Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases

Patel, Ankur R.; Nedzi, Lucien A.; Lau, Steven; Barnett, Samuel L.; Mickey, Bruce; Moore, William; Bindal, Shivani; Wardak, Zabihullah; Dan, Tu; Timmerman, Robert; Patel, Toral

doi:10.1016/j.wneu.2018.08.107

Cited by 28 publications

(19 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In accordance with the pre-specified criteria, 7 retrospective cohort studies were included, categorized as level IIb of evidence ( Table 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ]. Quality assessment returned low risk of bias for all included articles, predisposing this study to an overall low risk of bias ( Supplementary File S1 ).…”

Section: Resultsmentioning

confidence: 99%

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Palmisciano

Ferini²,

Khan

et al. 2022

Cancers

View full text Add to dashboard Cite

Background: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were searched following the PRISMA guidelines to include studies and ongoing trials reporting NaSRT for BMs. Indications, protocols, and outcomes were analyzed using indirect random-effect meta-analyses. Results: We included 7 studies comprising 460 patients with 483 BMs, and 13 ongoing trials. Most BMs originated from non-small lung cell carcinoma (41.4%), breast cancer (18.7%) and melanoma (43.6%). Most patients had single-BM (69.8%) located supratentorial (77.8%). Patients were eligible if they had histologically-proven primary tumors and ≤4 synchronous BMs candidate for non-urgent surgery and radiation. Patients with primary tumors clinically responsive to radiotherapy, prior brain radiation, and leptomeningeal metastases were deemed non-eligible. Median planning target volume was 9.9 cm3 (range, 2.9–57.1), and NaSRT was delivered in 1-fraction (90.9%), 5-fraction (4.8%), or 3-fraction (4.3%), with a median biological effective dose of 39.6 Gy10 (range, 35.7–60). Most patients received piecemeal (76.3%) and gross-total (94%) resection after a median of 1-day (range, 1–10) post-NaSRT. Median follow-up was 19.2-months (range, 1–41.3). Actuarial post-treatment rates were 4% (95%CI: 2–6%) for symptomatic radiation necrosis, 15% (95%CI: 12–18%) and 47% (95%CI: 42–52%) for local and distant recurrences, 6% (95%CI: 3–8%) for leptomeningeal metastases, 81% (95%CI: 75–87%) and 59% (95%CI: 54–63%) for 1-year local tumor control and overall survival. Conclusion: NaSRT is effective and safe for BMs. Ongoing trials will provide high-level evidence on long-term post-treatment outcomes, further compared to adjuvant stereotactic radiotherapy.

show abstract

Section: Resultsmentioning

confidence: 99%

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Palmisciano

Ferini²,

Khan

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…RN data was not provided. Additional single institution studies, some with mixed prospective and retrospective cohorts, have observed symptomatic RN, MD, and 1-year LF rates of 0-5%, 0-17%, and 14-50% with pre-operative techniques [16][17][18][19] . One retrospective analysis compared outcomes for preoperative versus postoperative SRS.…”

Section: Discussionmentioning

confidence: 99%

Comparing Pre-Operative Versus Post-Operative Single and Fractionated Stereotactic Radiotherapy for Patients with Resectable Brain Metastases

Perlow

Matsui

et al. 2022

Preprint

View full text Add to dashboard Cite

BackgroundThe standard treatment for patients with large brain metastases and limited intracranial disease is surgical resection and post-operative stereotactic radiosurgery (SRS). However, post-operative SRS still has elevated rates of local failure (LF) and is complicated by radiation necrosis (RN), and meningeal disease (MD). Pre-operative SRS may reduce the risk of RN and MD, while fractionated therapy may improve local control through delivering a higher biological effective dose. We hypothesize that pre-operative fractionated stereotactic radiation therapy (FSRT) will have less toxicity compared to patients who receive post-operative SRS or FSRT. MethodsA multi-institutional analysis was conducted and included patients who had surgical resection and stereotactic radiation therapy to treat at least one brain metastasis. Pertinent demographic, clinical, radiation, surgical, and follow up data were collected for each patient. The primary outcome was a composite endpoint defined inclusive of events of 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. Results279 patients were eligible for analysis. The median follow-up time was 9 months. 87% of patients received fractionated treatment. 29% of patients received pre-operative treatment. The composite endpoint incidences for post-operative SRS (n = 10), post-operative FSRT (n = 189), pre-operative SRS (n = 27), and pre-operative FSRT (n = 53) were 0%, 17%, 15%, and 7.5%, respectively. ConclusionsIn our study, the composite endpoint of 7.5% for pre-operative FSRT compares favorably to our post-operative FSRT rate of 17%. Pre-operative FSRT was observed to have low rates of LF, MD, and RN. Prospective validation is needed.

show abstract

“…Neoadjuvant SRS allows a better definition of the target, with a potentially reduced risk of LMD (sterilizing microscopic disease) and RN compared to the adjuvant setting. Several single arm studies have collected retrospective and prospective data on neoadjuvant SRS, showing interesting efficacy and toxicity profile (including low rates of RN and LMD), but the small sample sizes are still inadequate to provide a robust evidence (51)(52)(53)(54)(55)(56). The recent PROPS-BM, a multicenter cohort study from 5 American institutions, represents the largest series of patients treated with neoadjuvant SRS to date.…”

Section: Neoadjuvant Srsmentioning

confidence: 99%

“…Several single arm studies have collected retrospective and prospective data on neoadjuvant SRS, showing interesting efficacy and toxicity profile (including low rates of RN and LMD), but the small sample sizes are still inadequate to provide a robust evidence ( 51 – 56 ).…”

Section: Rt Complementary To Surgerymentioning

confidence: 99%

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

et al. 2021

View full text Add to dashboard Cite

Brain metastases (BMs) represent the most frequent event during the course of Non-Small Cell Lung Cancer (NSCLC) disease. Recent advancements in the diagnostic and therapeutic procedures result in increased incidence and earlier diagnosis of BMs, with an emerging need to optimize the prognosis of these patients through the adoption of tailored treatment solutions. Nowadays a personalized and multidisciplinary approach should rely on several clinical and molecular factors like patient’s performance status, extent and location of brain involvement, extracranial disease control and the presence of any “druggable” molecular target. Radiation therapy (RT), in all its focal (radiosurgery and fractionated stereotactic radiotherapy) or extended (whole brain radiotherapy) declinations, is a cornerstone of BMs management, either alone or combined with surgery and systemic therapies. Our review aims to provide an overview of the many modern RT solutions available for the treatment of BMs from NSCLC in the different clinical scenarios (single lesion, oligo and poly-metastasis, leptomeningeal carcinomatosis). This includes a detailed review of the current standard of care in each setting, with a presentation of the literature data and of the possible technical solutions to offer a “state-of-art” treatment to these patients. In addition to the validated treatment options, we will also discuss the future perspectives on emerging RT technical strategies (e.g., hippocampal avoidance whole brain RT, simultaneous integrated boost, radiosurgery for multiple lesions), and present the innovative and promising findings regarding the combination of novel targeted agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with brain irradiation.

show abstract

Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases

Cited by 28 publications

References 28 publications

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Comparing Pre-Operative Versus Post-Operative Single and Fractionated Stereotactic Radiotherapy for Patients with Resectable Brain Metastases

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

Contact Info

Product

Resources

About