The strategy of repeat stereotactic radiosurgery without whole brain radiation treatment for new brain metastases: Outcomes and implications for follow-up monitoring

Shen, Colette J.; Rigamonti, Daniele; Redmond, Kristin J.; Kummerlowe, Megan N.; Lim, Michael; Kleinberg, Lawrence

doi:10.1016/j.prro.2016.04.004

Cited by 25 publications

(17 citation statements)

References 25 publications

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“…More recently, Shen et al reported patients with SBME treated with at least 2 courses of SRS without whole-brain radiation. On MVA, ECOG performance status as well as controlled extracranial disease and interval between initial and second SRS > 6 months correlated with improved survival (11). …”

Section: Discussionmentioning

confidence: 99%

“…For renal cell and melanoma, only KPS and number of brain metastases was significant compared with breast and GI cancer where only KPS was significant (7, 8). Survival prognosticators for patients facing a second brain metastatic event (SBME) have been reported (9–11). The purpose of the current study is to document survival for patients treated with SRS alone for brain metastases either at initial presentation or for salvage in conjunction with other known prognostic factors, such as RPA in a single institutional community setting with comparison to current literature.…”

Section: Introductionmentioning

confidence: 99%

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Single Institutional Experience of Stereotactic Radiosurgery Alone for First Brain Metastatic Event and Salvage of Second Brain Metastatic Event in a Community Setting with Review of the Literature

et al. 2017

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PurposeTo document survival for patients treated with stereotactic radiosurgery (SRS) alone for brain metastases either at initial presentation or for salvage in conjunction with other known prognostic factors in a single institutional community setting with comparison to current literature.MethodsAll patients treated for brain metastases with SRS between October 2006 and October 2013 were reviewed. We identified 91 patients treated with SRS alone for first brain metastatic event (FBME) and 87 patients treated with SRS for second brain metastatic event (SBME). We excluded the 14 patients treated with SRS for both FBME and SBME to satisfy the independence assumption for comparison of groups. Patient demographics, including age, gender, primary cancer type, presence of extracranial metastases, number of brain metastases, initial site of metastases (brain vs. other), recursive partitioning analysis (RPA), and Karnofsky Performance status (KPS) were documented.ResultsThere were no significant differences in overall survival for patients treated with SRS for FBME compared with SBME (log-rank p = 0.9347). Univariate and multivariable Cox regression modeling revealed KPS (p = 0.0003) and RPA (p = 0.0143) were the only independent prognostic factors for survival. Specifically, patients with RPA 1 had a 61% decreased risk of death compared to those with RPA 3. Patients with RPA 2 had a 33% decreased risk of death compared to those with RPA 3. The 1-year survival rate was 36.5% for patients with RPA1, 33.3% for those with RPA 2, and 17.1% for those with RPA 3. Patients with KPS 90–100 had a 62% decreased risk of death compared to those with KPS < 70. The 1-year survival rate for patients KPS 90–100, 70–80, and <70 were 60.7, 24.6, and 16.7%, respectively.ConclusionNo difference in survival was noted for FBME and SBME with performance status, the single most important prognostic factor following SRS. Aggressive treatment should be considered for patients with good performance status regardless if presenting with FBME or SBME. Our results are consistent with single, multi-institutional, and randomized trials after literature review.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Single Institutional Experience of Stereotactic Radiosurgery Alone for First Brain Metastatic Event and Salvage of Second Brain Metastatic Event in a Community Setting with Review of the Literature

et al. 2017

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“…По данным С. Shen и соавт. [21], 44 % пациентов с повторной радиохирургией получили таргетную терапию, в то время как в группе однократной радиохирургии таргетную терапию получали только 36 % пациентов.…”

Section: Discussionunclassified

“…Median cumulative tumor volume, maximal lesion volume, number of brain metastases in the studied patient group were 5.4 cm 3 , 3.6 cm 3 , and 4, respectively. Mean marginal dose of ionizing radiation was 22 Gy (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Mean follow-up duration was 13.4 months.…”

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confidence: 99%

Results of Radiosurgical and Drug Treatment of Patients With Brain Metastases

Банов¹,

Golanov²,

Ильялов³

et al. 2017

Opuholi golovy šei

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Цель исследованияизучение показателей общей выживаемости пациентов с метастазами в головной мозг и частоты интракраниальных рецидивов у них после проведения радиохирургии в самостоятельном варианте лечения. Материалы и методы. Проведен анализ результатов радиохирургического лечения 579 пациентов с метастазами в головной мозг (248 мужчин и 331 женщина). Источниками метастазирования в головной мозг были: рак молочной железы (164 пациента), немелкоклеточный рак легкого (162), меланома (123), рак почки (87), колоректальный рак (43). Медианы суммарного объема метастазов, объема максимального очага, количество метастазов в головной мозг в исследуемой группе пациентов составили соответственно 5,4; 3,6 и 4 см 3 . Средняя краевая доза ионизирующего облучения равнялась 22 Гр (15-24 Гр). Среднее время клинического наблюдения составило 13,4 мес. Результаты. Общая выживаемость пациентов на сроке 12 и 24 мес была соответственно 42,8 и 24,8 %, с медианой общей выживаемости после проведения радиохирургии 9,8 мес (95 % доверительный интервал 8,5-11,3). Локальный контроль метастатических очагов достигнут у 81,3 % пациентов. Выживаемость без развития локального рецидива на сроке 12 мес равнялась 66,7 %. Дистантные метастазы развились у 235 (52,4 %) из 449 пациентов, у которых были доступны данные радиологического наблюдения. Выживаемость без развития дистантного метастазирования на сроке 12 и 24 мес составила 41,5 и 20,9 % соответственно. По результатам многофакторного анализа, факторами прогноза более длительной общей выживаемости пациентов с метастатическим поражением головного мозга были наличие метастазов рака молочной железы в головной мозг, ограниченное (4 очага и менее) метастатическое поражение головного мозга, высокий функциональный статус и отсутствие экстракраниальных метастазов. С увеличением срока выживаемости пациентов ассоциировалось проведение таргетной терапии (р = 0,0412) и повторной радиохирургии при возникновении интракраниальных рецидивов (р <0,0001). Заключение. Проведение радиохирургического лечения у пациентов с метастазами в головной мозг обеспечивает более высокую медиану общей выживаемости (до 9,8 мес), чем аналогичный показатель (7,1 мес) у больных 1-го класса (по шкале рекурсивного парциального анализа), которые получили облучение всего головного мозга в самостоятельном варианте лечения. Повторное проведение радиохирургии в случае развития интракраниальных рецидивов и таргетная терапия обеспечивают увеличение общей выживаемости пациентов с метастазами в головной мозг. Ключевые слова: метастазы в головной мозг, радиохирургия, облучение всего головного мозгаThe study objective is to study overall survival and the rate of intracranial recurrences in patients with brain metastases after radiosurgery as single treatment. Materials and methods. The results of radiosurgical treatment of 579 patients with brain metastases (248 men and 331 women) were analyzed. The sources of brain metastases were breast cancer (164 patients), non-small-cell lung carcinoma (162), melanoma (123), kidney cancer (87), colorectal c...

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“…This patient maintained brain imaging surveillance during her clinical course and most brain recurrences were identified while small in size and few in number such that they were suitable for SRS. A study reported by Shen, et al [ 4 ] of patients treated with salvage SRS also found that new brain lesions infrequently caused neurologic symptoms before routine imaging detection, and detecting brain lesions early may have advantages.…”

Section: Discussionmentioning

confidence: 99%

Salvage Stereotactic Radiosurgery for Multiple Brain Recurrences: How Much is Enough?

Hsu

2017

Cureus

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Stereotactic radiosurgery (SRS) can be used as a salvage treatment in selected patients with recurrent brain metastases after previous brain radiation. We report the case of a patient with metastatic lung adenocarcinoma who experienced recurrence numerous times in the brain and was successfully treated each time with SRS. For this patient, brain imaging surveillance helped identify metastases early for salvage SRS. We have also included a discussion of published literature regarding the neurocognitive toxicity of repeated courses of SRS.

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The strategy of repeat stereotactic radiosurgery without whole brain radiation treatment for new brain metastases: Outcomes and implications for follow-up monitoring

Cited by 25 publications

References 25 publications

Single Institutional Experience of Stereotactic Radiosurgery Alone for First Brain Metastatic Event and Salvage of Second Brain Metastatic Event in a Community Setting with Review of the Literature

Single Institutional Experience of Stereotactic Radiosurgery Alone for First Brain Metastatic Event and Salvage of Second Brain Metastatic Event in a Community Setting with Review of the Literature

Results of Radiosurgical and Drug Treatment of Patients With Brain Metastases

Salvage Stereotactic Radiosurgery for Multiple Brain Recurrences: How Much is Enough?

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