Repeat Stereotactic Radiosurgery for Recurred Metastatic Brain Tumors

Abstract

ObjectiveWe investigated the outcomes of repeat stereotactic radiosurgery (SRS) for metastatic brain tumors that locally recurred despite previous SRS, focusing on the tumor control. MethodsA total of 114 patients with 176 locally recurring metastatic brain tumors underwent repeat SRS after previous SRS. The mean age was 59.4 years (range, 33 to 85), and there were 68 male and 46 female patients. The primary cancer types were non-small cell lung cancer (n=67), small cell lung cancer (n=12), gastrointestinal tract cancer (n=15), breast cancer (n=10), and others (n=10). The number of patients with a single recurring metastasis was 95 (79.8%), and another 19 had multiple recurrences. At the time of the repeat SRS, the mean volume of the locally recurring tumors was 5.94 mL (range, 0.42 to 29.94). We prescribed a mean margin dose of 17.04 Gy (range, 12 to 24) to the isodose line at the tumor border primarily using a 50% isodose line. ResultsAfter the repeat SRS, we obtained clinical and magnetic resonance imaging follow-up data for 84 patients (73.7%) with a total of 108 tumors. The tumor control rate was 53.5% (58 of the 108), and the median and mean progression-free survival (PFS) periods were 246 and 383 days, respectively. The prognostic factors that were significantly related to better tumor control were prescription radiation dose of 16 Gy (p=0.000) and tumor volume less than both 4 mL (p=0.001) and 10 mL at the repeat SRS (p=0.008). The overall survival (OS) periods for all 114 patients after repeat SRS varied from 1 to 56 months, and median and mean OS periods were 229 and 404 days after the repeat SRS, respectively. The main cause of death was systemic problems including pulmonary dysfunction (n=58, 51%), and the identified direct or suspected brain-related death rate was around 20%. ConclusionThe tumor control following repeat SRS for locally recurring metastatic brain tumors after a previous SRS is relatively lower than that for primary SRS. However, both low tumor volume and high prescription radiation dose were significantly related to the tumor control following repeat SRS for these tumors after previous SRS, which is a general understanding of primary SRS for metastatic brain tumors.

Treatment strategies for breast cancer brain metastases

“…However, both low tumour volume and high-prescription radiation dose were significantly related to the tumour control following repeat SRS for these tumours after previous SRS, which is a general understanding of primary SRS for metastatic brain tumours. 53 In asymptomatic patients, a systemic therapy approach, based on the BC subtype, might be preferred. In the absence of cerebral symptomatology, the urgency is to systemic control and the best treatment for brain metastasis remains the treatment of cancer.…”

Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review

“…Among them, 22 were excluded due to a lack of prior SRS/SRT to the target metastasis (previous WBRT only or mixed interventions) or insufficient data reporting [ 21 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. A total of 13 studies met the inclusion criteria and were analyzed in the final meta-analysis [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. They included 464 patients and 549 treated metastases with a median follow-up of 11 (1–124) months by pooling patients from the 11 studies for which this data was available.…”

“…Regarding the risk of bias for missing data, only four studies had short or unreported data, leading to a moderate level of risk. For the remaining articles reviewed, the level of risk was considered low because of the application of an adequate follow-up schedule with sufficient time to assess the efficacy and toxicity of radiation therapy [ 51 , 53 , 56 , 60 ]. Nevertheless, no study reported analytical strategies to account for loss of information.…”

Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis

“…Thirty-two full-text papers were initially included out of 1136 potential references after check for duplicate or pertinence. Among them, 21 were excluded due to lack of prior SRS to the target metastasis (previous WBRT only, or first stereotactic irradiation of the target lesion after prior SRS to another intracranial site, or mixed interventions) or insufficient data reporting (Guan et al (2019); Maranzano et al, 2019;Kim et al, 2018;Koiso et al, 2016;Huang et al, 2017;Shen et al, 2016;Bates et al, 2016;Yomo and Hayashi, 2016;Shultz et al, 2015;Monaco et al, 2014;Kurtz et al, 2014;Kim et al, 2013;Maranzano et al, 2012;Kwon et al, 2007a;Shuto et al, 2004;Hillard et al, 2003;Wowra et al, 2002;Bhatnagar et al, 2002;Noël et al, 2001;Davey et al, 1994;Kwon et al, 2007b). Hence, eleven studies were considered eligible for data extraction and included in the final meta-analysis (Iorio-Morin et al, 2019;Dincoglan et al, 2019;Moreau et al, 2018;Balermpas et al, 2018;Rana et al, 2017;McKay et al, 2017;Minniti et al, 2016;Greto et al, 2014;Terakedis et al, 2014;Holt et al, 2015;Koffer et al, 2020), accounting for 335 patients and 389 treated metastases.…”