Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

Chen, William; Baal, Ulysis; Baal, Joe D.; Pai, Jon S.; Boreta, Lauren; Braunstein, Steve; Raleigh, David R.

doi:10.1001/jamaoncol.2021.1262

Cited by 25 publications

(48 citation statements)

References 55 publications

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“…However, the reported survival of SRS series might suggest a different scenario. In the present analysis, the median cancer-speci c survival was 14.6 months which is in line with previous evidence on BM patients 21 . By comparison the median survival in the study of Tri letti et al 24 was 5.6 months and the 1-year survival 32.7%.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, the majority of these patients were treated with gamma-knife, with few data available for linear accelerator (linac)-based SRS. A recent systematic review and meta-analysis of those retrospective studies demonstrated the e cacy of SRS in the treatment of BSM; however, only few predictive parameters of treatment response were identi ed 21 . Therefore, it is hard to date to infer speci c recommendation on dose prescription, as well as the identi cation of predictive parameters, considering the limited available data 22 .…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

Nicosia

Navarria

Pinzi

et al. 2022

Preprint

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Background: brainstem metastases (BSM) is a rare site of occurrence and their management is a challenging issue. Based on the lack of evidences, the optimal radiation treatment of BSM remains controversial. We evaluated the efficacy and toxicity of linear accelerator (linac)-based stereotactic radiosurgery (SRS) and steretotactic radiotherapy (SRT) in the treatment of BMS in a series of patients treated in different centers. Methods: we conducted a multicentric retrospective study of patients affected by 1-2 BSM from different solid who underwent SRS/SRT. Freedom from local progression (FLP), cancer-specific survival (CSS), overall survival (OS), and toxicity were evaluated. Moreover, predictive factors of treatment response and survival were evaluated.Results: Between 2008 and 2021, 105 patients with 111 BMS received SRS or SRT for 1-2 BSM. Median follow-up time was 10 months (range 3-130). One-year FLP rate was 90.4%. At the univariate analysis, tumor volume ≤0.4 cc and concomitant target therapy were associated with longer FLP, with concomitant target therapy that remained a significant independent predictor [0.058, HR 0.139 (95% CI 0.0182-1.064]. Median OS and CSS were 11 months and 14.6 months, respectively. At multivariate analysis, concomitant target therapy administration was significantly associated with longer OS [HR 0.514 (95%CI 0.302-0.875); p=0.01]. Neurological death occurred in 30.4% of patients, although this was due to BSM progression in only 3 (2.8%) patients. Conclusion: brainstem metastases can be safely treated with linac-based SRS with apparent no detrimental effect on survival. When treated with ablative intent, BSM are an uncommon cause of neurological death. Future prospective trial should answer the question of whether BSM should be excluded a priori from clinical trial.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

Nicosia

Navarria

Pinzi

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Symptomatic lesions should be treated at the beginning of treatment to avoid worsening and because radiation, mainly SRS, and other local treatments can control symptoms quickly. A recent PRISMA analysis concluded SRS led to a symptom improvement of 55%, and these results compared favorably to trials of targeted or immunotherapy for BMs ( 233 ). Concerning painful metastasis, ablative radiotherapy is efficient but compared to conventional irradiation, comparisons have yielded contradictory results ( 234 , 235 ).…”

Section: Questions To Be Further Discussed and Consideredmentioning

confidence: 99%

International consensus on radiotherapy in metastatic non-small cell lung cancer

Zhu¹,

Ni²,

Cai³

et al. 2022

Transl Lung Cancer Res

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Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established. Conclusions:In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

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“…Moreover, the majority of these patients were treated with gamma-knife SRS, with few data available for frameless linear accelerator (linac)-based SRS. A recent systematic review and meta-analysis of those retrospective studies demonstrated the efficacy of SRS in the treatment of BSM; however, only a few predictive parameters of treatment response were identified [22] . Therefore, it is hard to date to infer specific recommendations on dose prescription, as well as the identification of predictive factors of outcome because of the limited available data.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

et al. 2022

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Background Brainstem metastases (BSM) are associated with a poor prognosis and their management represents a therapeutic challenge. BSM are often inoperable and, in absence of randomized trials, the optimal radiation treatment of BSM remains to be defined. We evaluated the efficacy and toxicity of linear accelerator (linac)-based stereotactic radiosurgery (SRS) and hypofractionated steretotactic radiotherapy (HSRT) in the treatment of BSM in a series of patients treated in different clinical centers. Methods We conducted a multicentric retrospective study of patients affected by 1–2 BSM from different histologies who underwent SRS/HSRT. Freedom from local progression (FLP), cancer-specific survival (CSS), overall survival (OS), and treatment-related toxicity were evaluated. In addition, predictors of treatment response and survivals were evaluated. Results Between 2008 and 2021, 105 consecutive patients with 111 BMS who received SRS or HSRT for 1–2 BSM were evaluated. Median follow-up time was 10 months (range 3–130). One-year FLP rate was 90.4%. At the univariate analysis, tumor volume ≤ 0.4 cc, and concurrent targeted therapy were associated with longer FLP, with combined treatment that remained a significant independent predictor [0.058, HR 0.139 (95% CI 0.0182–1.064]. Median OS and CSS were 11 months and 14.6 months, respectively. At multivariate analysis, concurrent targeted therapy administration was significantly associated with longer OS [HR 0.514 (95%CI 0.302–0.875); p = 0.01]. Neurological death occurred in 30.4% of patients, although this was due to local progression in only 3 (2.8%) patients. Conclusion Linac-based SRS/HSRT offers excellent local control to patients with BSM, with low treatment-related toxicity and no apparent detrimental effects on OS. When treated with ablative intent, BSM are an uncommon cause of neurological death. The present results indicates that patients with BSM should not be excluded a priori from clinical trials.

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Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

Cited by 25 publications

References 55 publications

Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

International consensus on radiotherapy in metastatic non-small cell lung cancer

Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study

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