Single-fraction versus hypofractionated stereotactic radiosurgery for medium-sized brain metastases of 2.5 to 3 cm

Chon, Haemin; Yoon, Kwan Han; Lee, Doheui; Kwon, Do Hoon; Cho, Young Hyun

doi:10.1007/s11060-019-03265-1

Cited by 27 publications

(21 citation statements)

References 25 publications

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“…The two fractionation regimens utilized in this study had a BED 10 ≥ 50 (52.5 for 5Gy × 7 and 56 for 4Gy × 10), which supports our observation of more durable local control with higher BED. Similarly, Chon et al recently reported a SF-SRS versus HF-SRS comparison study limited to larger lesions measuring 2.5-3.0 cm which revealed significant improvement in local control and decreased risk of radiation necrosis associated with HF-SRS [37]. The median BED 10 in their HF-SRS cohort was 59.5Gy compared to 42.6Gy in the present study.…”

Section: Discussionsupporting

confidence: 67%

“…A literature review of patients treated with HF-SRS using various dosing regimens is reported in Table 4 [ [16][17][18][19][20][21][22][23][37][38][39][40][41][42]. While most studies report excellent 1 year local control with low rates of radiation necrosis (< 10%) associated with HF-SRS, there appears to be a dose response when the BED 10 falls below 50Gy.…”

Section: Discussionmentioning

confidence: 99%

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A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis

et al. 2020

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Background: Hypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes between SF-SRS versus HF-SRS across our multi-center academic network. Methods: Patients treated with SF-SRS or HF-SRS for brain metastasis from 2013 to 2018 across 5 radiation oncology centers were retrospectively reviewed. SF-SRS dosing was standardized, whereas HF-SRS dosing regimens were variable. The co-primary endpoints of local control and radiation necrosis were estimated using the Kaplan Meier method. Multivariate analysis using Cox proportional hazards modeling was performed to evaluate the impact of select independent variables on the outcomes of interest. Propensity score adjustments were used to reduce the effects confounding variables. To assess dose response for HF-SRS, Biologic Effective Dose (BED) assuming an α/β of 10 (BED 10) was used as a surrogate for total dose.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis

et al. 2020

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“…In a recent study of 105 metastases sized 2.5–3 cm, Chon et al also found a significantly improved local control for FSRT with a median of 35 Gy in 3–5 fractions compared to SRS with a median of 20 Gy: 1-year local control was 92.4% in the FSRT arm compared to 66.6% in the SRS arm ( p = 0.028) ( 31 ). In addition, similarly to the work of Minniti et al radiation necrosis was also markedly reduced in the FSRT arm with a radionecrosis rate of 0% in the FSRT arm compared to 39.8% for the SRS group ( 31 ). In the subgroup of large brain metastases, some negative comparative studies have also been published, which were mainly characterized by small patient numbers ( 32 – 34 ).…”

Section: Discussionmentioning

confidence: 98%

FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study

et al. 2020

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Background: While the role of stereotactic radiotherapy for brain metastases is increasing, evidence on the comparative efficacy and safety of fractionated stereotactic radiotherapy (FSRT) and single-session radiosurgery (SRS) is scarce. Methods: Longitudinal volumetric analysis was performed in a consecutive cohort of 120 patients and 190 brain metastases (>0.065 cm 3 in volume / > ∼5 mm in diameter) treated exclusively with FSRT (n = 98) and SRS (n = 92), respectively. A total of 972 tumor segmentations was used, averaging 5.1 time points per metastasis. Progression was defined using a volumetric extension of the RANO-BM criteria. Local control and radionecrosis were compared for lesions treated with FSRT and SRS, respectively. Results: Metastases treated with FSRT were significantly larger at baseline (mean, 4.66 vs. 0.40 cm 3 , p < 0.001). Biologically effective dose (BED) for metastases (α/β = 12, linear-quadratic-cubic model) was significantly associated with local control, whereas BED for normal brain (α/β = 2, linear-quadratic model) was significantly associated with radionecrosis. Median time to local progression was 22.9 months in the FSRT group compared to 14.5 months in the SRS group (p = 0.022). Overall radionecrosis rate at 12 months was 3.4% for FSRT and 14.8% for SRS (p = 0.010). Radionecrosis • IV requiring resection with histologic proof of radiation necrosis also was significantly reduced in the FSRT group (FSRT 0.0% vs. SRS 3.9%, p = 0.041). In multivariate analysis, FSRT was associated with reduced risk of progression (HR 0.47, p = 0.015) and reduced risk of radionecrosis (HR 0.18, p = 0.045). Conclusions: This volumetric study provides initial evidence that the improvements in therapeutic ratio expected for FSRT in larger brain metastases, might equally extend into the domain of smaller metastases, traditionally less considered for fractionated treatment. FSRT might constitute an important tool to further increase local control and reduce radionecrosis risk in stereotactic radiotherapy for brain metastases, that should be assessed in randomized intervention trials.

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“…Toxicities were classified according to the Common Terminology Criteria for Adverse Events version 4.0. Radionecrosis was evaluated and considered according to the previous description [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Fractionated Stereotactic Radiation Therapy Using Volumetric Modulated Arc Therapy in Patients with Solitary Brain Metastases

Zhou

Xia

Huang

et al. 2020

BioMed Research International

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Purpose. To analyze retrospectively the clinical efficacy and safety for patients treated with fractionated stereotactic radiation therapy (FSRT) using volumetric modulated arc therapy. Methods. Between 2016 and 2017, 46 patients with solitary brain metastasis who underwent FSRT consisting of 25-40 Gy/5 fractions were recruited in this study. All targets within the same course received different prescriptions according to size. Toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Results. The median follow-up was 11 months (3-53 months). The 6-month and 12-month local control rate calculated by Kaplan-Meier estimate was, respectively, 95% and 86%. Tumor diameter<2.5 cm obtained 100% improved 12-month local control rate compared with 66% in those with ≥2.5 cm (P<0.001). The 12-month local control calculated by Kaplan-Meier estimate was 95% in tumors with >30 Gy treatment and only 60% in tumors with ≤30 Gy treatment (P=0.001). Multivariate analysis revealed that the prescription dose≤30 Gy resulted in increased local failure (hazard ratio (HR), 0.14 (range, 0.019-0.95; P=.046)). Grade 3 or worse toxic effects were found in 5 (11%) patients, and no patient experienced surgical resection for symptomatic radioactive necrosis. Conclusions. FSRT for solid brain metastasis appears to have the advantages of a high rate of local control with a minimal risk of severe toxicity and deserves application in the clinical practice.

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Single-fraction versus hypofractionated stereotactic radiosurgery for medium-sized brain metastases of 2.5 to 3 cm

Cited by 27 publications

References 25 publications

A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis

A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis

FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study

Fractionated Stereotactic Radiation Therapy Using Volumetric Modulated Arc Therapy in Patients with Solitary Brain Metastases

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