A prospective phase II trial on reirradiation of brain metastases with radiosurgery

Maranzano, Ernesto; Terenzi, Sara; Anselmo, Paola; Casale, M.; Arcidiacono, Fabio; Loreti, Fabio; Marzo, A. Di; Draghini, Lorena; Italiani, M.; Trippa, Fabio

doi:10.1016/j.ctro.2019.04.003

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Thirty five full-text papers were initially included after checking for duplicates and pertinence. Among them, 22 were excluded due to a lack of prior SRS/SRT to the target metastasis (previous WBRT only or mixed interventions) or insufficient data reporting [ 21 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. A total of 13 studies met the inclusion criteria and were analyzed in the final meta-analysis [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review

Lucia

Touati

Crainic

et al. 2021

Cancers

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Recent advances in cancer treatments have increased overall survival and consequently, local failures (LFs) after stereotactic radiotherapy/radiosurgery (SRS/SRT) have become more frequent. LF following SRS or SRT may be treated with a second course of SRS (SRS2) or SRT (SRT2). However, there is no consensus on whenever to consider reirradiation. A literature search was conducted according to PRISMA guidelines. Analysis included 13 studies: 329 patients (388 metastases) with a SRS2 and 135 patients (161 metastases) with a SRT2. The 1-year local control rate ranged from 46.5% to 88.3%. Factors leading to poorer LC were histology (melanoma) and lack of prior whole-brain radiation therapy, large tumor size and lower dose at SRS2/SRT2, poorer response at first SRS/SRT, poorer performance status, and no controlled extracranial disease. The rate of radionecrosis (RN) ranged from 2% to 36%. Patients who had a large tumor volume, higher dose and higher value of prescription isodose line at SRS2/SRT2, and large overlap between brain volume irradiated at SRS1/SRT1 and SRS2/SRT2 at doses of 18 and 12 Gy had a higher risk of developing RN. Prospective studies involving a larger number of patients are still needed to determine the best management of patients with local recurrence of brain metastases

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review

Lucia

Touati

Crainic

et al. 2021

Cancers

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“…Thirty-two full-text papers were initially included out of 1136 potential references after check for duplicate or pertinence. Among them, 21 were excluded due to lack of prior SRS to the target metastasis (previous WBRT only, or first stereotactic irradiation of the target lesion after prior SRS to another intracranial site, or mixed interventions) or insufficient data reporting (Guan et al (2019); Maranzano et al, 2019;Kim et al, 2018;Koiso et al, 2016;Huang et al, 2017;Shen et al, 2016;Bates et al, 2016;Yomo and Hayashi, 2016;Shultz et al, 2015;Monaco et al, 2014;Kurtz et al, 2014;Kim et al, 2013;Maranzano et al, 2012;Kwon et al, 2007a;Shuto et al, 2004;Hillard et al, 2003;Wowra et al, 2002;Bhatnagar et al, 2002;Noël et al, 2001;Davey et al, 1994;Kwon et al, 2007b). Hence, eleven studies were considered eligible for data extraction and included in the final meta-analysis (Iorio-Morin et al, 2019;Dincoglan et al, 2019;Moreau et al, 2018;Balermpas et al, 2018;Rana et al, 2017;McKay et al, 2017;Minniti et al, 2016;Greto et al, 2014;Terakedis et al, 2014;Holt et al, 2015;Koffer et al, 2020), accounting for 335 patients and 389 treated metastases.…”

Section: Resultsmentioning

confidence: 99%

Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis

Loi

Caini

Scoccianti

et al. 2020

Critical Reviews in Oncology/Hematology

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Introduction: Local failure (LF) following stereotactic radiosurgery (SRS) of brain metastases (BM) may be treated with a second course of SRS (SRS2), though this procedure may increase the risk of symptomatic radionecrosis (RN). Methods: A literature search was conducted according to PRISMA to identify studies reporting LF, overall survival (OS) and RN rates following SRS2. Meta-analysis was performed to identify predictors of RN. Results: Analysis included 11 studies (335 patients,389 metastases). Pooled 1-year LF was 24 %(CI95 % 19-30 %): heterogeneity was acceptable (I2 = 21.4 %). Median pooled OS was 14 months (Confidence Interval 95 %, CI95 % 8.8-22.0 months). Cumulative crude RN rate was 13 % (95 %CI 8 %-19 %), with acceptable heterogeneity (I2 = 40.3 %). Subgroup analysis showed higher RN incidence in studies with median patient age ≥59 years (13 % [95 %CI 8 %-19 %] vs 7 %[95 %CI 3 %-12 %], p = 0.004) and lower incidence following prior Whole Brain Radiotherapy (WBRT, 19 %[95 %CI 13 %-25 %] vs 7%[95 %CI 3 %-13 %], p = 0.004). Conclusions: SRS2 is an effective strategy for in-site recurrence of BM previously treated with SRS.

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“…Specific data on local and distant control rates after salvage WBRT are scarce, which can be possibly explained by the short survival of these patients [ 114 ]. More recently, a small number of trials were published, reporting on the use of SRS for re-irradiation of BMs after previous WBRT [ 115 , 116 , 117 ]. There are data on local control rates as high as 90% when using SRS for relapses after WBRT or repeated in-field SRS [ 118 ].…”

Section: The Challenge Of Recurrence Radioresistance and Radionecrosismentioning

confidence: 99%

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

Jablonska

Bosch-Barrera

Serrano

et al. 2021

Cancers

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Approximately 20% patients with non-small cell lung cancer (NSCLC) present with CNS spread at the time of diagnosis and 25–50% are found to have brain metastases (BMs) during the course of the disease. The improvement in the diagnostic tools and screening, as well as the use of new systemic therapies have contributed to a more precise diagnosis and prolonged survival of lung cancer patients with more time for BMs development. In the past, most of the systemic therapies failed intracranially because of the inability to effectively cross the blood brain barrier. Some of the new targeted therapies, especially the group of tyrosine kinase inhibitors (TKIs) have shown durable CNS response. However, the use of ionizing radiation remains vital in the management of metastatic brain disease. Although a decrease in CNS-related deaths has been achieved over the past decade, many challenges arise from the need of multiple and repeated brain radiation treatments, which carry along not insignificant risks and toxicity. The combination of stereotactic radiotherapy and systemic treatments in terms of effectiveness and adverse effects, such as radionecrosis, remains a subject of ongoing investigation. This review discusses the challenges of the use of radiation therapy in NSCLC BMs in view of different systemic treatments such as chemotherapy, TKIs and immunotherapy. It also outlines the future perspectives and strategies for personalized BMs management.

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A prospective phase II trial on reirradiation of brain metastases with radiosurgery

Cited by 8 publications

References 26 publications

Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review

Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review

Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

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