Stereotactic radiosurgery for four or more intracranial metastases

Bhatnagar, Ajay; Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade

doi:10.1016/j.ijrobp.2005.08.035

Cited by 291 publications

(136 citation statements)

References 44 publications

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“…3-5 Moreover, several retrospective studies have described a benefit of SRS for patients with more than four lesions. 6-8 …”

Section: Introductionmentioning

confidence: 99%

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Lau¹,

Zakeri²,

Zhao³

et al. 2015

Neurosurgery

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Background Stereotactic radiosurgery is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. Objective To report our initial clinical experience applying a novel single-isocenter technique to frameless VMAR for simultaneous treatment of multiple intracranial metastases. Methods We performed a retrospective analysis of 15 patients undergoing frameless VMAR for multiple intracranial metastases using a single, centrally-located isocenter between 2009 and 2011. Among these, 3 patients were treated for progressive or recurrent intracranial disease. A total of 62 metastases (median 3 per patient, range 2-13) were treated to a median dose of 20 Gy (range, 15-30 Gy). 3 patients were treated with fractionated SRS. Follow-up including clinical examination and magnetic resonance imaging (MRI) occurred every 3 months. Results Median follow-up for all patients was 7.1 months (range, 1.1-24.3), with 11 patients (73.3%) followed until death. For the remaining 4 patients alive at the time of analysis, median follow-up was 19.6 months (range, 9.2-24.3). Local control at 6 and 12 months was 91.7 (95% Confidence Interval [C.I.], 84.6-100.0%) and 81.5 (95% C.I., 67.9-100.0%), respectively. Regional failure was observed in 9 patients (60.0%), and 7 patients (46.7%) received salvage therapy. Overall survival at 6 months was 60.0% (95% C.I., 40.3-88.2%). Grade 3 or greater treatment-related toxicity was not observed. Median total treatment time was 7.2 minutes (range, 2.8-13.2 minutes). Conclusion Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared to conventional radiosurgery.

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“…3-5 Moreover, several retrospective studies have described a benefit of SRS for patients with more than four lesions. 6-8 …”

Section: Introductionmentioning

confidence: 99%

Single-Isocenter Frameless Volumetric Modulated Arc Radiosurgery for Multiple Intracranial Metastases

Lau¹,

Zakeri²,

Zhao³

et al. 2015

Neurosurgery

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“…A multivariate analysis of 205 patients who received SRS for 4 or more brain metastases showed total treatment volume to be the most significant prognostic factor of survival, whereas the number of metastases did not reach significance. 6 The same group conducted another analysis that identified a favorable subgroup of patients with a total treatment volume either less than 7 mL and fewer than 7 brain lesions. These patients had significantly prolonged median survival (13 months) compared with other patients (6 months; P <.00005).…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

“…12 Other predictors of longer survival with SRS include younger age, good performance status, and primary tumor control. 6,10,11,13 …”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Central Nervous System Cancers, Version 2.2014

Nabors

Portnow

Ammirati

et al. 2014

J Natl Compr Canc Netw

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The NCCN Guidelines for Central Nervous System Cancers provide multidisciplinary recommendations for the clinical management of patients with cancers of the central nervous system. These NCCN Guidelines Insights highlight recent updates regarding the management of metastatic brain tumors using radiation therapy. Use of stereotactic radiosurgery (SRS) is no longer limited to patients with 3 or fewer lesions, because data suggest that total disease burden, rather than number of lesions, is predictive of survival benefits associated with the technique. SRS is increasingly becoming an integral part of management of patients with controlled, low-volume brain metastases.

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“…Risk factors for the development of brain metastases from breast cancer include young age, greater than three involved axillary lymph nodes, high grade tumor, primary tumor size greater than 2 cm, and negative hormone receptor status [4][5][6][7]. The rate of CNS metastases from breast cancer appears to be increasing [8][9][10], in part because improved systemic therapies are allowing patients to survive long enough to develop distant metastases, including to the brain. Many of these new targeted agents are large molecules which do not cross the blood-brain barrier and are, therefore, likely to be ineffective at controlling CNS disease.…”

Section: Introductionmentioning

confidence: 99%

“…Stereotactic radiosurgery has been shown to improve overall survival in patients with brain metastases compared with observation or steroids [9,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%