Reirradiation for progressive brain metastases

Bahl, Amit; Kumar, Mohan; Sharma, Daya Nand; Basu, Koushik; Jaura, Maninder Singh; Rath, Goura Kishor; Julka, P.K.

doi:10.4103/0973-1482.57120

Cited by 12 publications

(7 citation statements)

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“…Considering that only a certain number of patients can benefit from an active retreatment with SRS, it is necessary an appropriate patient selection. Generally, selection is based on good KPS, absence of debilitating neurologic deficits, 1–4 BM, primary controlled and/or indolent disease, and previous WBRT carried out at least 4–6 months before reirradiation [1] , [2] , [8] , [24] , [25] . These selection criteria should be adopted not only when reirradiation of BM was done with no dedicated linear accelerators but also with dedicated machines as GammaKnife or CyberKnife [26] .…”

Section: Discussionmentioning

confidence: 99%

A prospective phase II trial on reirradiation of brain metastases with radiosurgery

Maranzano

Terenzi

Anselmo

et al. 2019

Clinical and Translational Radiation Oncology

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Highlights Reirradiation with radiosurgery of brain metastases is feasible and safe. Good KPS and controlled systemic disease are most important selection criteria. An accurate patient selection is essential to avoid brain toxicity. If diameter is ≤ 2 cm and dose ≤ 20 Gy local control is high without late toxicity.

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Section: Discussionmentioning

confidence: 99%

A prospective phase II trial on reirradiation of brain metastases with radiosurgery

Maranzano

Terenzi

Anselmo

et al. 2019

Clinical and Translational Radiation Oncology

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“…Application of QUARTZ trial in clinical practice has shown that gender, performance status and EGFR mutation had impact on survival (10). However, almost half of the patients treated with WBRT gradually develop progressive intracranial disease (11). The median survival of lung cancer patients with brain metastases is around 4 months (12).…”

Section: Brain Re-irradiation In Lung Cancer -Not An Exercise In Futimentioning

confidence: 99%

“…Re-irradiation (re-RT) in such patients can be offered using WBRT, partial brain radiotherapy (RT) or high dose conformal stereotactic radiotherapy (SRT). But considering tolerance dose of brain and weighing the risk-benefit ratio of re-RT, only 3-10% of patients are offered re-RT (11).…”

Section: Brain Re-irradiation In Lung Cancer -Not An Exercise In Futimentioning

confidence: 99%

Brain Re-Irradiation in Lung Cancer – Not an Exercise in Futility

Agarwal

Karmakar

Tibdewal

et al. 2020

Preprint

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BACKGROUND: Whole brain radiation therapy (WBRT) is an effective palliative measure and provides durable symptom relief in lung cancer patients with multiple brain metastases (BM). Clinico radiological progression of BM after WBRT is a common and challenging scenario; treatment is tailored, with various factors like driver mutation status, age, performance status, progression free interval and time since last irradiation influencing the treatment decision. Surgery or focal RT with stereotactic techniques may be an option for patients with oligometastases. However, they might not be a feasible option for patients with multiple BM. We aim to study the impact and outcome of patients with BM from lung cancer receiving reWBRT for clinico-radiological progression. MATERIALS AND METHODS: We retrospectively analyzed patients with BM from lung cancer who were registered at Tata Memorial Hospital, Mumbai, India between January 2016 to January 2019 and had undergone two courses of WBRT. Data of patients were retrieved from electronic medical records. Patients were treated using conventional or conformal technique with either telecobalt or Linear accelerator. RESULTS: Out of 446 patients with lung cancer, diagnosed and treated with WBRT for BM, 6% patients (n=28) received reWBRT. There were 16 men and 12 women with a median age of 53 years (range 30 to 70 years). Primary histology was adenocarcinoma in all except two patients who had small cell histology. Eighteen patients had driver mutation positive disease (11 with EGFR and 7 with ALK mutation) and a majority of patients (54%) had BM at presentation. Clinico-radiological progression was the commonest indication of re-WBRT. A majority of these patients had developed new symptoms while about 25% had recurrence of previous symptoms. Mean Karnofsky performance score (KPS) prior to re-WBRT was more than 70 in 13 patients (57%). Mean time interval between the two courses of WBRT were 16 months (range 5 to 37 months). Most patients received WBRT using a conventional technique (91%) and were treated in a telecobalt unit (83%). Re-WBRT fractionation schedule was 25 Gy in 10 fractions (n=17, 61%) or 20 Gy in 5 fractions (n=10, 36%). Mean biological effective dose (BED2Gy) for the first and second courses of WBRT were 63Gy and 56Gy respectively. The average cumulative BED2Gy was 118.91Gy (range 116.25 to 120Gy). Almost all patients received short acting steroids during the course of reWBRT. All patients except for one completed the course of treatment. At a median follow up of 2.5 years, median survival of patients after reWBRT was 5 months. Median survival since reWBRT was 8 months if pre first course of WBRT ds-GPA was 3.5-4 vs 1 month if it was 0-1 (p= 0.025). CONCLUSION: In lung cancer patients with symptomatic progression of multiple BM and good prognostic features (driver mutation positive, good performance status and long time interval since last WBRT), re-WBRT is safe and associated with better outcomes.

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“…More than half the patients who are treated for brain metastases will in their lifetime eventually present with progressive disease in the brain, and more and more often as the only site of progression 18. Patients present with multiple symptoms such as headache, motor deficit, impaired mentation and seizures, where headache being the most common presenting symptom at debut of brain metastases, while motor deficit is the most frequent symptom at recurrence 19.…”

Section: Introductionmentioning

confidence: 99%

Multiple brain metastases - current management and perspectives for treatment with electrochemotherapy

Linnert

Iversen

Gehl³

2012

Radiology and Oncology

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Background. Due to the advanced oncological treatments of cancer, an overall increase in cancer incidence, and better diagnostic tools, the incidence of brain metastases is on the rise. This review addresses the current treatment options for patients with multiple brain metastases, presenting electrochemotherapy (ECT) as one of the new experimental treatments for this group of patients.Conclusions. Neurosurgery, stereotactic surgery, and whole-brain radiotherapy are the evidence-based treatments that can be applied for patients with multiple brain metastases. Treatment with chemotherapy and molecularly targeted agents may also be warranted. Several experimental treatments are emerging, one of which is ECT, an effective cancer treatment comprising electric pulses given by electrodes in the tumor tissue, causing electroporation of the cell membrane, and thereby augmenting uptake and the cytotoxicity of the chemotherapeutic drug bleomycin by 300 times. Preclinical data are promising and the first patient has been treated in an ongoing clinical trial for patients with brain metastases. Perspectives for ECT in the brain include treatment of primary and secondary brain tumors as well as soft tissue metastases elsewhere.

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Reirradiation for progressive brain metastases

Cited by 12 publications

References 0 publications

A prospective phase II trial on reirradiation of brain metastases with radiosurgery

A prospective phase II trial on reirradiation of brain metastases with radiosurgery

Brain Re-Irradiation in Lung Cancer – Not an Exercise in Futility

Multiple brain metastases - current management and perspectives for treatment with electrochemotherapy

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