Estimating the Additive Benefit of Surgical Excision to Stereotactic Radiosurgery in the Management of Metastatic Brain Disease

Quigley, Matthew R.; Bello, Nicholas; Jho, Diana; Fuhrer, Russell; Karlovits, Stephen; Buchinsky, Farrel J.

doi:10.1227/neu.0000000000000707

Cited by 21 publications

(13 citation statements)

References 38 publications

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“…Advances in SRS, SRT, IMRT, and WBRT have continually increased the accuracy and conformity of radiotherapy 25 . The progress in surgical techniques and targeted therapy has also improved the outcomes of patients with brain metastasis 26 – 28 . The efficiency of anti-angiogenesis targeted therapy for radiation necrosis has also made physicians increasingly willing to treat patients aggressively with radiotherapy, such as SRS, IMRT, or WBRT 27 , 29 , 30 .…”

Section: Discussionmentioning

confidence: 99%

Microsurgery vs. radiosurgery for the treatment of multiple metastases in the brain: a retrospective cohort study

et al. 2021

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Objective: Multiple brain metastases are a severe condition for cancer patients. To date, no general consensus exists regarding the optimal treatment procedure for multiple brain metastases. Radiotherapy is the most commonly used treatment option. The role of surgical resection for multiple brain metastases is unclear. The aim of this study was to compare the outcomes of patients with multiple brain metastases treated with either surgery or stereotactic radiosurgery (SRS). Methods: The medical records of 279 consecutive adult patients with multiple brain metastases treated with either surgery (26 patients) or SRS (253 patients) were retrospectively reviewed. Propensity score matching was conducted to correct for discrepancies in the baseline characteristics, and 78 patients (26 receiving surgery and 52 receiving SRS) were chosen for comparison of outcomes, such as overall survival, local tumor control rate, and symptom improvement. Results: The tumor size in the surgery group was significantly greater than that in the SRS group after propensity score matching. However, the neurological recovery rate, incidence of leptomeningeal metastasis after surgery, 1-year local tumor control rate, and overall survival were not significantly different between groups. Conclusions: Our data demonstrate that surgery and radiosurgery have identical overall survival and local tumor control rates in patients with 2 to 4 brain metastases. Although SRS remains the primary and standard option for patients with brain metastasis, surgery offers several distinct advantages, such as establishing a diagnosis or relieving mass effects, and may additionally be beneficial in carefully selected patients with 2–4 brain metastases.

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Section: Discussionmentioning

confidence: 99%

Microsurgery vs. radiosurgery for the treatment of multiple metastases in the brain: a retrospective cohort study

et al. 2021

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“…These factors were evaluated by recursive partitioning analysis (RPA) in a landmark analysis which established RPA classes for patient selection, demonstrating that RPA class 1 patients—with age under 65, KPS of at least 70, and controlled primary disease without additional sites of metastasis—are most likely to benefit from surgery ( 22 ). In appropriately selected patients with tumor size > 2.5cm, resection carries a benefit in overall survival and local control over whole-brain radiation alone as demonstrated in studies of both disease-specific cohorts and all patients with oligometastatic disease ( 9 , 23 – 26 ). Resection should be considered first-line means of local control for metastatic lesions > 3cm in diameter, as lesions of this size are less responsive to radiotherapy regardless of modality.…”

Section: Treatmentmentioning

confidence: 95%

Review of Current Principles of the Diagnosis and Management of Brain Metastases

Brenner

Patel

2022

Front. Oncol.

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Brain metastases are the most common intracranial tumors and are increasing in incidence as overall cancer survival improves. Diagnosis of brain metastases involves both clinical examination and magnetic resonance imaging. Treatment may involve a combination of surgery, radiotherapy, and systemic medical therapy depending on the patient’s neurologic status, performance status, and overall oncologic burden. Advances in these domains have substantially impacted the management of brain metastases and improved performance status and survival for some patients. Indications for surgery have expanded with improved patient selection, imaging, and intraoperative monitoring. Robust evidence supports the use of whole brain radiotherapy and stereotactic radiosurgery, for both standalone and adjuvant indications, in almost all patients. Lastly, while systemic medical therapy has historically provided little benefit, modern immunotherapeutic agents have demonstrated promise. Current investigation seeks to determine the utility of neoadjuvant radiotherapy and laser interstitial thermal therapy, which have shown benefit in limited studies to date. This article provides a review of the epidemiology, pathology, diagnosis, and treatment of brain metastases and the corresponding supporting evidence.

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“…Quigley et al compared 162 consecutive patients (46% single lesions) that received surgery + SRS boost (49 patients) vs SRS alone (113 patients). Surgery + SRS boost resulted in greater local control and survival when complete resection was achieved ( 35 ).…”

Section: Upfront Focal Rtmentioning

confidence: 99%

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

et al. 2021

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Brain metastases (BMs) represent the most frequent event during the course of Non-Small Cell Lung Cancer (NSCLC) disease. Recent advancements in the diagnostic and therapeutic procedures result in increased incidence and earlier diagnosis of BMs, with an emerging need to optimize the prognosis of these patients through the adoption of tailored treatment solutions. Nowadays a personalized and multidisciplinary approach should rely on several clinical and molecular factors like patient’s performance status, extent and location of brain involvement, extracranial disease control and the presence of any “druggable” molecular target. Radiation therapy (RT), in all its focal (radiosurgery and fractionated stereotactic radiotherapy) or extended (whole brain radiotherapy) declinations, is a cornerstone of BMs management, either alone or combined with surgery and systemic therapies. Our review aims to provide an overview of the many modern RT solutions available for the treatment of BMs from NSCLC in the different clinical scenarios (single lesion, oligo and poly-metastasis, leptomeningeal carcinomatosis). This includes a detailed review of the current standard of care in each setting, with a presentation of the literature data and of the possible technical solutions to offer a “state-of-art” treatment to these patients. In addition to the validated treatment options, we will also discuss the future perspectives on emerging RT technical strategies (e.g., hippocampal avoidance whole brain RT, simultaneous integrated boost, radiosurgery for multiple lesions), and present the innovative and promising findings regarding the combination of novel targeted agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with brain irradiation.

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Estimating the Additive Benefit of Surgical Excision to Stereotactic Radiosurgery in the Management of Metastatic Brain Disease

Abstract: Complete surgical resection + SRS boost is associated with improved survival and reduced likelihood of local tumor recurrence in comparison with SRS alone. Incomplete resection did not improve survival or TTLR compared with SRS alone.

Cited by 21 publications

References 38 publications

Microsurgery vs. radiosurgery for the treatment of multiple metastases in the brain: a retrospective cohort study

Microsurgery vs. radiosurgery for the treatment of multiple metastases in the brain: a retrospective cohort study

Review of Current Principles of the Diagnosis and Management of Brain Metastases

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

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