Disparities in the Use of Single-fraction Stereotactic Radiosurgery for the Treatment of Brain Metastases From Non-small Cell Lung Cancer

Modh, Ankit; Doshi, Abhishek; Burmeister, Charlotte; Elshaikh, Mohamed A.; Lee, Ian; Shah, Mira

doi:10.7759/cureus.4031

Cited by 13 publications

(15 citation statements)

References 20 publications

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“…[1][2][3] As the incidence of brain metastases steadily increases due to increased utilization of magnetic resonance imaging and improvements in systemic therapy, both the need for and utilization of SRS have increased accordingly. [4][5][6] Historically, SRS has been delivered in a single fraction, with dosing typically as per The Radiation Therapy Oncology Group 90-11 study. 7 Brain radiation necrosis (RN) is an important late complication of SRS that may lead to irreversible neurologic symptoms in some patients.…”

Section: Introductionmentioning

confidence: 99%

Intracranial Stereotactic Radiation Therapy With a Jawless Ring Gantry Linear Accelerator Equipped With New Dual Layer Multileaf Collimator

Knutson

Kennedy

Reynoso

et al. 2020

Advances in Radiation Oncology

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To test the feasibility of a simplified, robust, workflow for intracranial stereotactic radiation therapy (SRT) using a ring gantry linear accelerator (RGLA) equipped with a dual-layer stacked, staggered, and interdigitating multileaf collimator. Materials and Methods: Twenty recent clinical SRT cases treated using a radiosurgery c-arm linear accelerator were anonymized. From these data sets, a new planning workflow was developed and used to replan these cases, which then were compared to their clinical counterparts. Population-based dose-volume histograms were analyzed for target coverage and sparing of healthy brain. All plans underwent plan review and quality assurance and were delivered on an end-to-end verification phantom using image guidance to simulate treatment. Results: The RGLA plans were able to meet departmental standards for target coverage and organ-at-risk sparing and showed plan quality similar to the clinical plans. RGLA plans showed increases in the 50% isodose in the axial plane but decreases in the sagittal and coronal planes. There were no statistically significant differences in the homogeneity index or number of monitor units between the 2 systems. There were statistically significant increases in conformity and gradient indices, with median values of 1.09 versus 1.11 and 2.82 versus 3.13, respectively, for the c-arm versus RGLA plans. These differences were not believed to be clinically significant because they met clinical goals. The population-based dose-volume histograms showed target coverage and organ-at-risk sparing similar to that of the clinical plans. All plans were able to meet the departmental quality assurance requirements and were delivered under image guidance on an end-to-end phantom with measurements agreeing within 3% of the expected value. RGLA plans showed a median reduction in delivery time of z50%.

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Section: Introductionmentioning

confidence: 99%

Intracranial Stereotactic Radiation Therapy With a Jawless Ring Gantry Linear Accelerator Equipped With New Dual Layer Multileaf Collimator

Knutson

Kennedy

Reynoso

et al. 2020

Advances in Radiation Oncology

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“…With the development of targeted therapy, immunotherapy, and radiation therapy, the survival time of lung cancer patients continues to lengthen, but the treatment of brain metastases is still difficult in lung cancer treatment . For brain metastases from lung cancer, radiation therapy is an important therapeutic approach . Stereotactic radiosurgery for the treatment of brain metastases can lead to higher local control rates and lower radiation doses to surrounding normal brain tissue, which plays an important role in the treatment of brain metastases.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery combined with anlotinib for limited brain metastases with perilesional edema in non‐small cell lung cancer: Rvision‐001 study protocol

Wang

Guan

et al. 2020

Thoracic Cancer

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Introduction: About 50% of patients with non-small cell lung cancers (NSCLC) are diagnosed with brain metastases during treatment, and stereotactic radiosurgery (SRS) is an important treatment for brain oligometastasis. Some patients with brain metastases have cerebral edema before treatment, and radiation therapy may also cause, or aggravate brain edema. Vascular endothelial growth factor (VEGF) promotes angiogenesis and increase vascular permeability, and previous studies have shown that anti-VEGF treatment can reduce brain edema. We hypothesized that anlotinib hydrochloride can reduce perilesional edema around brain metastases, create conditions for subsequent SRS, increase local control rate and improve patient prognosis. Methods: From one week before stereotactic radiosurgery, patients begin to receive anlotinib once a day (12 mg) from day 1-14 of a 21 day cycle, with two cycles in total. Brain magnetic resonance imaging (MRI) scan is taken before treatment, one week and one month after medication. A total of 50 patients will be included in this study. The primary endpoint is the Edema Index, and the secondary endpoints are intracranial objective response rate (iORR), intracranial progression-free survival (iPFS), objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), safety, and the rate of SRS after anlotinib treatment. Discussion: This study is a multicenter, prospective, single-arm, phase II clinical study, and explores the efficacy and tolerability of SRS with anlotinib in NSCLC patients with limited brain metastases. The aim of the study is to provide new treatment options for NSCLC patients with brain metastases.

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“…A study of glioblastoma patients who received chemoradiation therapy after surgical resection or biopsy reported improved OS for patients treated at academic facility compared to patients treated at community hospitals (HR: 0.86, CI: 0.82-0.91) 27 . Receiving treatment at an academic hospital was associated with improved OS in a study of patients age ≥ 70 diagnosed with glioblastoma (HR: 0.76, CI: 0.66-0.86) compared to receiving treatment at non-academic facilities 26 for patients diagnosed with BMs from NSCLC 23 . In our study, academic centers were more likely to use chemotherapy (56% vs. 53%) and RT (74% vs. 71%) compared to non-academic centers.…”

Section: Discussionmentioning

confidence: 99%

“…Studies of various malignancies have indicated that the choice of treatments and survival outcomes varies by academic vs. non-academic hospitals. A study found that academic centers used stereotactic radiosurgery (SRS) more frequently (22% versus 13%, p < .001) compared to community facilities for brain metastasis from NSCLC 23 . A meta-analysis of head and neck cancer patients who received surgical resection of the tumor examined survival outcomes between patients treated at high volume vs. low volume centers and demonstrated better overall survival among patients treated by high-volume hospitals than among patients treated by low-volume hospitals 24 .…”

Section: Introductionmentioning

confidence: 99%

The Association of Treatment Facility Type With the Survival of Brain Metastases Patients Regardless of the Primary Site Cancer

Amin

Baine

Meza

et al. 2020

Preprint

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Background. Cancer patients with brain metastases (BMs) require multidisciplinary care, and treatment facility may play a role. This study aimed to investigate the impact of receiving treatment at academic centers on the overall survival (OS) of cancer patients with brain metastases (BMs) regardless of the primary cancer site.Methods. This retrospective analysis of the National Cancer Database (NCDB) included patients diagnosed with non-small cell lung cancer, small-cell lung cancer, other types of lung cancer, breast cancer, melanoma, colorectal cancer, and renal cancer and had brain metastases at the time of diagnosis. The data were extracted from the de-identified file of the NCDB, a joint program of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The Cox proportional hazard model adjusted for age of diagnosis, race, sex, place of living, income, education, primary tumor type, year of diagnosis, chemotherapy, radiation therapy (RT), and surgery of the primary cancer site was used to determine treatment facility-associated hazard ratios (HR) for survival. Overall survival was the primary outcome which was analyzed with multivariable Cox proportional hazards regression modeling. Results. A total of 93,633 patients were analyzed, among whom 31,579/93,633 (34.09%) were treated at academic centers. Based on the log-rank analysis, patients who received treatment at an academic facility had significantly improved median OS (6.18, CI: 6.05-6.31 vs. 4.57, CI: 4.50-4.63; p <0.001) months compared to patients who were treated at non-academic facilities. In the multivariable Cox regression analysis, receiving treatment at an academic facility was associated with significantly improved OS (HR: 0.85, CI: 0.84-0.87; p <0.001) compared to the non-academic facility. Conclusions. In this extensive analysis of the NCDB, receiving treatment at academic centers was associated with significantly improved OS compared to treatment at non-academic centers.

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Disparities in the Use of Single-fraction Stereotactic Radiosurgery for the Treatment of Brain Metastases From Non-small Cell Lung Cancer

Cited by 13 publications

References 20 publications

Intracranial Stereotactic Radiation Therapy With a Jawless Ring Gantry Linear Accelerator Equipped With New Dual Layer Multileaf Collimator

Intracranial Stereotactic Radiation Therapy With a Jawless Ring Gantry Linear Accelerator Equipped With New Dual Layer Multileaf Collimator

Stereotactic radiosurgery combined with anlotinib for limited brain metastases with perilesional edema in non‐small cell lung cancer: Rvision‐001 study protocol

The Association of Treatment Facility Type With the Survival of Brain Metastases Patients Regardless of the Primary Site Cancer

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