Heterogeneity in intracranial relapses after complete resection of lung adenocarcinoma: Distinct features of brain‐only relapse versus synchronous extracranial relapse

Xu, Fei; Li, Junling; Xing, Puyuan; Liu, Yutao; Wang, Yan

doi:10.1002/cam4.5961

Cited by 2 publications

(2 citation statements)

References 52 publications

(84 reference statements)

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“…Brain metastases (BMs) without locoregional or any other distant tumor seeding are a pattern of recurrence after definitive surgery of non-small cell lung cancer (NSCLC) [1]. Local treatment such as external-beam radiotherapy (EBRT) or surgical resection is generally preferred over systemic therapy for oligo-BMs [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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Fifteen-Fraction Radiosurgery Followed by Reduced-Dose Whole-Brain Irradiation With a Total Biologically Effective Dose of >90-100 Gy for a Locally Invasive Brain Metastasis From Lung Adenocarcinoma With a High Dissemination Potential

Ohtakara,

Ohka,

Tanahashi

et al. 2023

Cureus

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A deep-seated, locally infiltrative 5.8-cm brain metastasis (BM) involving the ventricular wall and optic radiation is deemed unamenable for a safe total resection, while preventing tumor seeding. Meanwhile, radiotherapeutic management alone for such a BM close to the brainstem is also challenging.We describe such a BM (gross tumor volume [GTV] 40.3 cm 3 ) from lung adenocarcinoma (LAC), located in the left temporo-occipital lobes, with extensive invasion to the tentorium cerebelli and a high potential for dissemination. The BM was treated with 15-fraction(s) (fr) stereotactic radiosurgery (SRS) followed by whole-brain irradiation (WBI) at 27 Gy/15 fr with a 19-day interval. During the SRS, the solid component away from the tentorium showed obvious shrinkage. The cumulative biologically effective doses (BEDs) of the minimum and D 99% of the GTV were ≥92.3 Gy and ≥102.6 Gy, respectively, where the BED was based on the linear-quadratic formula at an alpha/beta ratio of 10 (BED 10 ). Despite a maximum response with nearly complete regression at 7.5 months, local tumor regrowth near the tentorial incisura became gradually apparent from 11.2 to 19.3 months. Salvage re-SRS with 53 Gy/10 fr specific to these lesions resulted in obvious regression at 5.8 months. However, radiation injury concomitant with triventriculomegaly progressed from 7.9 to 13.9 months, eventually leading to meningeal dissemination and patient mortality at 34.6 months. This case demonstrates that a BED 10 ≥90-100 Gy in 30 fr to the GTV boundary with a more than two-week interval without combined systemic therapy is insufficient for achieving complete local tumor eradication of a 40-cc LAC-BM. Shorter treatment duration with a steeper dose gradient outside and inside the GTV in the SRS or a volumetric modulated arc-based SRS combined with simultaneously integrated WBI may improve efficacy and safety.

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Section: Introductionmentioning

confidence: 99%

“…Local treatment such as external-beam radiotherapy (EBRT) or surgical resection is generally preferred over systemic therapy for oligo-BMs [2][3][4]. A single isolated BM requires long-term control (local curability) and safety with localized treatment, which can significantly affect prognosis [1,3].…”

Section: Introductionmentioning

confidence: 99%