Analysis of tumor control and toxicity in patients who have survived at least one year after radiosurgery for brain metastases

Varlotto, John M.; Flickinger, John C.; Niranjan, Ajay; Bhatnagar, Ajay; Kondziolka, Douglas; Lunsford, L.D.

doi:10.1016/s0360-3016(03)00568-6

Cited by 141 publications

(81 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20,21 The incidence of RN is directly related to total radiation dose, volume, and fraction size. [22][23][24][25][26][27][28][29][30][31][32] RTOG 90-05 established that for patients who had previously received irradiation for primary brain tumors or brain metastases, maximum tolerated dose of single-fraction SRS was 24 Gy, 18 Gy, and 15 Gy for tumors 20 mm, 21 to 30 mm, and 31 to 40 mm in maximum diameter, respectively, with larger tumor diameter predictive of greater central nervous system (CNS) toxicity. 12 Incidence of RN in RTOG 90-05 was 5% at 6 months after SRS, and increased incrementally with time thereafter, up to 11% at 24 months.…”

Section: Discussionmentioning

confidence: 99%

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose: Many patients treated with stereotactic radiosurgery (SRS) alone as initial treatment require 1 or more subsequent salvage therapies. This study aimed to determine if commonly used salvage strategies are associated with differing risks of radiation necrosis (RN). Methods and materials: All patients treated with upfront SRS alone for brain metastases at our institution were retrospectively analyzed. Salvage treatment details were obtained for brain failures. Patients who underwent repeat SRS to the same lesion were excluded. RN was determined based on pathological confirmation or advanced brain imaging consistent with RN in a symptomatic patient. Patients were grouped according to salvage treatment and rates of RN were compared via Fisher's exact tests. Results: Of 284 patients treated with upfront SRS alone, 132 received salvage therapy and 44 received multiple salvage treatments. This included 31 repeat SRS alone, 58 whole brain radiation therapy (WBRT) alone, 28 SRS and WBRT, 7 surgery alone, and 8 surgery with adjuvant radiation. With a median follow-up of 10 months, the rate of RN among all patients was 3.17% (9/284), salvaged patients 4.55% (6/132), and never salvaged patients 1.97% (3/152). Receiving salvage therapy did not significantly increase RN risk (P Z .31). Of the patients requiring salvage treatments, the highest RN rate was among patients that had both salvage SRS and WBRT (delivered as separate salvage therapies) (6/28, 21.42%). RN rate in this group was significantly higher than in those treated with repeat SRS alone (0/31), WBRT alone (0/58), surgery alone (0/7), and surgery with adjuvant radiation (0/8). Comparing salvage WBRT doses <30 Gy versus 30 Gy revealed no effect of dose on RN rate. Additionally, among patients who received multiple SRS treatments, number of treated lesions was not predictive of RN incidence. Conclusion: Our results suggest that initial management approach for recurrent brain metastasis after upfront SRS does not affect the rate of RN. However, the risk of RN significantly increases when patients are treated with both repeat SRS and salvage WBRT. Methods to improve prediction of toxicity and optimize patient selection for salvage treatments are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…8 For framed SRS, 1-year local progression-free survival (PFS) was reported to be up to 70% to 90%, and median overall survival (OS) of 6 to 12 months. [9][10][11][12][13][14][15] The outcomes of frameless SRS have been reported only in limited series, with 1-year local control of 79% to 95%. 5,[16][17][18] Patient selection and tailor-made management are indeed challenging.…”

Section: New Knowledge Added By This Studymentioning

confidence: 99%

Frameless stereotactic radiosurgery for brain metastases: a review of outcomes and prognostic scores evaluation

et al. 2017

View full text Add to dashboard Cite

Introduction: Stereotactic brain radiosurgery provides good local control in patients with limited brain metastases. A newly developed frameless system allows pain-free treatment. We reviewed the effectiveness of this frameless stereotactic brain radiosurgery and identified prognostic factors that may aid better patient selection. Methods:Medical records of patients with brain metastases treated with linear accelerator-based frameless stereotactic brain radiosurgery between January 2010 and July 2015 in a university affiliated hospital in Hong Kong were reviewed. Outcomes including local and distant brain control rate, progression-free survival, and overall survival were analysed. Prognostic factors were identified by univariable and multivariable analyses. Association of outcomes with four common prognostic scores was performed.Results: In this study, 64 patients with 94 lesions were treated with a median dose of 18 Gy (range, 12-22 Gy) in a single fraction. The median follow-up was 11.5 months. One-year actuarial local and distant brain control rates were 72% and 71%, respectively. The median overall survival was 13.0 months. On multivariable analysis, Karnofsky performance status score (>50 vs ≤50) and number of lesions (1-2 vs ≥3) were found to associate significantly with distinct brain progression-free survival (P=0.022, hazard ratio=0.20, 95% confidence interval 0.05-0.80 and P=0.003, hazard ratio=0.31, 95% confidence interval 0.14-0.68, respectively). Overall survival was

show abstract

“…However, doses have varied from 16 to 24 Gy depending on lesional size and location. One of the additional advantages of SRS over WBRT is the relative uniformity of response of different histopathological tumors to the same SRS treatment dose (Kim, 2011;Powell, 2008, Varlotto, 2003Wegner, 2011).…”

Section: Stereotactic Radiosurgery and The Gamma Knifementioning

confidence: 99%

Outcomes Following Gamma Knife for Metastases

Park¹,

Yu²,

Knisely³

et al. 2011

Gamma Knife Radiosurgery

View full text Add to dashboard Cite

Analysis of tumor control and toxicity in patients who have survived at least one year after radiosurgery for brain metastases

Cited by 141 publications

References 39 publications

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Frameless stereotactic radiosurgery for brain metastases: a review of outcomes and prognostic scores evaluation

Outcomes Following Gamma Knife for Metastases

Contact Info

Product

Resources

About