Role of Radiosurgery/Stereotactic Radiotherapy in Oligometastatic Disease: Brain Oligometastases

Mazzola, Rosario; Corradini, Stefanie; Gregucci, Fabiana; Figlia, Vanessa; Fiorentino, Alba; Alongi, Filippo

doi:10.3389/fonc.2019.00206

Cited by 35 publications

(28 citation statements)

References 46 publications

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“…A separate retrospective analysis by Bowden et al examined outcomes in patients with more than 15 brain lesions and found no significant difference between patients treated with STRT versus STRT + WBRT [ 22 ]. Other retrospective studies have further supported the efficacy of STRT in patients with multiple brain lesions [ 23 , 24 ]. These findings, in combination with reports of increased cognitive impairment in patients treated with WBRT, may explain the declining use of WBRT at our center [ 25 ].…”

Section: Discussionmentioning

confidence: 93%

A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases

et al. 2021

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Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher’s exact and Mann–Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as “real world” data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices.

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Section: Discussionmentioning

confidence: 93%

A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases

et al. 2021

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“…The term oligometastases is referred to a limited tumor burden potentially amenable to local approaches. In this last clinical scenario, high-dose radiation therapy, also known as stereotactic body radiotherapy (SBRT), represents a viable treatment option able to modify the natural history of the oligometastatic disease [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Oligometastasis and local ablation in the era of systemic targeted and immunotherapy

et al. 2020

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Background: During these last years, new agents have dramatically improved the survival of the metastatic patients. Oligometastases represent a continuous field of interest in which the integration of metastases-directed therapy and drugs could further improve the oncologic outcomes. Herein a narrative review is performed regarding the main rationale in combining immunotherapy and target therapies with SBRT looking at the available clinical data in case of oligometastatic NSCLC, Melanoma and Kidney cancer. Material and method: Narrative Review regarding retrospective and prospective studies published between January 2009 to November 2019 with at least 20 patients analyzed. Results: Concerning the combination between SBRT and Immunotherapy, the correct sequence of remains uncertain, and seems to be drug-dependent. The optimal patients' selection is crucial to expect substantial benefits to SBRT/ Immunotherapy combination and, among several factors. A potential field of interest is represented by the so-called oligoprogressed disease, in which SBRT could improve the long-term efficacy of the existing target therapy. Conclusions: A low tumor burden seems to be the most relevant, thus making the oligometastatic disease represent the ideal setting for the use of combination therapies with immunological drugs.

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“…The use of SRT or even radiosurgery in the adjuvant setting (on the surgical bed) has been suggested [8,11], .also with the purpose of lowering such side effects.…”

Section: Discussion and Teaching Point(s)mentioning

confidence: 99%

Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report

et al. 2020

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Background: Distant Metastases from Head and Neck Squamous cell carcinomas are uncommon (9-11%) and they are usually found in the lung and less frequently in the liver, kidney and adrenals. Central nervous system (CNS) metastases are extremely rare (2-8%), and they are described mainly in patients who already have extracranial metastases. So there's scarcity of data about their optimal management. Methods and results: A patient presented CNS metastases after having been successfully treated with induction chemotherapy and definitive radiotherapy for a pyriform sinus carcinoma. The patient's work up, treatment and outcome are described. Conclusions: CNS metastases from Head and Neck carcinomas are exceptionally rare. Nevertheless, clinicians should be alert of neurological symptoms in these patients, in order to set up a timely assessment and treatment. Secondarily, given the rarity of this condition, additional research on this topic is warranted in order to improve therapeutic strategies and outcomes of such patients.

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Role of Radiosurgery/Stereotactic Radiotherapy in Oligometastatic Disease: Brain Oligometastases

Cited by 35 publications

References 46 publications

A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases

A Contemporary Report of Clinical Outcomes in Patients with Melanoma Brain Metastases

Oligometastasis and local ablation in the era of systemic targeted and immunotherapy

Squamous cell carcinoma (SCC) of the Pyriform sinus with multiple metachronous brain metastases, a case report

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