≥ 3) and uncontrolled extracranial disease. Superior OSrec was associated with receipt of ≥4 chemotherapy cycles before brain recurrence and receipt of chemotherapy, SRS, or repeat WBI afterward. Receipt of chemotherapy after brain recurrence correlated with brain progression. Conclusions Some patients with brain recurrence after WBI for SCLC can survive for extended periods with appropriate intervention, especially those with adequate performance status or controlled extracranial disease.
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Affiliation(s)
- Ryoko Suzuki
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Xiong Wei
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Pamela K Allen
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - James W Welsh
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - James D Cox
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA
| | - Steven H Lin
- Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, USA. .,Present address: Department of Radiation Oncology, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyō, Tokyo, 113-8510, Japan.
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Logie N, Jimenez RB, Pulenzas N, Linden K, Ciafone D, Ghosh S, Xu Y, Lefresne S, Wong E, Son CH, Shih HA, Wong WW, Tyldesley S, Dennis K, Chow E, Fairchild AM. Estimating prognosis at the time of repeat whole brain radiation therapy for multiple brain metastases: The reirradiation score. Adv Radiat Oncol 2017; 2:381-390. [PMID: 29114606 PMCID: PMC5605302 DOI: 10.1016/j.adro.2017.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/07/2017] [Accepted: 05/31/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Whole brain radiation therapy (WBRT) remains the standard of care for patients with multiple brain metastases, but more than half of treated patients will develop intracranial progression. Because there is no clear consensus on the optimal therapeutic approach, a prognostic index would be helpful to guide treatment options at progression. We explored whether the recursive partitioning analysis (RPA) score prior to repeat WBRT is predictive of survival. METHODS AND MATERIALS This multi-institutional pooled analysis included patients with 2 or more brain metastases from any solid primary tumor that was treated with 2 courses of WBRT. Information on demographics, disease characteristics, and intervals between courses was collected. RPA class was abstracted or retrospectively assigned, and descriptive statistics calculated. Median survival (MS) was determined using the Kaplan-Meier method and compared using log rank tests. Univariate and multivariate analyses were performed via Cox regression analysis. RESULTS For 205 patients, the median age was 55 years (range, 25-83 years), 68% were female, 40.5% had non-small cell lung cancer, and 31.2% had small cell lung cancer. Prior to the second WBRT, 4.9% of patients were RPA class 1, 36.6% were RPA2, and 58.5% were RPA3, with an MS of 7.5 months (95% confidence interval [CI], 4.7-10.3), 5.2 months (95% CI, 3.7-6.7 months), and 2.9 months (95% CI, 2.2-2.9 months), respectively (P = .001). On univariate and multivariate analyses, a Karnofsky Performance Status of <80, extracranial metastases, interval between courses <9 months, small cell lung cancer histology, and uncontrolled primary significantly correlated with shorter MS. By assigning a score of 1 to each of these factors, a new prognostic index was created, the reirradiation (ReRT) score. Survival on the basis of ReRT score grouping ranged from 2.2 to 7.2 months and demonstrated significant differences in MS. CONCLUSIONS In the largest reported cohort to receive repeat WBRT, application of the RPA score was not predictive of MS. The new ReRT score is a simple tool based on readily available clinical information.
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Affiliation(s)
- Natalie Logie
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Rachel B. Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalie Pulenzas
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelly Linden
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Denise Ciafone
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Sunita Ghosh
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Yuhui Xu
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Shilo Lefresne
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Erin Wong
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christina H. Son
- Department of Radiation Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Helen A. Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Scott Tyldesley
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alysa M. Fairchild
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
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