Stereotactic Radiosurgery in the Management of Brain Metastases: An Institutional Retrospective Analysis of Survival

Frazier, James L.; Batra, Sachin; Kapor, Sumit; Vellimana, Ananth K.; Gandhi, Rahul; Carson, Kathryn A.; Shokek, Ori; Lim, Michael; Kleinberg, Lawrence; Rigamonti, Daniele

doi:10.1016/j.ijrobp.2009.03.028

Cited by 45 publications

(48 citation statements)

References 58 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An overall median survival of 4.05 months was observed from the time of radiosurgery and 6.67 months after diagnosis of brain metastasis. This contrasts with patients harboring brain metastasis from breast cancer where a median survival of 11-13 months from radiosurgery has been reported [15,19,20,27]. Similarly, higher survival [11][12][13] is also observed after radiosurgery in lung cancer patients with brain metastases [I5-16].…”

Section: Discussionmentioning

confidence: 99%

“…Radiosurgery in well-selected patients enhances survival from 2.1 -3 months in those who receive palliative treatment using steroids or whole brain radiation therapy [13][14][15] to 7.1 -11 months. Unfortunately, most existing studies are based on heterogeneous histological groups or pertain to the primaries most likely to metastasize to brain, like non-small cell lung carcinoma [16][17][18], breast carcinoma [19][20][21], melanoma [22] or renal cell carcinomas [23][24].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Stereotactic Radiosurgery of Colorectal Carcinoma Brain Metastasis: A multi-institutional experience.

Wolf¹,

Batra²,

Bortoletto³

et al. 2012

Cureus

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery of Colorectal Carcinoma Brain Metastasis: A multi-institutional experience.

Wolf¹,

Batra²,

Bortoletto³

et al. 2012

Cureus

Self Cite

View full text Add to dashboard Cite

“…AIRS is perhaps the most significant late toxicity associated with SRS, causing neurologic symptoms in up to one third of treated patients [16,18,31,32]. The underlying inflammatory mechanism is thought to result from dysfunctional astrocytes and microglia surrounding the central necrotic zone of the treated lesion [7].…”

Section: Discussionmentioning

confidence: 99%

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Tsvankin¹,

Howell²,

Fecci³

2017

JNSK

View full text Add to dashboard Cite

Brain metastases are the most common type of intracranial tumor, and confer a dismal prognosis. Morbidity in these patients arises not only from tumor burden but from treatment-related toxicities. Among the most significant of these is radiation necrosis, a common sequelae of stereotactic radiosurgery that may cause neurologic impairment through mass effect or steroid-refractory edema. Truly, "radiation necrosis" is a misnomer, as the process is more accurately an adverse inflammatory response post-stereotactic radiotherapy (AIRS). Because it is impossible to reliably distinguish AIRS from tumor recurrence without a biopsy, and because high-dose steroids are poorly tolerated, management of AIRS poses a significant therapeutic challenge. Laser interstitial thermal therapy (LITT) is an emerging minimally-invasive treatment modality which uses hyperthermia to ablate intracranial pathologic tissues. Here, we describe the use of LITT in a patient with steroid-refractory AIRS following radiosurgery for a right supplementary motor area metastatic focus, and provide a brief review of the utility of LITT in patients with AIRS. direct heat application across the lesion volume, resulting in controlled cell death [30]. In contrast to open surgery, LITT can be performed through the same basic operating platform as a biopsy, allowing the neurosurgeon to avoid the risk of performing a craniotomy. The incision is less than 1cm long; at our institution, patients do not require ICU admission postoperatively, and most are discharged either the same day or the following morning. The result is a minimally-morbid diagnostic and treatment option for patients with previously-treated intracranial tumors. Here, we offer an illustrative case and brief review of LITT application in the setting of AIRS. Citation Case ReportThe patient is a 66 year old right-handed female with a history of lung adenocarcinoma, initially diagnosed in January of 2014 when she presented with cough and hemoptysis. Surveillance imaging demonstrated a solitary 1cm metastasis of the right frontal lobe, and the patient was treated with Cyber Knife on 3/5/2014. She underwent concurrent chemoradiation with carboplatin/paclitaxel and 60Gy radiation to the right upper lung, mediastinum and SCV region (completed 4/16/2014), followed by an additional two cycles of chemotherapy (completed 5/20/2014). She was subsequently placed on erlotinib due to EGFR mutation, then switched to afatenib in September 2014.In July 2015 the patient noted a sense of imbalance and left hand weakness; an MRI demonstrated enlargement of the previously-treated brain metastasis at the posterior margin of the right superior frontal gyrus, with significant associated edema (Figure 1). She was started on dexamethasone, with some symptomatic improvement. Given her continued weakness, however, a plan was made for the patient to undergo stereotactic biopsy with possible subsequent LITT.On 10/12/2015 the patient was electively taken to the operating room. Using frameless stereotaxy, a biopsy was...

show abstract

“…No influence on survival of the primary tumor have been reported (Lorenzoni, 2004;Nam, 2005;Rades, 2007;Frazier, 2010), on the other hand other studies have demonstrated significant association of this variable with survival: Hasegawa (Hasegawa, 2003), in the multivariate analysis found significant lower survival in patients harboring malignant melanoma. In multivariate studies Simonová (Simonová, 2000) reported better survival in patients with breast or renal cancer, Petrovich (Petrovich, 2002) found worse survival in patients with Melanoma and colon cancer and better survival in patients with breast cancer.…”

Section: Location or Histology Of The Primary Tumormentioning

confidence: 90%

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

Lorenzoni¹,

Zarate²,

Ramón³

et al. 2011

Gamma Knife Radiosurgery

View full text Add to dashboard Cite

Stereotactic Radiosurgery in the Management of Brain Metastases: An Institutional Retrospective Analysis of Survival

Cited by 45 publications

References 58 publications

Stereotactic Radiosurgery of Colorectal Carcinoma Brain Metastasis: A multi-institutional experience.

Stereotactic Radiosurgery of Colorectal Carcinoma Brain Metastasis: A multi-institutional experience.

Laser Interstitial Thermal Therapy for Radiation Necrosis/Adverse Inflammatory Responses to SRS - Case Report and Literature Review

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

Contact Info

Product

Resources

About