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

Palmisciano, Paolo; Ferini, Gianluca; Khan, Ramlah; Bin-Alamer, Othman; Umana, Giuseppe Emmanuele; Yu, Kenny; Cohen-Gadol, Aaron; Ahmadieh, Tarek Y. El; Haider, Ali S

doi:10.3390/cancers14174328

Cited by 8 publications

(7 citation statements)

References 50 publications

(105 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As other studies have shown the risk of radionecrosis to be dose-dependent, some therapeutic strategies using de-escalated doses and subsequent surgery (neoadjuvant SRS) or staged dosing over some weeks (staged SRS) might be safer options than definitive SRS in certain conditions. 33 , 34 In addition, since the radionecrosis risk depends on the proportion of the healthy brain tissue exposed to high radiation doses, some SRS techniques, which are characterized by greater dose conformity than that in our study, might determine better outcomes than ours. 35 - 37 However, this assumption should be addressed in specific trials.…”

Section: Discussionmentioning

confidence: 67%

Clinical Outcomes of Stereotactic Radiosurgery-Related Radiation Necrosis in Patients with Intracranial Metastasis from Melanoma

Thomson

Ensign

Edmonds

et al. 2023

Clin Med Insights Oncol

View full text Add to dashboard Cite

Background: Radiation necrosis (RN) is a clinically relevant complication of stereotactic radiosurgery (SRS) for intracranial metastasis (ICM) treatments. Radiation necrosis development is variable following SRS. It remains unclear if risk factors for and clinical outcomes following RN may be different for melanoma patients. We reviewed patients with ICM from metastatic melanoma to understand the potential impact of RN in this patient population. Methods: Patients who received SRS for ICM from melanoma at Mayo Clinic Arizona between 2013 and 2018 were retrospectively reviewed. Data collected included demographics, tumor characteristics, radiation parameters, prior surgical and systemic treatments, and patient outcomes. Radiation necrosis was diagnosed by clinical evaluation including brain magnetic resonance imaging (MRI) and, in some cases, tissue evaluation. Results: Radiation necrosis was diagnosed in 7 (27%) of 26 patients at 1.6 to 38 months following initial SRS. Almost 92% of all patients received systemic therapy and 35% had surgical resection prior to SRS. Patients with RN trended toward having larger ICM and a prior history of surgical resection, although statistical significance was not reached. Among patients with resection, those who developed RN had a longer period between surgery and SRS start (mean 44 vs 33 days). Clinical improvement following treatment for RN was noted in 2 (29%) patients. Conclusions: Radiation necrosis is relatively common following SRS for treatment of ICM from metastatic melanoma and clinical outcomes are poor. Further studies aimed at mitigating RN development and identifying novel approaches for treatment are warranted.

show abstract

Section: Discussionmentioning

confidence: 67%

Clinical Outcomes of Stereotactic Radiosurgery-Related Radiation Necrosis in Patients with Intracranial Metastasis from Melanoma

Thomson

Ensign

Edmonds

et al. 2023

Clin Med Insights Oncol

View full text Add to dashboard Cite

show abstract

“…Lung-molGPA reportedly provides a better predictive value, suggesting that lung-molGPA can comprehensively and accurately reflect the prognosis of NSCLC complicated by brain metastases ( 24 , 28 – 30 ). These also suggest the importance of individualized therapy for craniocerebral radiotherapy ( 12 , 31 – 33 ). Moreover, most previous retrospective studies have shown that EGFR-TKI concurrently administered with radiotherapy was more effective than treatment with EGFR-TKI alone, which was not consistent with the results of our study ( 10 , 19 , 34 , 35 ).…”

Section: Discussionmentioning

confidence: 96%

Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

Deng

Tan

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

Background and PurposeEpidermal growth factor receptor (EGFR)-mutant lung cancers are associated with a high risk of developing brain metastases (BM). Craniocerebral radiotherapy is a cornerstone for the treatment of BM, and EGFR-TKIs act on craniocerebral metastases”. However, whether EGFR-TKIs combined with craniocerebral radiotherapy can further increase the efficacy and improve the prognosis of patients is unclear. This study aimed to evaluate the difference in efficacy between targeted-therapy alone and targeted-therapy combined with radiotherapy in EGFR-mutant lung adenocarcinoma patients with BM.Materials and MethodsA total of 291 patients with advanced non-small cell lung cancer (NSCLC) and EGFR mutations were enrolled in this retrospective cohort study. Propensity score matching (PSM) was conducted using a nearest-neighbor algorithm (1:1) to adjust for demographic and clinical covariates. Patients were divided into two groups: EGFR-TKIs alone and EGFR-TKIs combined with craniocerebral radiotherapy. Intracranial progression-free survival (iPFS) and overall survival (OS) were calculated. Kaplan–Meier analysis was used to compare iPFS and OS between the two groups. Brain radiotherapy included WBRT, local radiotherapy, and WBRT+Boost.ResultsThe median age at diagnosis was 54 years (range: 28–81 years). Most patients were female (55.9%) and non-smokers (75.5%). Fifty-one pairs of patients were matched using PSM. The median iPFS for EGFR-TKIs alone (n=37) and EGFR-TKIs+craniocerebral radiotherapy (n=24) was 8.9 and 14.7 months, respectively. The median OS for EGFR-TKIs alone (n=52) and EGFR-TKIs+craniocerebral radiotherapy (n=52) was 32.1 and 45.3 months, respectively.ConclusionIn EGFR-mutant lung adenocarcinoma patients with BM, targeted therapy combined with craniocerebral radiotherapy is an optimal treatment.

show abstract

“…By allowing the 3 physicians to delineate brain metastases based on the contours generated initially with our AI tool, the contouring time was reduced by 60%, with the contouring accuracy being improved. The resulting time savings could also be useful for streamlining therapeutic strategies that require timely contouring interventions, such as in neoadjuvant SRS ( 29 ). These findings suggest that our AI tool can be useful in performing single brain metastasis contouring for GK planning in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a fully automatic tissue delineation model for brain metastasis using a deep neural network

Zhao,

Cao,

Chen

et al. 2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

Background Stereotactic radiosurgery (SRS) treatment planning requires accurate delineation of brain metastases, a task that can be tedious and time-consuming. Although studies have explored the use of convolutional neural networks (CNNs) in magnetic resonance imaging (MRI) for automatic brain metastases delineation, none of these studies have performed clinical evaluation, raising concerns about clinical applicability. This study aimed to develop an artificial intelligence (AI) tool for the automatic delineation of single brain metastasis that could be integrated into clinical practice. Methods Data from 426 patients with postcontrast T1-weighted MRIs who underwent SRS between March 2007 and August 2019 were retrospectively collected and divided into training, validation, and testing cohorts of 299, 42, and 85 patients, respectively. Two Gamma Knife (GK) surgeons contoured the brain metastases as the ground truth. A novel 2.5D CNN network was developed for single brain metastasis delineation. The mean Dice similarity coefficient (DSC) and average surface distance (ASD) were used to assess the performance of this method. Results The mean DSC and ASD values were 88.34%±5.00% and 0.35±0.21 mm, respectively, for the contours generated with the AI tool based on the testing set. The DSC measure of the AI tool’s performance was dependent on metastatic shape, reinforcement shape, and the existence of peritumoral edema (all P values <0.05). The clinical experts’ subjective assessments showed that 415 out of 572 slices (72.6%) in the testing cohort were acceptable for clinical usage without revision. The average time spent editing an AI-generated contour compared with time spent with manual contouring was 74 vs. 196 seconds, respectively (P<0.01). Conclusions The contours delineated with the AI tool for single brain metastasis were in close agreement with the ground truth. The developed AI tool can effectively reduce contouring time and aid in GK treatment planning of single brain metastasis in clinical practice.

show abstract

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

Cited by 8 publications

References 50 publications

Clinical Outcomes of Stereotactic Radiosurgery-Related Radiation Necrosis in Patients with Intracranial Metastasis from Melanoma

Clinical Outcomes of Stereotactic Radiosurgery-Related Radiation Necrosis in Patients with Intracranial Metastasis from Melanoma

Effect of EGFR-TKIs combined with craniocerebral radiotherapy on the prognosis of EGFR-mutant lung adenocarcinoma patients with brain metastasis: A propensity-score matched analysis

Development and validation of a fully automatic tissue delineation model for brain metastasis using a deep neural network

Contact Info

Product

Resources

About