Dose-Volume Response Relationship for Brain Metastases Treated with Frameless Single-Fraction Linear Accelerator-Based Stereotactic Radiosurgery

Amsbaugh, Mark J.; Pan, Jianmin; Dragun, Anthony E.; Guan, Timothy; Boling, Warren; Rai, Shesh; Woo, Shiao Y.

doi:10.7759/cureus.587

Cited by 16 publications

(26 citation statements)

References 27 publications

(41 reference statements)

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“…From a practical standpoint, these were lesions larger than 3 cm in maximal diameter. Similar considerations of lesion volume have been reported in the radiosurgery literature [11,12]. While we do not propose precluding larger lesions, it is important to counsel patients that the procedure may be associated with a longer operative time, longer hospital stay, and a higher risk for a surgical complication.…”

Section: Discussionmentioning

confidence: 92%

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases

Kamath

Friedman

Hacker

et al. 2017

Stereotact Funct Neurosurg

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mas, metastases, epilepsy foci, and radionecrosis. The rate of complications/unexpected readmission was 6.0%, and the mortality rate was 2.2%. With high-grade tumors, tumor volumes >3 cm in diameter trended toward a higher rate of complication (p = 0.056). Median progression-free survival (PFS) and overall survival (OS) for recurrent GBM were 7.4 and 11.6 months, respectively. As a frontline treatment for newly diagnosed GBM, median PFS and OS were 5.9 and 11.4 months, respectively. For metastases, median PFS was not yet reached, and OS was 17.2 months. Conclusion: Our series suggests that ILA is a safe and efficacious treatment for a variety of intracranial pathologies, can be tailored to treat difficult-to-access lesions, and may offer a novel alternative to open craniotomy in properly selected patients. Abstract Background: Managing difficult-to-access lesions or surgically accessible lesions in fragile patients is a central problem in neurosurgery. MRI-guided interstitial laser ablation (ILA) is a minimally invasive option that may provide a safe means of treating these challenging patients. Objective: We aim to (1) evaluate safety, efficacy, and preliminary outcomes within a diverse and large series of ILA treatments; and (2) report technical details and operative trends that proved useful over time in the authors' experience and that may be of use to neurosurgeons who perform ILA. Methods: A retrospective evaluation of ILA patients was performed in terms of demographics, surgical techniques, and clinical outcomes. Results: A total of 133 intracranial lesions in 120 patients were treated with ILA, including glioblastomas (GBM), other glio-

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Section: Discussionmentioning

confidence: 92%

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases

Kamath

Friedman

Hacker

et al. 2017

Stereotact Funct Neurosurg

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“…This relationship also predicted LC for lesions. We have previously demonstrated a dose–size response relationship in small brain metastases treated with a linear accelerator, 18 but analysis was limited by the lack of tumor volume data and complex dosimetric data. The current study builds on this previous work by using robust statistical analyses to identify factors predictive of LC and to characterize the relationship between dose per volume and LF.…”

Section: Discussionmentioning

confidence: 99%

A Dose–Volume Response Model for Brain Metastases Treated With Frameless Single-Fraction Robotic Radiosurgery: Seeking to Better Predict Response to Treatment

Amsbaugh

Gaskins

Dragun

et al. 2016

Technol Cancer Res Treat

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Purpose/Objective(s):To establish a dose–volume response relationship for brain metastases treated with single-fraction robotic stereotactic radiosurgery and identify predictors of local control.Materials/Methods:We reviewed a prospective institutional database of all patients treated for intact brain metastases with stereotactic radiosurgery alone using the CyberKnife robotic radiosurgery system from 2012 to 2015. Tumor response was determined based on Response Evaluation Criteria In Solid Tumors version 1.1. Survival was estimated using the Kaplan-Meier method. Logistic regression modeling was used to identify predictors of outcome and establish a dose–volume response relationship. Receiver operating characteristic curves were constructed to evaluate the predictive capability of the relationship.Results:There were 357 metastases evaluated in 111 patients with a median diameter of 8.14 mm (2.00-40.77 mm). At 6 and 12 months, local control was 86.9% and 82.2%, respectively. For lesions of similar volumes, higher maximum dose, mean dose, and minimum dose (all P values <.05) predicted for better local control. Tumor volume and diameter were strongly correlated, and a dose–volume response relationship was constructed using mean dose per lesion diameter (Gy/mm) that was predictive of local control (odds ratio: 1.34, 95% confidence interval: 1.06-1.70). Area under the receiver operating characteristic curve for local control and mean dose by volume was 0.6199 with a threshold of 2.05 Gy/mm (local failure 7.6% above and 17.3% below 2.05 Gy/mm).Conclusion:A dose–volume response relationship exists for brain metastases treated with robotic stereotactic radiosurgery. Mean dose per volume is strongly predictive of local control and can be potentially useful during stereotactic radiosurgery plan evaluation while respecting previously established dose constraints.

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“…Ten patients had a total of 36 tumors; of these, 22 lesions with a mean volume of 12.3 ml (range, 7-78.4 ml) underwent two-session radiosurgery. The mean prescription dose for the first treatment was 13 Gy (range, [9][10][11][12][13][14][15][16][17][18] to the 50% isodose line, and the intratumoral mean dose was 17.9 Gy (12-22.9). All 10 patients had neurological symptoms, with a mean Karnofsky physical score (KPS) of 60 (range, 50-70) on the day of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Shaw et al recommend that radiosurgery doses to large lesions be limited, with reference doses of 24 Gy recommended for lesions <2 cm in diameter, doses of 18 Gy recommended for lesions >2 cm and <3 cm in diameter, and doses of 15 Gy recommended for lesions >3 cm [12]. Nevertheless, doses below 20 Gy were found insufficient to provide long-term (i.e., one-year) control by several authors [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Two-session Radiosurgery as Initial Treatment for Newly Diagnosed Large, Symptomatic Brain Metastases from Breast and Lung Histology

Lovo¹,

Torres²,

Campos³

et al. 2019

Cureus

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Introduction Surgery is considered the treatment of choice for patients with large, symptomatic brain metastases. This report describes a series of patients treated with upfront two-session radiosurgery rather than surgery for large brain metastases from breast and lung histology. Methods From October 2016 to January 2019, 10 consecutive patients with neurologic symptoms from large brain metastases producing mass effects underwent two sessions of radiosurgical treatments 30 days apart. The response was assessed by imaging and clinical evaluations. Results Ten patients had a total of 36 tumors; of these, 22 lesions with a mean volume of 12.3 ml (range, 7-78.4 ml) underwent two-session radiosurgery. The mean prescription dose for the first treatment was 13 Gy (range, 9-18 Gy) to the 50% isodose line, and the intratumoral mean dose was 17.9 Gy (12-22.9). All 10 patients had neurological symptoms, with a mean Karnofsky physical score (KPS) of 60 (range, 50-70) on the day of treatment. None of these patients required neurosurgical or emergency consultation related to worsening of neurological symptoms between the first and second treatments. At 30 days, the mean KPS was 80 and maintained at 80 at the last follow-up (range, 60-100; P=0.002), and mean lesion volume was 4.1 ml (range, 1.3-70 ml). The mean prescription dose for the second treatment was 12 Gy (range, 9-18 Gy) to the 50% isodose line, and the intratumoral mean dose was 17.9 Gy (11-22.4). The mean overall survival was 24 months (range, 3-32 months). At last follow-up, three patients (30%) had died, two of systemic progression and one of tumor progression, and at one year, local tumor control was 91% and 19 (86%) lesions showed documented local control at last follow up. In those tumors that progressed, the mean time to progression was eight months (range, 5-20 months), and the mean time to surgery was nine months (range, 5-32 months). Conclusion Two-session radiosurgery proved to be a safe treatment for patients with large, symptomatic metastases in this series. Neurological worsening after radiosurgery for large lesions of breast and lung histology may be an infrequent event. This strategy in radiosurgery may have neurological benefits for these patients providing adequate local tumor control while reducing the need of upfront surgery at diagnosis.

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Dose-Volume Response Relationship for Brain Metastases Treated with Frameless Single-Fraction Linear Accelerator-Based Stereotactic Radiosurgery

Cited by 16 publications

References 27 publications

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases

MRI-Guided Interstitial Laser Ablation for Intracranial Lesions: A Large Single-Institution Experience of 133 Cases

A Dose–Volume Response Model for Brain Metastases Treated With Frameless Single-Fraction Robotic Radiosurgery: Seeking to Better Predict Response to Treatment

Two-session Radiosurgery as Initial Treatment for Newly Diagnosed Large, Symptomatic Brain Metastases from Breast and Lung Histology

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