Single- and hypofractionated stereotactic radiosurgery for large (&gt; 2 cm) brain metastases: a systematic review

Lee, Eun Jung; Choi, Kyu Sun; Park, Eun Suk; Cho, Young Hyun

doi:10.1007/s11060-021-03805-8

Cited by 14 publications

(18 citation statements)

References 65 publications

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“…Other local factors such as PIV, prescription dose, and hypofractionation did not show significant association with postoperative prognosis. Hypofractionated radiosurgery were known to be associated with higher local control with acceptable incidence of radiation necrosis compared to single fractionation in patients with brain metastases 31 , 32 . However the patients in this study had symptomatic RN which were refractory to medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Kim

Choi

Kong

et al. 2022

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A late-onset treatment-related changes (TRCs), which represent radiographic radiation necrosis (RN), frequently occur after stereotactic radiosurgery (SRS) for brain metastases and often need surgical treatment. This study aimed to validate the true pathology and investigate clinical implication of surgically resected TRCs on advanced magnetic resonance imaging (MRI). Retrospective analyses of 86 patients who underwent surgical resection after radiosurgery of brain metastases were performed. Fifty-four patients displayed TRCs on preoperative MRI, comprising pure RN in 19 patients (TRC-RN group) and mixed viable tumor cells in 35 patients (TRC-PD group). Thirty-two patients revealed the consistent diagnosis of progressive disease in both MRI and histopathology (PD–PD group). The TRC-PD group showed larger prescription isodose volume (9.4 cm3) than the TRC-RN (4.06 cm3, p = 0.014) group and a shorter time interval from SRS to preoperative MRI diagnosis (median 4.07 months) than the PD–PD group (median 8.77 months, p = 0.004). Progression-free survival was significantly different among the three groups (p < 0.001), but not between TRC-RN and TRC-PD (post hoc test, p = 1.00), while no difference was observed in overall survival (p = 0.067). Brain metastases featured as TRCs after SRS frequently contained viable tumor cells. However, this histologic heterogeneity had a minor impact on benign local prognosis of TRCs after surgical resection.

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Section: Discussionmentioning

confidence: 99%

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Kim

Choi

Kong

et al. 2022

Sci Rep

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“…There is no consensus on the definition of small brain metastases, although traditionally, FSRT has been reserved for lesions >2 cm ( 12 , 18 ). A unique aspect of our analysis is that a considerable proportion of the treated metastases (nearly 16%) were smaller than 1 cm.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Hypofractionated Stereotactic Radiotherapy for Small and Moderate-Sized Brain Metastases: A Single-Institution Analysis

et al. 2022

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BackgroundStereotactic radiosurgery (SRS) is the standard treatment for limited intracranial metastases. With the advent of frameless treatment delivery, fractionated stereotactic radiotherapy (FSRT) has become more commonly implemented given superior control and toxicity rates for larger lesions. We reviewed our institutional experience of FSRT to brain metastases without size restriction.MethodsWe performed a retrospective review of our institutional database of patients treated with FSRT for brain metastases. Clinical and dosimetric details were abstracted. All patients were treated in 3 or 5 fractions using LINAC-based FSRT, did not receive prior cranial radiotherapy, and had at least 6 months of MRI follow-up. Overall survival was estimated using the Kaplan–Meier method. Local failure and radionecrosis cumulative incidence rates were estimated using a competing risks model with death as the competing risk. Univariable and multivariable analyses using Fine and Gray’s proportional subdistribution hazards regression model were performed to determine covariates predictive of local failure and radionecrosis.ResultsWe identified 60 patients and 133 brain metastases treated at our institution from 2016 to 2020. The most common histologies were lung (53%) and melanoma (25%). Most lesions were >1 cm in diameter (84.2%) and did not have previous surgical resection (88%). The median duration of imaging follow-up was 9.8 months. The median survival for the whole cohort was 20.5 months. The local failure at 12 months was 17.8% for all lesions, 22.1% for lesions >1 cm, and 13.7% for lesions ≤1 cm (p = 0.36). The risk of radionecrosis at 12 months was 7.1% for all lesions, 13.2% for lesions >1 cm, and 3.2% for lesions ≤1 cm (p = 0.15).ConclusionsFSRT is safe and effective in the treatment of brain metastases of any size with excellent local control and toxicity outcomes. Prospective evaluation against single-fraction SRS is warranted for all lesion sizes.

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“…Almost all histological types of solid primary malignancies can metastasise to the brain, with reported incidences ranging from 15% to 41%. 1 Improvements in systemic therapies have translated to significantly increased overall survival and extra-cranial disease control for cancer patients, 2,3 necessitating the need to optimise intracranial disease management strategies and to better understand treatment-related changes during follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…8 However, this goal is not always achievable, especially when treating larger lesions. 2,9 Radiation necrosis (RN) is a histologically benign, but often clinically challenging, late treatment toxicity caused by SRS. Patients with RN usually present with asymptomatic imaging changes during post-treatment surveillance.…”

Section: Introductionmentioning

confidence: 99%

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Radiation necrosis and therapeutic outcomes in patients treated with linear accelerator‐based hypofractionated stereotactic radiosurgery for intact intracranial metastases

et al. 2023

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Introduction: Balancing disease control and treatment-related toxicities can be challenging when treating higher-risk brain metastases (BMs) that are larger in size or eloquent anatomical locations. Hypofractionated stereotactic radiosurgery (hfSRS) is expected to offer superior or equal efficacy with lower toxicity profile compared with single-fraction SRS (sfSRS). We report the efficacy and toxicity profiles of hfSRS in a consecutive cohort of patients to support this predicted benefit from hfSRS for high-risk BMs. Methods: We retrospectively analysed 185 consecutive individual lesions from 152 patients with intact BMs treated with hfSRS between 1 July 2016 and 31 October 2019 and followed up to 30 April 2022 with serial brain magnetic resonance imaging (MRI). The primary endpoint was the event of radiation necrosis (RN). Local control (LC) rate and distant brain failure (DBF) were reported as secondary outcomes. Kaplan-Meier method was used to report the cumulative incidence of RN and overall survival and the incidence of DBF. Potential risk factors for RN were assessed using univariable Cox regression analysis. Results: The median follow-up was 38.0 months, and the median survival post-SRS was 9.5 months. The cumulative incidence rate of RN was 13.2% (95% CI: 7.0-24.7%), and 18.1% of patients with confirmed RN were symptomatic. Higher mean dose delivered to planning target volume (PTV) (HR 1.22, 95% CI: 1.05-1.42, P = 0.01), higher mean BED 10 (biological equivalent dose assuming a tissue α=β ratio of 10) (HR 1.12, 95% CI: 1.04-1.2, P < 0.001), and higher mean BED 2 (HR 1.02, 95% CI: 1-1.04, P = 0.04) delivered to the lesion was associated with increased risk of RN. LC rate was 86% and the cumulative incidence of DBF was 36% with a median onset of 28.4 months. Conclusions: Our results support the predicted radiobiological benefit of the use of hfSRS in high-risk BMs to limit treatment-related toxicity with low risk for symptomatic RN comparable with lower risk population receiving sfSRS while achieving satisfactory local disease control.

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Single- and hypofractionated stereotactic radiosurgery for large (> 2 cm) brain metastases: a systematic review

Cited by 14 publications

References 65 publications

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Outcomes of Hypofractionated Stereotactic Radiotherapy for Small and Moderate-Sized Brain Metastases: A Single-Institution Analysis

Radiation necrosis and therapeutic outcomes in patients treated with linear accelerator‐based hypofractionated stereotactic radiosurgery for intact intracranial metastases

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