Accelerator-Based Stereotactic Radiosurgery for Brainstem Metastases

Lin, Chun–Shu; Selch, Michael T.; Lee, Steve P.; Wu, Jang‐Yen; Xiao, Furen; Hong, David S.; Chen, Chien‐Hua; Hussain, Aamir; Lee, Percy P.; Salles, Antonio Af De

doi:10.1227/neu.0b013e31823c40fe

Cited by 32 publications

(22 citation statements)

References 25 publications

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“…(Table 4) and our overall survival was comparable to other studies. Relative to other studies that reported WBRT doses up to 45 Gy combined with SRS to the brainstem, the WBRT doses employed in our study were lower and hypofractionated [11, 12, 17–19, 22, 23], but outcomes were similar to published series. The impact of WBRT dose on local control and toxicity when used in conjunction with brainstem SRS has not been investigated or reported previously.…”

Section: Discussionsupporting

confidence: 65%

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

et al. 2016

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ObjectiveThe objective of this study was to investigate outcomes for patients with brainstem metastases treated with stereotactic radiosurgery (SRS).MethodsPatients with brainstem metastases treated with SRS between April 2006 and June 2012 were identified from a prospective database. Patient and treatment-related factors were recorded. Kaplan-Meier analysis was used to calculate survival and freedom from local and distant brain progression. Univariate and multivariate Cox regression was used to identify factors important for overall survival.ResultsIn total, 44 patients received SRS for 48 brainstem metastases of whom 33 (75 %) also received whole brain radiotherapy (WBRT): 23 patients (52 %) WBRT prior to SRS, 6 (13.6 %) WBRT concurrently with SRS and 4 (9.0 %) WBRT after SRS. Eight patients received a second course of WBRT at further progression. Median target volume was 1.33 cc (range 0.04–12.17) and median prescribed marginal dose was 15 Gy (range 10–22). There were four cases of local failure, and 6-month and 1-year freedom from local failure was 84.6 and 76.9 %, respectively. Median overall survival (OS) was 5.4 months. There were four cases of radionecrosis, 2 (4.8 %) of which were symptomatic. The absence of external beam brain radiotherapy (predominantly WBRT) showed a trend towards improved OS on univariate analysis. Neither local nor distant brain failure significantly impacted OS.ConclusionThis retrospective series of patients treated with SRS for brainstem metastases, largely in combination with at least one course of WBRT, demonstrates that this approach is safe and results in good local control. In this cohort, no variables significantly impacted OS, including intracranial control.Electronic supplementary materialThe online version of this article (doi:10.1007/s13566-016-0281-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 65%

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

et al. 2016

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“…As a result, a dose threshold, volume threshold, or other prognostic factor that can estimate radiation-related toxicity was not developed. Although the existing studies demonstrated statistically significant results and recommendations regarding brainstem SRS, other reports have failed to demonstrate a dose-response relationship (11-18, 27-30). …”

Section: Discussionmentioning

confidence: 91%

“…The literature notes conflicting recommendations regarding the optimum margin dose to maximize the therapeutic ratio (17, 18, 20, 21). Although some small series demonstrated improve local control with the use of doses of at least 15 to 20 Gy (20-22), other series recommend tumor margin doses as low as 12 Gy(18, 26). Additionally, the radiosurgical technology used may affect the rate of fall-off of radiation beyond the tumor margin and impact toxicity rate.…”

Section: Discussionmentioning

confidence: 99%

“…This realization has led some to use lower doses that are potentially ineffective for tumor control. Some reports of severe toxicity after brainstem SRS margin doses >16 Gy have led some authors to recommend avoiding doses this high(18, 26). Because of the small sample sizes, there was limited statistical power to associate SRS brainstem toxicity with tumor volume, location, margin dose, or previous WBRT.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies had limited ability to draw conclusions because of their small sample size and heterogeneity across patients. Moreover, some reports have established conflicting recommendations regarding several prognostic factors, including optimum SRS margin dose(17, 18, 20-22). …”

Section: Introductionmentioning

confidence: 99%

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Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity

Trifiletti

Lee

Kano

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). Methods and Materials Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. Results Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. Conclusions Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.

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Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

Chen

Baal

et al. 2021

JAMA Oncol

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IMPORTANCEOwing to the proximity to critical neurologic structures, treatment options for brainstem metastases (BSM) are limited, and BSM growth can cause acute morbidity or death. Stereotactic radiosurgery (SRS) is the only local therapy for BSM, but efficacy and safety of this approach are incompletely understood because patients with BSM are excluded from most clinical trials.OBJECTIVE To perform a systematic review and comparative meta-analysis of SRS studies for BSM in the context of prospective trials of SRS or molecular therapy for nonbrainstem brain metastases (BM).

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Accelerator-Based Stereotactic Radiosurgery for Brainstem Metastases

Cited by 32 publications

References 25 publications

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity

Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

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