Fifty percent patients avoid whole brain radiotherapy: stereotactic radiotherapy for multiple brain metastases. A retrospective analysis of a single center

Chen, Xiujun; Xiao, Jianping; Li, Xiangpan; Jiang, Xuesong; Zhang, Ye; Xu, Yuanfu; Dai, Jianrong

doi:10.1007/s12094-012-0849-4

Cited by 10 publications

(10 citation statements)

References 28 publications

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“…Our findings add to the growing body of evidence supporting intensive local and multifocal treatment for brain metastases 12,30,[32][33][34] with sparing of the surrounding white matter fibers, vessels, and myelin in an effort to preserve NCF. 35 Neurocognitive testing provides a quantitative tool for monitoring the effects of therapy and developing tailored therapies to enhance functional well being.…”

Section: Discussionsupporting

confidence: 63%

Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers

Brem

Meyers

Palmer

et al. 2013

Cancer

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BackgroundNeurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC).MethodsNCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals.ResultsSignificant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up.ConclusionsPatients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option.

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Section: Discussionsupporting

confidence: 63%

Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers

Brem

Meyers

Palmer

et al. 2013

Cancer

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“…Although, neurocognitive outcomes [46] and quality of life [47] were worse in the early WBRT group. Therefore, some authors suggest that WBRT after SR or SRS could be avoided in some cases, especially in patients with subtypes of MBC who live longer than the the more aggressive triple negative subtypes [48]. …”

Section: Local Treatmentmentioning

confidence: 99%

Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

et al. 2013

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Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10–30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.

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“…A randomized trial of osimertinib with or without SRS for EGFR-mutated NSCLC with BMs from the Trans-Tasman Radiation Oncology Group to compare the iPFS at 12 months is ongoing (NCT03497767). We had previously explored the effectiveness of upfront SRS and deferred WBRT in BM patients with focus larger than 3 cm (23). The results showed that the use of SRS as the initial treatment while reserving WBRT as the salvage therapy in case of distant intracranial recurrence made about 50% of the patients avoid WBRT throughout their lives.…”

Section: Discussionmentioning

confidence: 99%

“…We had previously explored the effectiveness of upfront SRS and deferred WBRT in BM patients with focus larger than 3 cm ( 23 ). The results showed that the use of SRS as the initial treatment while reserving WBRT as the salvage therapy in case of distant intracranial recurrence made about 50% of the patients avoid WBRT throughout their lives.…”

Section: Discussionmentioning

confidence: 99%

The Sequence of Intracranial Radiotherapy and Systemic Treatment With Tyrosine Kinase Inhibitors for Gene-Driven Non-Small Cell Lung Cancer Brain Metastases in the Targeted Treatment Era: A 10-Year Single-Center Experience

Yang

Xiao

et al. 2021

Front. Oncol.

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PurposeThe high intracranial efficacy of targeted therapeutic agents poses a challenge in determining the optimal sequence of local radiation therapy (RT) and systemic treatment with tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC) patients with brain metastasis (BM). Therefore, we conducted a cohort study to elucidate the appropriate treatment strategy, either upfront RT or deferred RT including a toxicity assessment, in these patients.Patients and MethodsWe retrospectively evaluated patients with gene-driven BMs from a single institution and divided them into deferred and upfront RT groups. Survival was estimated using a log-rank test. Intracranial progression was estimated using Fine-Gray competing risks model. Cox proportional hazards regression was performed for multivariable analysis in the entire group and subgroups.ResultsAmong the 198 eligible patients, 94 and 104 patients received deferred and upfront RT, respectively. The upfront RT group showed a lower intracranial progression risk with an adjusted sub-distribution hazard ratios of 0.41 (95% CI, 0.30–0.57) than did the deferred RT group (median intracranial progression-free survival [iPFS], 19.9 months vs. 11.1 months; p < 0.001). The median overall survival (OS; 43.2 months vs. 49.1 months, p = 0.377) and BM-specific survival (92.1 months vs. 82.9 months, p = 0.810) after salvage therapy were not significantly different between the upfront and deferred groups. Among patients with progressed extracranial disease, the deferred RT group showed significantly better OS than did the upfront RT group (44.0 vs. 28.1 months, p = 0.022). Grade 3–4 treatment-related adverse events were rare, and similar toxicities were observed between the two groups.ConclusionCompared to the deferred RT group, the upfront RT group achieved longer iPFS and similar survival outcomes in most patients with gene-driven NSCLC BM, although patients with progression of extracranial disease might benefit from deferred RT. Both groups showed well-tolerated toxicities.Trial registration IDNCT04832672.

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Fifty percent patients avoid whole brain radiotherapy: stereotactic radiotherapy for multiple brain metastases. A retrospective analysis of a single center

Cited by 10 publications

References 28 publications

Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers

Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers

Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

The Sequence of Intracranial Radiotherapy and Systemic Treatment With Tyrosine Kinase Inhibitors for Gene-Driven Non-Small Cell Lung Cancer Brain Metastases in the Targeted Treatment Era: A 10-Year Single-Center Experience

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