Long-term disease outcome and volume-based decision strategy in a large cohort of multiple brain metastases treated with a mono-isocentric linac-based Stereotactic Radiosurgery technique

Alongi, Filippo; Nicosia, Luca; Figlia, Vanessa; Giaj-Levra, Niccolò; Cuccia, Francesco; Mazzola, Rosario; Ricchetti, F.; Rigo, Michele; Vitale, Claudio; Simone, Antonio De; Naccarato, S.; Sicignano, G.; Gurrera, Davide; Corradini, Stefanie; Ruggeri, R.

doi:10.1007/s12094-020-02550-0

Cited by 17 publications

(19 citation statements)

References 24 publications

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“…In the univariate analysis, a marginal dose < 16 Gy was associated with worse local control; however, the correlation was not confirmed in the multivariate analysis. These results compare with those reported in series of SRS for cerebral and cerebellar metastases, reporting 1-year local control rates of 86.7% to 95% [2 , 25] .…”

Section: Discussionsupporting

confidence: 81%

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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Section: Discussionsupporting

confidence: 81%

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

et al. 2022

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“…The traditional practice of delivering radiosurgery to each lesion with a unique isocenter plan can result in prolonged treatment times for patients with many brain lesions. Conversely, single-isocenter, multitarget (SIMT) techniques, in which all brain lesions are simultaneously treated using a common isocenter, 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 substantially reduce treatment time. Similarly, single-fraction SRS also is limited to treatment of modest individual and aggregate lesion volumes in noneloquent brain structures, as the prescribed dose must be reduced to prevent toxicity for large lesions or those located in structures such as the brainstem, which in turn may limit local control.…”

Section: Introductionmentioning

confidence: 99%

“…Hypofractionated SRS (HF-SRS, SRS delivered in 2-5 fractions) potentially provides a broader therapeutic window than single-fraction SRS, permitting large lesions and aggregate lesion volumes, as well as lesions within critical structures, to be safely and effectively treated. 14 , 15 Retrospective studies have shown that SIMT using 1 to 5 fractions is technically feasible and affords reasonable control of treated lesions with minimal toxicity, 6 , 9 , 11 , 12 although additional systematic prospective studies of the indications, efficacy, and toxicities associated with this technique would be beneficial.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Buckley¹,

Herndon²,

Allen³

et al. 2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Tumor volume >10cm 3 but not number of BMs has been associated with worse OS ( 12 , 70 ) and a PTV <7.1 cm 3 was the only significant prognostic factor for survival (64.1 vs 39.5% 1 year survival) in the series reported by Alongi et al. ( 30 ). When choosing a cumulative volume cut-off from the literature, it is important to consider the technique employed.…”

Section: Discussionmentioning

confidence: 84%

“…10/17 described outcomes following SRS for patients with five or more brain metastases and seven publications with patients with four or more brain metastases were included, as the cut-off for the definition of MBM is arbitrary ( Table 4 ). Only two series used a linac to deliver SRS ( 25 , 30 ). Considering all patients and the data provided, the median number of brain metastases irradiated per patient was 7 and the median cumulative tumour volume per patient was 5.7cm 3 .…”

Section: Resultsmentioning

confidence: 99%

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

et al. 2022

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PurposeStereotactic radiosurgery (SRS) is now mainstream for patients with 1-4 brain metastases however the management of patients with 5 or more brain metastases remains controversial. Our aim was to evaluate the clinical outcomes of patients with 5 or more brain metastases and to compare with published series as a benchmarking exercise.MethodsPatients with 5 or more brain metastases treated with a single isocentre dynamic conformal arc technique on a radiosurgery linac were identified from the institutional database. Endpoints were local control, distant brain failure, leptomeningeal disease and overall survival. Dosimetric data were extracted from the radiosurgery plans. Series reporting outcomes following SRS for multiple brain metastases were identified by a literature search.Results36 patients, of whom 35 could be evaluated, received SRS for 5 or more brain metastases between February 2015 and October 2021. 25 patients had 5-9 brain metastases (group 1) and 10 patients had 10-15 brain metastases (group 2). The mean number of brain metastases in group 1 was 6.3 (5-9) and 12.3 (10-15) in group 2. The median cumulative irradiated volume was 4.6 cm3 (1.25-11.01) in group 1 and 7.2 cm3 (2.6-11.1) in group 2. Median follow-up was 12 months. At last follow-up, local control rates per BM were 100% and 99.8% as compared with a median of 87% at 1 year in published series. Distant brain failure was 36% and 50% at a median interval of 5.2 months and 7.4 months after SRS in groups 1 and 2 respectively and brain metastasis velocity at 1 year was similar in both groups (9.7 and 11). 8/25 patients received further SRS and 7/35 patients received whole brain radiotherapy. Median overall survival was 10 months in group 1 and 15.7 months in group 2, which compares well with the 7.5 months derived from the literature. There was one neurological death in group 2, leptomeningeal disease was rare (2/35) and there were no cases of radionecrosis.ConclusionWith careful patient selection, overall survival following SRS for multiple brain metastases is determined by the course of the extracranial disease. SRS is an efficacious and safe modality that can achieve intracranial disease control and should be offered to patients with 5 or more brain metastases and a constellation of good prognostic factors.

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Long-term disease outcome and volume-based decision strategy in a large cohort of multiple brain metastases treated with a mono-isocentric linac-based Stereotactic Radiosurgery technique

Cited by 17 publications

References 24 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

Outcomes in Patients With 4 to 10 Brain Metastases Treated With Dose-Adapted Single-Isocenter Multitarget Stereotactic Radiosurgery: A Prospective Study

Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature

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