Repeated stereotactic radiosurgery for patients with progressive brain metastases

Minniti, Giuseppe; Scaringi, Claudia; Paolini, Sergio; Clarke, Enrico; Cicone, Francesco; Esposito, Vincenzo; Romano, Andrea; Osti, Mattia Falchetto; Enrici, Riccardo Maurizi

doi:10.1007/s11060-015-1937-4

Cited by 65 publications

(48 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PWI holds promises in the setting of brain metastases as well, albeit the number of available studies and patients included is limited [149–151]. At present, a combined approach for differential diagnosis is to be encouraged, as already put in practice by single specialized centers [152, 153]. …”

Section: Introductionmentioning

confidence: 99%

Amino acid PET and MR perfusion imaging in brain tumours

Filß

Cicone

Shah

et al. 2017

Clin Transl Imaging

Self Cite

View full text Add to dashboard Cite

PurposeDespite the excellent capacity of the conventional MRI to image brain tumours, problems remain in answering a number of critical diagnostic questions. To overcome these diagnostic shortcomings, PET using radiolabeled amino acids and perfusion-weighted imaging (PWI) are currently under clinical evaluation. The role of amino acid PET and PWI in different diagnostic challenges in brain tumours is controversial.MethodsBased on the literature and experience of our centres in correlative imaging with PWI and PET using O-(2-[18F]fluoroethyl)-l-tyrosine or 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine, the current role and shortcomings of amino acid PET and PWI in different diagnostic challenges in brain tumours are reviewed. Literature searches were performed on PubMed, and additional literature was retrieved from the reference lists of identified articles. In particular, all studies in which amino acid PET was directly compared with PWI were included.ResultsPWI is more readily available, but requires substantial expertise and is more sensitive to artifacts than amino acid PET. At initial diagnosis, PWI and amino acid PET can help to define a site for biopsy but amino acid PET appears to be more powerful to define the tumor extent. Both methods are helpful to differentiate progression or recurrence from unspecific posttherapeutic changes. Assessment of therapeutic efficacy can be achieved especially with amino acid PET, while the data with PWI are sparse.ConclusionBoth PWI and amino acid PET add valuable diagnostic information to the conventional MRI in the assessment of patients with brain tumours, but further studies are necessary to explore the complementary nature of these two methods.

show abstract

Section: Introductionmentioning

confidence: 99%

Amino acid PET and MR perfusion imaging in brain tumours

Filß

Cicone

Shah

et al. 2017

Clin Transl Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…Multiple retrospective series have shown efficacy for SRS in new or recurrent tumours, including after WBRT, with adjustment to lower fraction dose in the setting of prior radiation exposure. These series suggest a local control rate comparable to first-time SRS [63][64][65].…”

Section: Stereotactic Radiosurgerymentioning

confidence: 57%

Current Management of Brain Metastases: Overview and Teaching Cases

Au¹,

Meng²,

Suppiah³

et al. 2017

New Approaches to the Management of Primary and Secondary CNS Tumors

View full text Add to dashboard Cite

Over the past two decades, increased global incidence of malignancy, improved systemic disease treatment with prolonged survival, and increased central nervous system (CNS) surveillance in cancer patients have all contributed to a rise in cerebral metastatic disease. As many patients retain good neurologic function, the approach to their management has shifted markedly; a pre-terminal prognosis and palliative treatment have been replaced by individualized care plans to prolong functional survival. However, the rapid shifts in disease characteristics, treatment options and emerging evidence can be challenging to navigate, and a rational approach to brain metastases is needed. We discuss the changing epidemiology of brain metastases and consider approaches to prognostic classification. We review current treatment modalities and discuss the significant studies pertaining to each, with emphasis on Level 1 evidence when available and cooperative group trials, as well as studies on adverse effects. To integrate the information presented, we offer case scenarios that highlight pertinent decision-making factors. The shift in care goal for cerebral metastases from symptom palliation to prolongation of survival is not only feasible, but in many cases indicated. The appropriate application of various treatment modalities must be considered in the context of individual patients and their primary cancer.

show abstract

“…Retrospective studies on the one-year outcome of repeated radiosurgery for local progression reported that local control was 61 to 88%, and OS was 37 to 90.6% [25][26][27]. Toxicity was reported as overall necrosis rates 9.2 to 19% after the repeated SRS or SRT [25,26]. Necrosis after repeated STI was shown to be significantly associated with the irradiated volume and the cumulative dose [16].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of salvage surgery for local progression of brain metastasis previously treated with stereotactic irradiation: diagnostic contribution, functional outcome, and prognostic factors

et al. 2020

View full text Add to dashboard Cite

Background: Stereotactic irradiation (STI) is a primary treatment for patients with newly diagnosed brain metastases. Some of these patients experience local progression, which is difficult to differentiate from radiation necrosis, and difficult to treat. So far, just a few studies have clarified the prognosis and effectiveness of salvage surgery after STI. We evaluated the diagnostic value and improvement of functional outcomes after salvage surgery. Based on these results, we reconsidered surgical indication for patients with local progression after STI. Methods: We evaluated patients with brain metastases treated with salvage surgery for local progression from October 2002 to July 2019. These patients had undergone salvage surgery based on magnetic resonance imaging findings and/or clinical evidence of post-STI local progression and stable systemic disease. We employed two prospective strategies according to the eloquency of the lesions. Lesions in non-eloquent areas had been resected completely with a safety margin, utilizing a fence-post method; while lesions in eloquent areas had been treated with minimal resection and postoperative STI. Kaplan-Meier curves were used for the assessment of overall survival. Prognostic factors for survival were analyzed. Results: Fifty-four salvage surgeries had been performed on 48 patients. The median age of patients was 63.5 years (range 36-79). The median interval from STI to surgery was 12 months. The median overall survival was 20.2 months from salvage surgery and 37.5 months from initial STI. Primary cancers were lung 31, breast 9, and others 8. Local recurrence developed in 13 of 54 lesions (24%). Leptomeningeal dissemination occurred after surgery in 3 patients (5.6%). Primary breast cancer (breast vs. lung: HR: 0.17), (breast vs. others: HR: 0.08) and RPA class 1-2 (RPA 1 vs. 3, HR:0.13), (RPA 2 vs 3, HR:0.4) were identified as good prognostic factors for overall survival (OS) in multivariate analyses. The peripheral neutrophil-to-lymphocyte ratio (NLR) of ≤3.65 predicted significantly longer OS (median 25.5 months) than an NLR > 3.65 (median 8 months).

show abstract

Repeated stereotactic radiosurgery for patients with progressive brain metastases

Cited by 65 publications

References 35 publications

Amino acid PET and MR perfusion imaging in brain tumours

Amino acid PET and MR perfusion imaging in brain tumours

Current Management of Brain Metastases: Overview and Teaching Cases

Retrospective analysis of salvage surgery for local progression of brain metastasis previously treated with stereotactic irradiation: diagnostic contribution, functional outcome, and prognostic factors

Contact Info

Product

Resources

About