Recent Advances and Applications of Radiation Therapy for Brain Metastases

Mathis, Noah J.; Wijetunga, N. Ari; Imber, Brandon S.; Pike, Luke; Yang, Jonathan T.

doi:10.1007/s11912-022-01209-z

Cited by 12 publications

(9 citation statements)

References 68 publications

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“…Based on randomized studies comparing SRS vs WBRT plus SRS, SRS is the current recommended treatment in patients with a limited number of BM (1–4). Its use has been conditionally recommended up to 10 BM in patients with good performance status [ 4 , 36 , 37 ], by using different approaches, including different monoisocentric techniques [ 38 ]. In the present analysis, SRS, given as single-fraction or fractionated schedule (2–5 fractions), is one of the most investigated radiation techniques used in interventional clinical trials for BM as either exclusive treatment or in combination with systemic therapy and surgery.…”

Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for brain metastases: analysis of ClinicalTrials.gov

et al. 2023

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Background The management of brain metastases (BM), the major cause of cancer morbidity and mortality, is becoming an emerging area of interest. Surgery, whole brain radiation therapy (WBRT), or stereotactic radiosurgery (SRS), have historically been the main focal treatments for BM. However, the introduction of innovative targeted- and immune-based therapies is progressively changing the paradigm of BM treatment, resulting in an increase in clinical trials investigating new therapeutic strategies. Methods Using ClinicalTrials.gov, the largest clinical trial registry with over 400,000 registered trials, we performed an analysis of phase II and phase III ongoing trials evaluating different systemic therapies, radiotherapy (RT), and surgery given alone or in combination in patients with BM. Results One hundred sixty-eight trials, 133 phase II and 35 phase III; the largest part having primarily the curative treatment of patients with BM from lung cancer, breast cancer and melanoma, were selected. One hundred sixty-three trials used systemic therapies. One hundred thirteen used tyrosine kinase inhibitors, more frequently Osimertinib, Icotinib and Pyrotinib, 50 used monoclonal antibodies, more frequently Trastuzumab, Pembrolizumab, Nivolumab, 20 used conventional chemotherapies whilst no oncological active drugs were used in 6 trials. Ninety-six trials include RT; 54 as exclusive treatment and 42 in combination with systemic therapies. Conclusion Systemic targeted- and/or immune-based therapies, combined or not with RT, are increasingly used in the routine of BM treatment. SRS is progressively replacing WBRT. All these trials intend to address multiple questions on the management of patients with BMs, including the recommended upfront treatment for different cancer histologies and the optimal timing between systemic therapies and radiation regarding brain control and neurocognitive outcome and quality of life.

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Section: Discussionmentioning

confidence: 99%

Current status and perspectives of interventional clinical trials for brain metastases: analysis of ClinicalTrials.gov

et al. 2023

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“…In terms of risk factors for RN, previous studies usually paid more attention to the CRT dose and volume [20][21][22] . Korytko et al analyzed the risk of RN and showed that when the cumulative dose reached 72 Gy and the dose per fraction was 2 Gy, the rate of RN reached > 5% [23] .…”

Section: Discussionmentioning

confidence: 99%

Brain Injury after Cranial Radiotherapy Combined with Immunotherapy for Brain Metastases in Lung Cancer: A Retrospective Study

et al. 2023

Future Oncol.

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Aim: To explore whether immune checkpoint inhibitors (ICIs) increase the incidence of radiation-induced brain injury in lung cancer patients with brain metastases. Methods: According to whether they received ICIs within 6 months before and after cranial radiotherapy (CRT), all patients were divided into two groups: ICIs + CRT group and CRT + non-ICIs group. Results: The incidence of radiation necrosis (RN) in the CRT + ICIs group was 14.3%, while that in the CRT + non-ICIs group was 5.8% (p = 0.090). If ICIs were used within 3 months of CRT, there was statistical significance. A maximum diameter of brain metastasis >3.3 cm and cumulative radiation dose of metastatic lesions >75.7 Gy were risk factors for RN. Conclusion: ICIs could increase the risk of RN, especially when used within 3 months of CRT.

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“…Twelve non hippocampal regions discovered in our study, such as the left IFGoperc, right SFGmedial, right PHG, right FFG and left MTG, that are associated with cognitive changes after radiotherapy should be delineated as dose-avoidance ROIs for cognitive function protection. Alternatively, the brain RT field has gradually moved toward more personalized treatment for BM, with a trend of increased utility of SRS or stereotactic radiotherapy (SRT) and a decrease in WBRT ( 40 ). This allows better dose sparing to the normal brain and thus better protection to those functional areas ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

Whole brain atlas-based diffusion kurtosis imaging parameters for the evaluation of multiple cognitive-related brain microstructure injuries after radiotherapy in lung cancer patients with brain metastasis

Xie¹,

Feng²,

Rong³

et al. 2023

Quant Imaging Med Surg

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Background Whole brain radiation therapy (WBRT) can cause cognitive dysfunctions in lung cancer patients with brain metastasis (BM). Diffusion kurtosis imaging (DKI) can detect brain microstructural alterations sensitivly. We aimed to identify the potential of DKI parameters for early radiation-induced brain injury and investigate the association between microstructure changes and neurocognitive function (NCF) decline. Methods Lung cancer patients with BM (n=35) who underwent WBRT in a single center in Zhejiang, China, were consecutively and prospectively enrolled between June 24th, 2020 and December 22nd, 2021, and the median follow-up time was 6.0 months (3.6–6.6 months). DKI and T1-weighted (T1W) MRI scans were acquired prior to and following WBRT. Diffusivity-based (mean diffusivity, MD; fractional anisotropy, FA) and kurtosis-based (mean kurtosis, MK; axial kurtosis, AK) parameters were calculated within the automated anatomical labeling (AAL) atlas-based regions. Reliable change indices practice effects (RCI-PE) scores of the Mini-Mental State Examination (MMSE) were calculated to determine significant neurocognitive decline by a one-sample t -test from baseline to 2–6 months post-WBRT. To assess the subacute induced effects within the whole brain, percentage changes of DKI parameters were evaluated at 170 atlas-based regions by a one-sample t -test. Linear regression analyses were used to evaluate the association between DKI parameter changes and RCI-PE scores. Results Finally, the study included 19 patients in the longitudinal follow-up. RCI-PE scores declined at 2–6 months post-WBRT (mean RCI-PE =−0.842, 95% CI, −0.376 to −1.310; P=0.002). With the atlas-based analysis of subacute effects after post-WBRT, a total of 28 regions changed in at least one diffusion parameter, revealing region-wise microstructural alterations in the brain. Significant correlations of at least one diffusion parameters with RCI-PEs were observed in 9 regions, such as the right orbital part of the inferior frontal gyrus [right IFGorb, r(AK) =0.47, P=0.03] and left middle temporal gyrus [left MTG, r(MK) =−0.49, P=0.03]. Conclusions DKI parameters can be used to detect early microstructure changes and represent important imaging predictors for cognitive decline. The reported 9 regions are more particularly vulnerable to neurocognitive radiation-induced impairment for lung cancer patients with BM, representing potential dose-avoidance targets for cognitive function preservation.

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Recent Advances and Applications of Radiation Therapy for Brain Metastases

Cited by 12 publications

References 68 publications

Current status and perspectives of interventional clinical trials for brain metastases: analysis of ClinicalTrials.gov

Current status and perspectives of interventional clinical trials for brain metastases: analysis of ClinicalTrials.gov

Brain Injury after Cranial Radiotherapy Combined with Immunotherapy for Brain Metastases in Lung Cancer: A Retrospective Study

Whole brain atlas-based diffusion kurtosis imaging parameters for the evaluation of multiple cognitive-related brain microstructure injuries after radiotherapy in lung cancer patients with brain metastasis

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