Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: Initial report of radiation therapy oncology group protocol 90-05

Shaw, Edward G.; Scott, Charles; Souhami, Luís; Dinapoli, Robert P.; Bahary, Jean Paul; Kline, Robert W.; Wharam, Moody D.; Schultz, Christopher G.; Davey, Phillip; Loeffler, Jay S.; Rowe, John Del; Marks, Lawrence B.; Fisher, Barbara; Shin, Kyu H.

doi:10.1016/0360-3016(95)02106-x

Cited by 252 publications

(109 citation statements)

References 15 publications

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“…Initial prospective results from the Radiation Therapy Oncology Group (RTOG) 90-05 trial suggested a local control advantage to GK SRS. 16 However, there were no significant survival differences between GK SRS and LINAC SRS in subgroup analysis of the more recent RTOG 95-08 study, although patients were not stratified by SRS modality prerandomization. 4 It should be noted that even though GK SRS was previously reimbursed more than twice as much as LINAC SRS, Section 634 of the American Taxpayer Relief Act of 2012 equalized reimbursement between the 2 modalities.…”

Section: Discussionmentioning

confidence: 93%

Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Park¹,

Wang²,

Rutter³

et al. 2016

JNS

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Stereotactic radiosurgery (SRS) has become highly desirable as first-line or salvage treatment for patients with limited brain metastases from non-small cell lung cancer (NSCLC) due to minimization of treatment-related morbidity. The addition of single-dose SRS to whole-brain radiotherapy improves local tumor control and maintenance of performance status for these patients, with a potential overall survival benefit in patients with a single metastasis. 4,10 In facilities where sensitive serial surveillance imaging with MRI and effective salvage therapies for intracranial failures are available, SRS without upfront whole-brain radiotherapy is increasingly being abbreviatioNs AOR = adjusted odds ratio; GK = Gamma Knife; LINAC = linear accelerator; NCDB = National Cancer Data Base; NSCLC = non-small cell lung cancer; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery. obJective Single-fraction stereotactic radiosurgery (SRS) is a crucial component in the management of limited brain metastases from non-small cell lung cancer (NSCLC). Intracranial SRS has traditionally been delivered using a framebased Gamma Knife (GK) platform, but stereotactic modifications to the linear accelerator (LINAC) have made an alternative approach possible. In the absence of definitive prospective trials comparing the efficacy and toxicities of treatment between the 2 techniques, nonclinical factors (such as technology accessibility, costs, and efficiency) may play a larger role in determining which radiosurgery system a facility may choose to install. To the authors' knowledge, this study is the first to investigate national patterns of GK SRS versus LINAC SRS use and to determine which factors may be associated with the adoption of these radiosurgery systems. methods The National Cancer Data Base was used to identify patients > 18 years old with NSCLC who were treated with single-fraction SRS to the brain between 2003 and 2011. Patients who received "SRS not otherwise specified" or who did not receive a radiotherapy dose within the range of 12-24 Gy were excluded to reduce the potential for misclassification. The chi-square test, t-test, and multivariable logistic regression analysis were used to compare potential demographic, clinicopathologic, and health care system predictors of GK versus LINAC SRS use, when appropriate. results This study included 1780 patients, among whom 1371 (77.0%) received GK SRS and 409 (23.0%) underwent LINAC SRS. Over time, the proportion of patients undergoing LINAC SRS steadily increased, from 3.2% in 2003 to 30.8% in 2011 (p < 0.001). LINAC SRS was adopted more rapidly by community versus academic facilities (overall 29.2% vs 17.2%, p < 0.001). On multivariable analysis, 4 independent predictors of increased LINAC SRS use emerged, including year of diagnosis in 2008-2011 versus 2003-2007 2.04, 95% CI 1.52-2.73, p < 0.001), community versus academic facility type (AOR 2.04, 95% CI 1.60-2.60, p < 0.001), non-West versus West geographic location (AOR 4.50, 95% CI 2.87-7.09, p < 0.001), ...

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Section: Discussionmentioning

confidence: 93%

Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Park¹,

Wang²,

Rutter³

et al. 2016

JNS

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“…The RTOG 90-05 study was initiated to study the maximum tolerable dose of single-fraction SRS in patients with previously irradiated primary brain tumors or brain metastases [50]. Multivariate analysis showed that maximum tumor diameter was associated with a significantly greater risk of grade 3, 4, or 5 neurotoxicity.…”

Section: Repeat Cranial Irradiationmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

144

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The brain, cranial nerves, leptomeninges, spinal cord, and eye compose the central nervous system (CNS) and are at risk for the development of metastases from breast cancer. Such metastases are diagnosed on the basis of clinical suspicion and substantiated by neuroimaging, resection when indicated, and sampling of cerebrospinal fluid when leptomeningeal metastasis (LM) is suspected. Treatment is aimed at palliation of symptoms and preservation of neurologic function. Historically, conventional radiation therapy has been the mainstay of palliative treatment for brain, cranial nerve, spinal cord, and ocular metastases. However, additional treatment options for brain metastases have been brought about by technological advances in surgery to resect brain metastases, and stereotactic radiosurgery (SRS) to focally irradiate metastases, both of which have been substantiated by data from randomized trials. Ongoing research is aimed at refining criteria to select which patients with brain metastases should undergo surgery and SRS and how these focal therapies should be optimally integrated with whole-brain radiotherapy. Therapy for LM must carefully balance the potential risks and perceived benefits associated with CNS-directed therapies. Despite advances in neuroimaging, surgery, and radiation therapy, novel treatments are needed to improve the effectiveness of treatments for CNS metastases, especially LM, while reducing attendant neurotoxicity.

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“…Only 9% of all patients were symptomatic from these imaging changes, which is in keeping with the reports of others. Symptomatic radionecrosis was reported as 0% by Gannet [7] and 6% by Shaw [4]. All patients with symptom progression had high-grade primary tumors, and all patients received external-beam irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…Shaw et al [4], analyzed 102 patients treated on RTOG 90-05 on which previously irradiated patients with recurrent primary brain tumors or recurrent brain metastases with a diameter of 40 mm or less were treated with radiosurgery (Gamma Knife or linear accelerator). The dose varied according to tumor size and ranged from 12-21 Gy.…”

Section: Discussionmentioning

confidence: 99%

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Gamma Knife Radiosurgery for Large Volume Brain Tumors: An Analysis of Acute and Chronic Toxicity

Linzer

Ling

Villalobos³

et al. 1998

Stereotact Funct Neurosurg

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Gamma Knife radiosurgery is often used to treat intracranial tumors <4 cm (approximately 13.5 cm³) in mean diameter. Larger lesions are rarely treated because of the expectation that increasing target volume will increase toxicity. We retrospectively analyzed 35 patients with primary or metastatic brain tumors of more than 13.5 cm³ treated with the Gamma Knife. Only 3 (8.5%) patients developed acute clinical toxicity. Nine (25%) patients developed post-Gamma Knife radionecrosis based on imaging studies, with only 3 of these patients (9% of the study population) having clinical progression of symptoms. Necrosis was not found to be related to prescribed dose, treatment volume or number of treated isocenters. We found no undue toxicity from the treatment of large brain tumors with the Gamma Knife.

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Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: Initial report of radiation therapy oncology group protocol 90-05

Cited by 252 publications

References 15 publications

Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Gamma Knife Radiosurgery for Large Volume Brain Tumors: An Analysis of Acute and Chronic Toxicity

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