Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1–3 cerebral metastases

Schüttrumpf, Lars; Niyazi, Maximilian; Nachbichler, Silke Birgit; Manapov, Farkhad; Jansen, Nathalie; Siefert, Axel; Belka, Claus

doi:10.1186/1748-717x-9-105

Cited by 43 publications

(48 citation statements)

References 27 publications

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“…As in previous reports (16), we found metachronous metastatic disease is one important risk factor for BM, however, despite the long survival until development of BM, survival after diagnosis of BM was only a median of 2.9 months (17,18). Our data also shows lung metastases and rectal cancer were associated with BM, and the location of the primary tumor may have a close relationship with the target organ of metastasis (2,19). These can be explained in part by the vascular anatomy of the colon and rectum.…”

Section: Discussionsupporting

confidence: 85%

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Cai

Liang

et al. 2019

BST

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Colorectal cancer (CRC) metastatic to the brain occurs rarely and remains highly lethal in clinical practice. The crude incidence of brain metastases (BM) from CRC is 0.27%, while in metastatic colorectal cancer, it increases to 1.36% (1). Besides, the occurrence rate of asymptomatic BM has been observed to increase simultaneously in past decades (2), which has been attributed to the improvement of multimodality therapy to extend survival of CRC and novel diagnostic radiographic techniques to detect small brain lesions (3,4). Unfortunately, the prognosis for CRC patients developed to BM is rather poor. Patients without any therapeutic intervention will only have a survival period of about 4 weeks after the occurrence of BM (5). In the past, whole brain radiation therapy (WBRT) and neurosurgery were usually used for the treatment of brain metastases (6), but the effect of radiotherapy or neurosurgery alone was unsatisfactory. Patients who underwent WBRT alone had a median survival of only 3-6 months (7,8), and the ability of neurosurgery to improve survival in patients with BM is not as effective as clinicians expected. Currently, the concept of multidisciplinary treatment has been widely accepted in the clinical diagnosis and treatment of CRC liver metastasis and lung metastasis (9,10), and proved that multidisciplinary treatment could bring significant survival benefits to those patients. Nevertheless, in CRC patients with BM, the concept of multidisciplinary treatment was not universal. The decision-making for treatment modalities is still empirical in patients with Summary Standard treatment options for brain metastases (BM) from colorectal cancer (CRC) are controversial. The purpose of this study was to evaluate the efficacy of multidisciplinary treatment modalities and provide optimal therapeutic strategies for selected patients with different clinical characteristics. All eligible patients diagnosed with BM from CRC during the past two decades (1997-2016) were identified in our center. Clinical characteristics, treatment modalities and relative survival were retrospectively analyzed. Median overall survival after the identification of BM was 6 months. The 1-and 2-year survival rates were 29.40% and 5.70%, respectively. On multivariate analysis, the number of BMs, Karnofsky performance score and the treatment modalities were found to be independent prognostic factors (the p-value was 0.006, 0.001 and < 0.001, respectively). In conclusion, multidisciplinary treatment is supported to be the optimal treatment for patients with BM from CRC. For patients with single brain metastases and KPS > 70, neurosurgery combined with chemotherapy could provide an additional survival benefit. For patients with multiple brain metastases or KPS ≤ 70, radiotherapy plus chemotherapy may be appropriate.

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Section: Discussionsupporting

confidence: 85%

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Cai

Liang

et al. 2019

BST

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“…These studies were not designed to robustly evaluate for the development of symptomatic radionecrosis and did not record asymptomatic treatment change. Multiple retrospective studies have reported higher rates of radionecrosis, ranging from 6.2 % to more than 30 % [3–7], likely reflecting differences in patient population, extent of follow up, and definition of radionecrosis.…”

Section: Discussionmentioning

confidence: 99%

Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases

et al. 2015

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Radionecrosis is a well-characterized effect of stereotactic radiosurgery (SRS) and is occasionally associated with serious neurologic sequelae. Here, we investigated the incidence of and clinical variables associated with the development of radionecrosis and related radiographic changes after SRS for brain metastases in a cohort of patients with long-term follow up. 271 brain metastases treated with single-fraction linear accelerator-based SRS were analyzed. Radionecrosis was diagnosed either pathologically or radiographically. Univariate and multivariate Cox regression was performed to determine the association between radionecrosis and clinical factors available prior to treatment planning. After median follow up of 17.2 months, radionecrosis was observed in 70 (25.8 %) lesions, including 47 (17.3 %) symptomatic cases. 22 of 70 cases (31.4 %) were diagnosed pathologically and 48 (68.6 %) were diagnosed radiographically. The actuarial incidence of radionecrosis was 5.2 % at 6 months, 17.2 % at 12 months and 34.0 % at 24 months. On univariate analysis, radionecrosis was associated with maximum tumor diameter (HR 3.55, p < 0.001), prior whole brain radiotherapy (HR 2.21, p = 0.004), prescription dose (HR 0.56, p = 0.02) and histology other than non-small cell lung, breast or melanoma (HR 1.85, p = 0.04). On multivariate analysis, only maximum tumor diameter (HR 3.10, p < 0.001) was associated with radionecrosis risk. This data demonstrates that with close imaging follow-up, radionecrosis after single-fraction SRS for brain metastases is not uncommon. Maximum tumor diameter on pre-treatment MR imaging can provide a reliable estimate of radionecrosis risk prior to treatment planning, with the greatest risk among tumors measuring >1 cm.

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“…Brain metastasis (BM) is the most common brain tumor leading to significant morbidity and mortality in patients with systemic malignancies. The median overall survival in patients with BM ranges between 5.7 and 15.2 months, based on the intervention . BM affects up to 40% of patients with a range of systemic malignancies and an incidence ranging between 8.3 and 14.3/100,000 populations based on epidemiological studies .…”

Section: Introductionmentioning

confidence: 99%

“…The median overall survival in patients with BM ranges between 5.7 and 15.2 months, based on the intervention . BM affects up to 40% of patients with a range of systemic malignancies and an incidence ranging between 8.3 and 14.3/100,000 populations based on epidemiological studies . With the increase in the incidence of systemic malignancies coupled with advances in systemic treatment regimens, BMs pose significant challenges to physicians managing these patients.…”

Section: Introductionmentioning

confidence: 99%

First follow‐up radiographic response is one of the predictors of local tumor progression and radiation necrosis after stereotactic radiosurgery for brain metastases

et al. 2017

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Local progression (LP) and radiation necrosis (RN) occur in >20% of cases following stereotactic radiosurgery (SRS) for brain metastases (BM). Expected outcomes following SRS for BM include tumor control/shrinkage, local progression and radiation necrosis. 1427 patients with 4283 BM lesions were treated using SRS at Cleveland Clinic from 2000 to 2012. Clinical, imaging and radiosurgery data were collected from the database. Local tumor progression and RN were the primary end points and correlated with patient and tumor‐related variables. 5.7% of lesions developed radiographic RN and 3.6% showed local progression at 6 months. Absence of new extracranial metastasis (P < 0.001), response to SRS at first follow‐up scan (local progression versus stable size (P < 0.001), partial resolution versus complete resolution at first follow up [P = 0.009]), prior SRS to the same lesion (P < 0.001), IDL% (≤55; P < 0.001), maximum tumor diameter (>0.9 cm; P < 0.001) and MD/PD gradient index (≤1.8, P < 0.001) were independent predictors of high risk of local tumor progression. Absence of systemic metastases (P = 0.029), good neurological function at 1st follow‐up (P ≤ 0.001), no prior SRS to other lesion (P = 0.024), low conformity index (≤1.9) (P = 0.009), large maximum target diameter (>0.9 cm) (P = 0.003) and response to SRS (tumor progression vs. stable size following SRS [P < 0.001]) were independent predictors of high risk of radiographic RN. Complete tumor response at first follow‐up, maximum tumor diameter <0.9 cm, tumor volume <2.4 cc and no prior SRS to the index lesion are good prognostic factors with reduced risk of LP following SRS. Complete tumor response to SRS, poor neurological function at first follow‐up, prior SRS to other lesions and high conformity index are favorable factors for not developing RN. Stable or partial response at first follow‐up after SRS have same impact on local progression and RN compared to those with complete resolution or progression.

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Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1–3 cerebral metastases

Cited by 43 publications

References 27 publications

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer

Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases

First follow‐up radiographic response is one of the predictors of local tumor progression and radiation necrosis after stereotactic radiosurgery for brain metastases

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