Repeat Stereotactic Radiosurgery in the Management of Brain Metastases from Non-Small Cell Lung Cancer

Abstract

Non-small cell lung cancer (NSCLC) is characterized by brain metastases that occur in about 30 to 50% of patients. To control tumor growth potential with maintaining neurocognitive function is important in the recent radiotherapy against brain metastases. From this viewpoint, we investigated the utility of repeat stereotactic radiosurgery (SRS) with a linear accelerator in the management of brain metastases from NSCLC. Between October 1998 and May 2010, 28 patients harboring brain metastases received repeat SRS (20 men and 8 women, with the age ranged from 51 to 79). The total number of SRS sessions ranged from 2 to 5, and the total number of lesions in one patient ranged from 1 to 8. Neurological decline due to uncontrolled brain lesions was identified in 9 of 28 patients after the repeat SRS, while the remaining 19 patients showed no neurological decline. Out of the 28 patients, 18 patients died by July 1, 2010; 12 patients died of active extracranial disease and 6 patients died from progressive brain lesions, considered neurological death. The 2-year and 4-year overall survival rates were 51% and 23%, respectively, and the median survival time was 26 months. In conclusion, repeat SRS is a preferred option to manage brain metastases from NSCLC, leading to a long survival with a decreased neurological decline. Repeat SRS is promising to preserve neurocognition, because the convergent dose distribution decreases the unfavorable influences from radiation on germinal niches, thereby preserving neural stem cells that are responsible for the nervous system repair.

Repeat Stereotactic Radiosurgery for Recurred Metastatic Brain Tumors

“…One of the advantages of SRS is that the procedure can be repeated for both recurrent and new metastases with more meaningful feasibility, effectiveness, and safety than other treatment modalities [ 6 ]. However, only a few papers have reported on repeat SRS for recurrent metastasis following earlier SRS [ 1 , 3 , 6 , 8 - 11 , 14 ], and moreover, they focused on the results of the repeat SRS itself and the targeted brain metastases included both locally recurring and newly developed tumors after the first SRS, which are clearly pathophysiologically different.…”

Tumor Bed Radiosurgery Following Resection and Prior Stereotactic Radiosurgery for Locally Persistent Brain Metastasis

“…Moreover, there are five known cases series presenting the clinical outcomes of rSRS for recurrent distant brain metastatic disease after prior SRS, with only three of the studies presenting overall survival from time of rSRS. Chen et al, Kwon et al, and Mariya et al presented median survivals from rSRS of 6.5, 7.3, and 11 months, respectively ( 18 – 20 ). Though the median survival reported from all of the studies from initial SRS was somewhat broader in range of 11.5–26 months ( 18 – 22 ).…”

Repeat stereotactic radiosurgery in the management of brain metastases from NSCLC: A case report and review of the literature

“…In addition, in a study by Kwon et al , 43 patients underwent salvage SRS and the median survival from the time of SRS for recurrent/progressive disease was 8 months (13). More recently, Mariya et al reported that repeat SRS is an effective treatment option, leading to a long survival with a decreased neurological decline (14,15). The authors analyzed 28 patients who underwent salvage radiosurgery for recurrent brain metastases from NSCLC showing a median survival from initial SRS of 26 months and 11 months for post-repeat SRS.…”