Management of initial and recurrent radiation-induced contrast enhancements following radiotherapy for brain metastases: Clinical and radiological impact of bevacizumab and corticosteroids

Meixner, Eva; Hörner-Rieber, Juliane; Lischalk, Jonathan W.; Eichkorn, Tanja; Krämer, Augustin; Sandrini, Elisabetta; Paul, Angela; Hoegen, Philipp; Deng, Maximilian; Welzel, Thomas; Erdem, Sinem; Debus, Jürgen; König, Laila

doi:10.1016/j.ctro.2023.100600

Cited by 5 publications

(6 citation statements)

References 40 publications

(50 reference statements)

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“…Eight fractions of the initial SRS may render the surrounding brain immune to a significant ARE after re-SRS with the high BED 10 . Bevacizumab, which was included in chemoimmunotherapy, could also attenuate AREs; however, mild radiation-induced edema appeared only in the right frontal lobe after discontinuation (Figures 6A - 6L , 7A - 7L ) [ 18 ]. Taken together, the criteria for determining the dominance of tumor regrowth and indication for re-SRS may include the following: insufficient GTV coverage (<98%) with a BED 10 of 80 Gy, relatively homogeneous GTV doses, and dose/fractionation selection with adequate consideration of brain tolerance and volume effects in prior mfSRS, in addition to progression with T1/T2 matching.…”

Section: Discussionmentioning

confidence: 99%

5-Fraction Re-radiosurgery for Progression Following 8-Fraction Radiosurgery of Brain Metastases From Lung Adenocarcinoma: Importance of Gross Tumor Coverage With Biologically Effective Dose ≥80 Gy and Internal Dose Increase

Ohtakara¹,

Tanahashi²,

Kamomae³

et al. 2023

Cureus

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The criteria for indication of salvage stereotactic radiosurgery (SRS) for local progression following multi-fraction (mf) SRS of brain metastases (BMs) remain controversial, along with the optimal planning scheme. Herein, we described a case of BMs from pan-negative lung adenocarcinoma (LAC), in which the two lesions of local progression following initial eight-fraction (8-fr) SRS were re-treated with 5-fr SRS with the biologically effective dose (BED 10 ) of ≥80 Gy, based on the linear-quadratic (LQ) formula with an alpha/beta ratio of 10. The re-SRS resulted in the alleviation of symptoms and favorable tumor responses with minimal adverse effects during the 7.3-month follow-up. In the lesions of local progression, the gross tumor volume (GTV) coverage with 49.6 Gy (BED 10 80 Gy) was generally insufficient, and the GTV dose wes relatively homogeneous with ≥87% isodose covering. In contrast, the 5-fr re-SRS was performed with sufficient GTV coverage with ≤68% isodose of 43 Gy (BED 10 80 Gy). Taken together, sufficient GTV coverage with a BED 10 of ≥80 Gy and steep dose increase inside the GTV boundary, that is, extremely inhomogeneous GTV dose, are important in 8-fr SRS for ensuring excellent local control of BMs from pan-negative LAC. For local progression following mfSRS that does not fulfill both criteria, re-SRS with the above planning scheme can be an efficacious and safe treatment option for at least six months, especially in cases in which the prior SRS was performed with a dose/fractionation under adequate consideration of brain tolerance. The BED 10 seems to be the most suitable for estimating the anti-tumor efficacies of SRS doses in 3-8 fr, similar to that of a single fraction of 24 Gy.

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Section: Discussionmentioning

confidence: 99%

5-Fraction Re-radiosurgery for Progression Following 8-Fraction Radiosurgery of Brain Metastases From Lung Adenocarcinoma: Importance of Gross Tumor Coverage With Biologically Effective Dose ≥80 Gy and Internal Dose Increase

Ohtakara¹,

Tanahashi²,

Kamomae³

et al. 2023

Cureus

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“…As with most high dose cerebral irradiations, there is a signi cant risk for radiation necrosis (RN) of brain tissue, especially after re-RT. Literature describes radiation induced contrast enhancement (RICE) as a term to morphologically describe said contrast enhancement in the brain tissue after RT, which can include blood-brain barrier lesions, pseudoprogression or even RN [14,15]. Since only neurosurgery and pathology can safely distinguish between the different RICE lesions but is not always safely amenable in patients -especially after multiple surgeries already -de nitive diagnosis and therefore treatment has proven to be di cult [14].…”

Section: Discussionmentioning

confidence: 99%

“…tissue (RICE)[14], all of which could be classi ed as CTCAE II°. Patient A had RICE after proton radiotherapy (60 Gy) in the primary situation.…”

mentioning

confidence: 99%

Efficacy and Toxicity of Photon, Proton, and Carbon Ion Radiotherapy in the Treatment of Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma

Ton,

Deng,

Meixner

et al. 2023

Preprint

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“…As CNS SFTs have a high tendency for recurrence [9], salvage therapies are also an active area of current research. Intracranial reirradiation carries high risks of toxicities and adverse events particularly when dose escalation is required [14,15]. Fortunately, modern radiation techniques and modalities could provide broadened options for re-RT in patients with recurrent SFTs.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and toxicity of photon, proton, and carbon ion radiotherapy in the treatment of central nervous system solitary fibrous tumor/hemangiopericytoma

Ton,

Deng,

Meixner

et al. 2024

Preprint

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Background Solitary fibrous tumors of the central nervous system are rare and treatment options are not well established. The aim of this study was to evaluate the clinical outcomes of radiotherapy and re-radiotherapy for de novo CNS-SFT and recurrent CNS-SFT.Methods This retrospective analysis included 35 patients (17 female, 18 male) who received RT for CNS-SFT at Heidelberg University Hospital between 2000 and 2020. Efficacy and toxicity of different RT modalities were analyzed in patients who received RT as primary treatment after de novo diagnosis (“primary group”). Of these patients, twelve developed a recurrence which was treated with re-RT (“recurrence group”). Median follow-up period was 54 months (0-282) in the primary group and 20.5 months (0–72) in the recurrence group. RT modalities included 3D-conformal RT, intensity-modulated RT, stereotactic radiosurgery, proton RT, and carbon-ion RT.Results The overall response rate was 40%, with 34% complete remissions and 6% partial remissions in the primary group, and 25% complete remissions and 17% partial remissions in the recurrence group. The 1-, 3-, and 5-year progression-free survival rates were 100%, 96%, and 86%, respectively, in the primary group, and 81%, 14%, and 14%, respectively, in the recurrence group. Proton therapy was associated with a lower likelihood of developing a recurrence in the primary setting than photon therapy (OR = 0.38; p = 0.002), likely due to higher RT-doses (median 60 Gy vs 56.43 Gy). Odds ratio for tumor recurrence was higher for women than for men (OR = 8.07; p = 0.014) with men having a median PFS of 136.3 months, compared to women with 66.2 months.Conclusion The data suggests RT as an effective treatment option for CNS-SFT, with high LPFS and PFS rates. Proton therapy may be associated with a lower risk of recurrence in the primary setting, likely due to the feasibility of higher RT-dose appliance.

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Management of initial and recurrent radiation-induced contrast enhancements following radiotherapy for brain metastases: Clinical and radiological impact of bevacizumab and corticosteroids

Cited by 5 publications

References 40 publications

5-Fraction Re-radiosurgery for Progression Following 8-Fraction Radiosurgery of Brain Metastases From Lung Adenocarcinoma: Importance of Gross Tumor Coverage With Biologically Effective Dose ≥80 Gy and Internal Dose Increase

5-Fraction Re-radiosurgery for Progression Following 8-Fraction Radiosurgery of Brain Metastases From Lung Adenocarcinoma: Importance of Gross Tumor Coverage With Biologically Effective Dose ≥80 Gy and Internal Dose Increase

Efficacy and Toxicity of Photon, Proton, and Carbon Ion Radiotherapy in the Treatment of Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma

Efficacy and toxicity of photon, proton, and carbon ion radiotherapy in the treatment of central nervous system solitary fibrous tumor/hemangiopericytoma

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