Stereotactic Radiosurgery With or Without Whole Brain Radiotherapy for Patients With a Single Radioresistant Brain Metastasis

Clarke, James W.; Register, Steven; McGregor, John M.; Grecula, J.C.; Mayr, Nina A.; Wang, Jian Z.; Li, Kaile; Gupta, Nilendu; Kendra, Kari; Olencki, Thomas; Cavaliere, Robert; Sarkar, Atom; Lo, Simon S.

doi:10.1097/coc.0b013e31819ccc8c

Cited by 39 publications

(27 citation statements)

References 31 publications

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“…Overall, the distribution of tumor volumes in our cohort were relatively small, with the rationale for using SRT related to eloquent tumor location in most cases, and therefore large size was not likely a factor reducing local control. With regard to histology, approximately 5 % of patients enrolled on the RTOG 95-08 and EORTC prospective trials had melanoma [2,3], which is significantly lower than in the present study, and this histology has been linked to greater radioresistance [23], though not in all studies [1,4], and was not associated with more aggressive local progression in our study. A recent study found that while local control after singlefraction SRS was similar between classically radiosensitive versus radioresistant brain metastasis histologies, SRT for radioresistant histologies demonstrated worse local control than for radiosensitive histologies, with an odds ratio of 5.37 (95 % CI 3.83-6.91; p = 0.032) [24].…”

Section: Discussionmentioning

confidence: 46%

Local control after fractionated stereotactic radiation therapy for brain metastases

et al. 2014

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Stereotactic radiosurgery (SRS) is frequently used in the management of brain metastases, but concerns over potential toxicity limit applications for larger lesions or those in eloquent areas. Fractionated stereotactic radiation therapy (SRT) is often substituted for SRS in these cases. We retrospectively analyzed the efficacy and toxicity outcomes of patients who received SRT at our institution. Seventy patients with brain metastases treated with SRT from 2006-2012 were analyzed. The rates of local and distant intracranial progression, overall survival, acute toxicity, and radionecrosis were determined. The SRT regimen was 25 Gy in 5 fractions among 87 % of patients. The most common tumor histologies were non-small cell lung cancer (37 %), breast cancer (20 %) and melanoma (20 %), and the median tumor diameter was 1.7 cm (range 0.4-6.4 cm). Median survival after SRT was 10.7 months. Median time to local progression was 17 months, with a local control rate of 68 % at 6 months and 56 % at 1 year. Acute toxicity was seen in 11 patients (16 %), mostly grade 1 or 2 with the most common symptom being mild headache. Symptomatic radiation-induced treatment change was seen on follow-up MRIs in three patients (4.3 %). SRT appears to be a safe and reasonably effective technique to treat brain metastases deemed less suitable for SRS, though dose intensification strategies may further improve local control.

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Section: Discussionmentioning

confidence: 46%

Local control after fractionated stereotactic radiation therapy for brain metastases

et al. 2014

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“…Patients with RCC may experience symptomatic improvement with whole brain radiation therapy, but RCC is considered to be radio-resistant in nature because of its poor response to standard radiation therapy. The 1-year intracranial local control rate is estimated to range from 0% to 14% [16]. In contrast, stereotactic radiosurgery for brain metastasis of RCC reportedly offers good control of tumor growth.…”

Section: Discussionmentioning

confidence: 99%

Extremely Delayed Brain Metastasis from Renal Cell Carcinoma

Choi

Koh

Song

et al. 2013

Brain Tumor Res Treat

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Brain metastasis occurs in 3.9-24% of patients with renal cell carcinoma (RCC), with an average interval from nephrectomy to brain metastasis of 1 to 3 years. A few cases have been reported where brain metastasis occurred after a delay of more than 10 years from the initial onset of renal cell carcinoma. This long interval for central nervous system metastasis from the primary cancer has been recognized as an indicator of better prognosis. Histopathological confirmation and aggressive treatment must be considered in these delayed brain metastases cases, since the patients usually show long survival and good prognosis. We present a case of a 76-year-old woman who developed extremely late multiple brain metastases 18 years after a nephrectomy for RCC.

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“…Recently, there has been a paradigm shift toward more focused radiation treatment. For patients with limited brain metastases, SRS can be used as an alternative to WBRT without compromising overall survival, and with reduced neurocognitive impairment (83)(84)(85)(86). Due to better response of melanoma to large radiation fraction dose, SRS treatment significantly improved the local control rate of melanoma brain metastases compared to those that were treated with WBRT (87,88).…”

Section: Role Of Palliative Rt For Melanomasmentioning

confidence: 99%

“…Due to better response of melanoma to large radiation fraction dose, SRS treatment significantly improved the local control rate of melanoma brain metastases compared to those that were treated with WBRT (87,88). The 12-month local control rate with SRS is about 65% (85)(86)(87)(88). More impressively, SRS also contributes to improved overall survival from 4 months to 6-8 months as compared to WBRT (85,89,90).…”

Section: Role Of Palliative Rt For Melanomasmentioning

confidence: 99%

Radiation Therapy for Melanoma

Shi

2017

Cutaneous Melanoma: Etiology and Therapy

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Although melanoma is a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option for the management of melanoma. RT as a primary treatment is often offered in well-defined situations, such as medical inoperability, lentiginous melanoma, mucosal melanoma, and ocular melanoma. Adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence; however, the role of adjuvant RT remains controversial and underutilized due to lack of overall survival benefit. On the other hand, RT is highly effective in providing symptom palliation for metastatic melanoma and is widely used. Advanced RT technologies such as stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) can achieve excellent local control with minimum toxicities. They are commonly used in the management of brain, lung, spine, and liver metastases. Most recently, it is under active investigation on combining RT with new systemic options, such as targeted therapy, or immunotherapy. The advancements in the treatment of patients with melanoma highlight the importance of multidisciplinary management in this disease. Radiation therapy will continue to be one of the key therapeutic options.

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Stereotactic Radiosurgery With or Without Whole Brain Radiotherapy for Patients With a Single Radioresistant Brain Metastasis

Abstract: Gamma Knife SRS is a safe and feasible strategy for treatment of patients with a single radioresistant brain metastasis. Radiosurgery alone is a reasonable treatment option, but may carry a greater likelihood of distant brain recurrence.

Cited by 39 publications

References 31 publications

Local control after fractionated stereotactic radiation therapy for brain metastases

Local control after fractionated stereotactic radiation therapy for brain metastases

Extremely Delayed Brain Metastasis from Renal Cell Carcinoma

Radiation Therapy for Melanoma

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