Local control and overall survival after frameless radiosurgery: A single center experience

Bilger, Angelika; Frenzel, F.; Oehlke, Oliver; Wiehle, R.; Milanović, D.; Prokic, V.; Nieder, Carsten; Grosu, Anca‐Ligia

doi:10.1016/j.ctro.2017.09.007

Cited by 25 publications

(25 citation statements)

References 28 publications

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“…This result reflects the fractionation recommendation of 3 Gy Â 10 described in treatment guidelines by the Norwegian Breast Cancer Group. 34 When using SRS, a single fractionation of 18-20 Gy is most commonly reported, 9,35,36 corresponding with our finding with 18 Gy Â 1 as the most Only variables significant in univariate analysis were included in multivariate analysis.…”

Section: Discussionsupporting

confidence: 75%

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

Gullhaug

Hjermstad

Yri

et al. 2021

Journal of Medical Imaging and Radiation Sciences

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Aim: To analyse the use of radiotherapy (RT) and factors affecting overall survival (OS) after RT in breast cancer patients with brain metastases.Methods: Breast cancer patients treated from 2008 to 2018 with whole brain RT (WBRT) or stereotactic radiosurgery (SRS) at a large regional cancer referral center were identified from the hospital's RT register. Clinical variables were extracted from medical records. OS was calculated from date of first RT until death or last follow up. Potential factors affecting OS were analyzed.Results: 255 females with WBRT (n ¼ 206) or SRS (n ¼ 49) as first RT were included. An increased use of initial SRS was observed in the second half of the study period. The most common WBRT fractionation regimen was 3 Gy Â 10. SRS was most often single fractions; 18 or 25 Gy between 2009 and 2016, while fractionated SRS was mostly used in 2017 and 2018. Median OS in the WBRT group was 6 months (CI 1-73) relative to 23 (CI 0-78) in the SRS group. Age, performance status, initial RT technique, extracranial disease, brain metastasis surgery, number of brain metastases and DS-GPA score had significant impact on OS. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis. Conclusion:WBRT was the most frequent primary RT. An increased use of initial SRS was observed in the second half of the study period. Only ECOG 0 and brain metastasis surgery were associated with superior OS in multivariate analysis.R ESUM E But : Analyser l'utilisation de la radioth erapie (RT) et les facteurs affectant la survie globale (SG) apr es la RT chez les patientes atteintes d'un cancer du sein avec m etastases au cerveau.Contributors: All authors contributed to the conception or design of the work, the acquisition, analysis, or interpretation of the data. All authors were involved in drafting and commenting on the paper and have approved the final version.

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Section: Discussionsupporting

confidence: 75%

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

Gullhaug

Hjermstad

Yri

et al. 2021

Journal of Medical Imaging and Radiation Sciences

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“…The 1-year LTC rate of 91.3% for boosted metastases was comparable to that obtained after SRS alone. 5,23,24 A similar improvement in LTC through dose escalation to metastases was shown in a meta-analysis by Patil et al, 25 who explored the combination of WBRT and SRS. In comparison, dose escalation through SIBs has the biological advantage of fractionation for both normal and tumor tissue and ensures better HA.…”

Section: Discussionmentioning

confidence: 60%

Hippocampus‐avoidance whole‐brain radiation therapy with a simultaneous integrated boost for multiple brain metastases

Popp

Rau

Hintz

et al. 2020

Cancer

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BACKGROUND:The current study was aimed at investigating the feasibility of hippocampus-avoidance whole-brain radiation therapy with a simultaneous integrated boost (HA-WBRT+SIB) for metastases and at assessing tumor control in comparison with conventional whole-brain radiation therapy (WBRT) in patients with multiple brain metastases. METHODS: Between August 2012 and December 2016, 66 patients were treated within a monocentric feasibility trial with HA-WBRT+SIB: hippocampus-avoidance WBRT (30 Gy in 12 fractions, dose to 98% of the hippocampal volume ≤ 9 Gy) and a simultaneous integrated boost (51 or 42 Gy in 12 fractions) for metastases/ resection cavities. Intracranial tumor control, hippocampal failure, and survival were subsequently compared with a retrospective cohort treated with WBRT via propensity score matching analysis. RESULTS: After 1:1 propensity score matching, there were 62 HA-WBRT+SIB patients and 62 WBRT patients. Local tumor control (LTC) of existing metastases was significantly higher after HA-WBRT+SIB (98% vs 82% at 1 year; P = .007), whereas distant intracranial tumor control was significantly higher after WBRT (82% vs 69% at 1 year; P = .016); this corresponded to higher biologically effective doses. Intracranial progression-free survival (PFS; 13.5 vs 6.4 months; P = .03) and overall survival (9.9 vs 6.2 months; P = .001) were significantly better in the HA-WBRT+SIB cohort. Four patients (6.5%) developed hippocampal metastases after hippocampus avoidance. The neurologic death rate after HA-WBRT+SIB was 27.4%. CONCLUSIONS: HA-WBRT+SIB can be an efficient therapeutic option for patients with multiple brain metastases and is associated with improved LTC of existing metastases, higher intracranial PFS, a reduction of the neurologic death rate, and an acceptable risk of radiation necrosis. The therapy has the potential to prevent neurocognitive adverse effects, which will be further evaluated in the multicenter, phase 2 HIPPORAD trial. Cancer 2020;126: 2694-2703.

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“…SRS for brain metastases offers a 12-month local control of 70–85% with a high proportion of distant brain failure of 50% or more [2] , [7] , [8] , [9] . In highly conformal treatments, such as SBRT and SRS, steep dose gradients are used to constrain the therapeutic dose to the target to limit doses to normal tissues; this may reduce the dose to microscopic disease not included in the clinical target volume (CTV).…”

Section: Discussionmentioning

confidence: 99%

The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases

Stolzmann

Ohri

Velten

et al. 2021

Clinical and Translational Radiation Oncology

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Stereotactic radiosurgery (SRS) for metastatic disease to the brain is associated with higher in-brain failures compared to whole brain radiation therapy (WBRT). Here we investigated the relationship between low-dose fall off during SRS and location of new brain lesions. Materials and Methods: One hundred sixty-seven patients treated with single fraction or fractionated SRS for intact or resected brain metastases at our institution from January 2016 to June 2018 were reviewed. Patients with imaging findings of new brain metastases after the initial SRS were included. Patients with WBRT before SRS were excluded. MRI scans for repeat treatments were fused with initial SRS plan. New lesions were outlined on the initial SRS planning CT. The mean dose that the site of new lesions received from initial SRS was tabulated. Results: Thirty-eight patients met inclusion criteria. 165 new lesions were evaluated. There was a lower propensity to develop new brain lesions with increasing dose received by the regions from prior SRS, with 66%, 34%, 19%, 13%, 6%, 5%, 2% and 1% of new lesions appearing in regions that received less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively. Higher doses are received by smaller brain volumes during SRS. After accounting for volume, 14, 14, 11, 7, 2, 2, 1 and 1 new lesions appeared per 100 cm 3 of brain in regions that received doses of less than 1 Gy, greater than or equal to 1, 2, 3, 4, 5, 6, and 7 Gy, respectively, from prior SRS. Conclusions: We identified low dose spillage during SRS to be associated with lower incidence of new brain metastases. Validation in larger dataset or prospective study of the combination of SRS with low dose WBRT would be crucial in order to establish causality of these findings.

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Local control and overall survival after frameless radiosurgery: A single center experience

Cited by 25 publications

References 28 publications

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

Use of radiotherapy in breast cancer patients with brain metastases: a retrospective 11-year single center study

Hippocampus‐avoidance whole‐brain radiation therapy with a simultaneous integrated boost for multiple brain metastases

The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases

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