Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Large Brain Metastases

Jeong, Won Joo; Park, Jae Hong; Lee, Eun Jung; Kim, Jeong Hoon; Kim, Chang‐Jin; Cho, Young Hyun

doi:10.3340/jkns.2015.58.3.217

Cited by 52 publications

(26 citation statements)

References 33 publications

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“…Histology of the primary, does not seem to influence recurrence, with similar local control for radiosensitive (i.e., breast and lung up to 94%) and radioresistant tumors [up to 90% i.e., melanoma, renal cell carcinoma ( 2 , 12 )] reported. Median survival after surgery and hypofractionated radiation treatment to cavities of large metastasis is 5.5–17 months ( 2 , 11 , 12 , 60 , 61 , 64 ). A possible advantage of WBRT over HFRT in the post operative setting is the risk of leptomeningeal disease.…”

Section: Post Operative Treatment Of Large Cavitiesmentioning

confidence: 99%

Hypofractionated Radiation Therapy for Large Brain Metastases

Masucci

2018

Front. Oncol.

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Single fraction radiosurgery (SRS) treatment is an effective and recognized alternative to whole brain radiation for brain metastasis. However, SRS is not always possible, especially in tumors of a larger diameter where the administration of high dose in a single fraction is limited by the possibility of acute and late side effects and the dose to the surrounding organs at risk. Hypofractionated radiation therapy allows the delivery of high doses of radiation per fraction while minimizing adverse events, all the while maintaining good local control of lesions. The optimal dose fractionation has however not been established. This overwiew presents available evidence and rationale supporting usage of hypofractionated radiation therapy in the treatment of large brain metastases.

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Section: Post Operative Treatment Of Large Cavitiesmentioning

confidence: 99%

Hypofractionated Radiation Therapy for Large Brain Metastases

Masucci

2018

Front. Oncol.

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“…56 More recently, in an attempt to overcome the modest LC observed in the management of LBM and also to decrease the radiation toxicity associated with SRS treatment, several novel strategies have been explored. Retrospective and prospective studies evaluating both hypofractionated SRS (hypo-FSRS), typically delivered in 3-6 fractions, 18,19,25,27,28,38,39,[42][43][44]46,71,72 and staged SRS 24,74,75 have been investigated in the management of LBM. The rationale was to increase the prescribed dose and hence the LC while decreasing the morbidity of radiation injury, by distributing the dose over time and perhaps to smaller targets at the time of second treatment.…”

Section: Discussionmentioning

confidence: 99%

“…4,22,32,42,44,52 Recently, SRS, fractionated stereotactic radiotherapy, or a combination of these modalities with more conventional treatment options has been studied in the management of LBM. 15,18,27,34,42,76 However, optimal treatment paradigms with radiosurgery remain unclear and controversial and are associated with a relatively inferior control rate compared with smaller lesions. 6,16,18,22,32,40,41,44,57,70,76 Furthermore, potential significant treatment-associated toxicities, most notably adverse effects (AEs) of radiation, 1,56,60 and their management remain concerning in patients with LBM.…”

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confidence: 99%

Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm

Angelov

Mohammadi

Bennett

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Stereotactic radiosurgery (SRS) is the primary modality for treating brain metastases. However, effective radiosurgical control of brain metastases ≥ 2 cm in maximum diameter remains challenging and is associated with suboptimal local control (LC) rates of 37%-62% and an increased risk of treatment-related toxicity. To enhance LC while limiting adverse effects (AEs) of radiation in these patients, a dose-dense treatment regimen using 2-staged SRS (2-SSRS) was used. The objective of this study was to evaluate the efficacy and toxicity of this treatment strategy. METHODS Fifty-four patients (with 63 brain metastases ≥ 2 cm) treated with 2-SSRS were evaluated as part of an institutional review board-approved retrospective review. Volumetric measurements at first-stage stereotactic radiosurgery (first SSRS) and second-stage SRS (second SSRS) treatments and on follow-up imaging studies were determined. In addition to patient demographic data and tumor characteristics, the study evaluated 3 primary outcomes: 1) response at first follow-up MRI, 2) time to local progression (TTP), and 3) overall survival (OS) with 2-SSRS. Response was analyzed using methods for binary data, TTP was analyzed using competing-risks methods to account for patients who died without disease progression, and OS was analyzed using conventional time-to-event methods. When needed, analyses accounted for multiple lesions in the same patient. RESULTS Among 54 patients, 46 (85%) had 1 brain metastasis treated with 2-SSRS, 7 patients (13%) had 2 brain metastases concurrently treated with 2-SSRS, and 1 patient underwent 2-SSRS for 3 concurrent brain metastases ≥ 2 cm. The median age was 63 years (range 23-83 years), 23 patients (43%) had non-small cell lung cancer, and 14 patients (26%) had radioresistant tumors (renal or melanoma). The median doses at first and second SSRS were 15 Gy (range 12-18 Gy) and 15 Gy (range 12-15 Gy), respectively. The median duration between stages was 34 days, and median tumor volumes at the first and second SSRS were 10.5 cm (range 2.4-31.3 cm) and 7.0 cm (range 1.0-29.7 cm). Three-month follow-up imaging results were available for 43 lesions; the median volume was 4.0 cm (range 0.1-23.1 cm). The median change in volume compared with baseline was a decrease of 54.9% (range -98.2% to 66.1%; p < 0.001). Overall, 9 lesions (14.3%) demonstrated local progression, with a median of 5.2 months (range 1.3-7.4 months), and 7 (11.1%) demonstrated AEs (6.4% Grade 1 and 2 toxicity; 4.8% Grade 3). The estimated cumulative incidence of local progression at 6 months was 12% ± 4%, corresponding to an LC rate of 88%. Shorter TTP was associated with greater tumor volume at baseline (p = 0.01) and smaller absolute (p = 0.006) and relative (p = 0.05) decreases in tumor volume from baseline to second SSRS. Estimated OS rates at 6 and 12 months were 65% ± 7% and 49% ± 8%, respectively. CONCLUSIONS 2-SSRS is an effective treatment modality that resulted in significant reduction of brain metastases ≥ 2 cm, with excellent 3-month (95%) ...

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“…Several clinical investigations have reported on the safety and efficacy of hypofractionated CK brain treatments. One such study [41] looking at CK treatments for large brain metastases delivering 30-41 Gy in 3-5 fractions, reported a crude local tumor control (LTC) rate of 86.8%. The estimated LTC rates at 12 and 24 months were 87 and 65.2%.…”

Section: Clinical Studies -Hypofractionated Brain Treatmentsmentioning

confidence: 99%

Image-Guided Hypofractionated Radiosurgery of Large and Complex Brain Lesions

Pinnaduwage¹,

Dong²,

Ma³

2016

From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery

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Hypofractionated radiosurgery either through frame or image guidance has emerged as the most important area of research and development for intracranial and extracranial radiosurgery. In this chapter, we focused on discussions of three state-of-the-art platforms: Frame-and Image-Guided Gamma Knife, Robotic X-Band Cykerknife, and Flattening-Filter-Free intensity-modulated S-band medical linear accelerators. Practical principles with detailed workflow and clinical implementations are presented in a systematic approach. With rapid evolvement of both hardware and software in the realm of delivering hypofractionated radiosurgery, this chapter aims to offer a reader physical clarity on judging and balancing of achieving high-precision and highquality treatments with practical examples and guidelines on intracranial applications.

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Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Large Brain Metastases

Cited by 52 publications

References 33 publications

Hypofractionated Radiation Therapy for Large Brain Metastases

Hypofractionated Radiation Therapy for Large Brain Metastases

Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm

Image-Guided Hypofractionated Radiosurgery of Large and Complex Brain Lesions

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