The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

Moraes, Fábio Ynoe de; Taunk, Neil K.; Marta, Gustavo Nader; Suh, John H.; Yamada, Yoshiya

doi:10.1634/theoncologist.2015-0293

Cited by 30 publications

(13 citation statements)

References 63 publications

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“… 58 , 59 , 60 However, the safety (neurotoxicity), dosage, and timing/scheduling of concurrent immunotherapy with SRS remains a topic of research, 61 , 62 and prospective randomized trials including standardized neuropsychological assessments are needed to investigate the effects of these targeted therapies in combination with SRS on the cognition in patients with BM. 63 , 64 …”

Section: Discussionmentioning

confidence: 99%

Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review

Schimmel

Gehring

Eekers

et al. 2018

Advances in Radiation Oncology

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PurposeStereotactic radiation surgery (SRS) is increasingly applied in patients with brain metastases (BM) and is expected to have fewer adverse effects on cognitive functioning than whole brain radiation therapy (WBRT). Patients with BM are often confronted with a relatively short life expectancy, and the prevention or delay of cognitive decline to maintain quality of life is a clinically and highly relevant treatment goal. This review systematically and specifically evaluates the current literature on the cognitive effects of SRS in patients with BM.Methods and materialsPublished trials on SRS alone or in combination with WBRT, including objective assessment of cognitive functioning, were identified through a systematic search of the PubMed database up to March 2018.ResultsOf the 241 records screened, 14 studies matched the selection criteria: 2 pilot studies, 7 single-group/observational trials (1 study update), and 5 randomized trials (1 secondary analysis).ConclusionsIn general, the results show little to no objective cognitive decline up to 4 months after SRS compared with WBRT. However, most trials suffered from methodologic limitations that hindered reliable conclusions. Most importantly, few studies investigated the specific cognitive effects of SRS alone or versus WBRT. Furthermore, disentangling the cognitive effects of SRS from the effects of the disease itself and from the effects of other treatments remains very difficult. By presenting this comprehensive review, we aim to encourage researchers to probe deeper into this area and to do so in a standardized and methodologically optimal manner. The ultimate objective of this line of research is to inform both doctors and patients more precisely about the cognitive effects they can expect from treatment. This study is expected to improve the quality of decision-making and maximize clinical outcomes for each individual patient.

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Section: Discussionmentioning

confidence: 99%

Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review

Schimmel

Gehring

Eekers

et al. 2018

Advances in Radiation Oncology

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“…Significant survival gains have been made in recent years for a small subset of patients because of targeted therapy 24 or immunotherapy 25,26 . In non-small cell lung cancer, for instance, it is estimated that <25 % of all patients derive genuine benefit from these therapies 27–29 .…”

Section: Discussionmentioning

confidence: 99%

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

et al. 2017

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Background The number of brain metastases (BM) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT). Methods We analyzed the survival of 5750 SRS-treated BM patients as a function of BM number. Survival analyses were performed using Kaplan-Meier analysis as well as univariate and multivariate Cox proportional hazards models. Results BM patients were first categorized as those with 1, 2–4, and 5–10 BM based on the scheme proposed by Yamamoto et al (Lancet Oncology 2014). Median overall survival for patients with 1 BM was superior to those with 2–4 BMs (7.1 mo v. 6.4 mo, p=0.009), and survival of patients with 2–4 BMs did not differ from those with 5–10 BMs (6.4 mo v. 6.3 mo, p=0.170). The median survival of patients with >10 BMs was lower than those with 2–10 BMs (6.3 mo v. 5.5 mo, p=0.025). In a multivariate model that accounted for age, Karnofsky Performance Score (KPS), systemic disease status, tumor histology, and cumulative intracranial tumor volume (CITV), we observed a ~10% increase in hazard of death when comparing patients with 1 versus 2–10 BM (p<0.001) or 10 versus >10 BM (p<0.001). When BM number was modeled as a continuous variable rather than using the Yamamoto classification, we observed a step-wise 5% increase in the hazard of death for every increment of 5–6 BM (p<0.001). Conclusions The contribution of BM number to overall survival is modest, and should be considered as one of the many variables considered in the decision between SRS and WBRT.

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“…66,67 In this regard, an increased risk of radionecrosis following SRS and immunotherapy has been suggested. 68 …”

Section: Neurooncologymentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

410

338

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The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of NeuroOncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care. Key wordsbrain metastases | chemotherapy | neuroimaging | neuropathology | stereotactic radiosurgery/stereotactic fractionated radiotherapy | supportive care | surgery | targeted therapy | whole-brain radiation therapy

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The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

Cited by 30 publications

References 63 publications

Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review

Cognitive effects of stereotactic radiosurgery in adult patients with brain metastases: A systematic review

Survival Patterns of 5750 Stereotactic Radiosurgery–Treated Patients with Brain Metastasis as a Function of the Number of Lesions

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

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