The Volumetric Response of Brain Metastases After Stereotactic Radiosurgery and Its Post-treatment Implications

Sharpton, Suzanne R.; Oermann, Eric K.; Moore, Dominic T.; Schreiber, Eric; Hoffman, Riane; Morris, David E.; Ewend, Matthew G.

doi:10.1227/neu.0000000000000190

Cited by 34 publications

(50 citation statements)

References 20 publications

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“…In the present series, a decrease in TV by more than half between the two sessions was the sole factor predicting a high local tumor control rate for large BM. This observation is consistent with the results recently reported by Sharpton et al [28] and appears to be both clinically rational and relevant.…”

Section: Discussionsupporting

confidence: 93%

A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery

Yomo

Hayashi²

2014

Radiat Oncol

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BackgroundLarge brain metastases (BM) remain a significant cause of morbidity and death for cancer patients despite current advances in multimodality therapies. The goal of the present study was to evaluate the efficacy and limitations of 2-session Gamma Knife stereotactic radiosurgery (SRS) for patients with large BM.MethodsThis is a prospective, open-label and single arm study analyzing 58 consecutive patients who received 2-session SRS for large BM (≥ 10 mL). The median age was 66 years, and the median Karnofsky performance status (KPS) score was 70. SRS was the initial treatment in 51 large tumors (84%) and was used as salvage after failed prior treatments for 10 tumors (16%). The fraction protocol was 20-30 Gy given in 2 fractions with 3–4 weeks between fractions. Overall survival (OS) and neurological death (ND), local tumor control and KPS were analyzed.ResultsThe median follow-up time was 9.0 months. One- and 2-year OS rates were 47% and 20%, respectively. The median OS time was 11.8 months (95% CI: 5.5-15.6). The causes of death were intracranial local progression in 5 cases, meningeal carcinomatosis in 3 and progression of the primary lesion in 39. One- and 2-year ND-free survival rates were 91% and 84%, respectively. In 52 of 61 large BM (85%) with sufficient radiological follow-up data, 6- and 12-month local tumor control rates were 85% and 64%, respectively. The mean KPS improved from 70 at the 1st SRS to 82 at the 2nd; the first follow-up mean KPS was 87 (P < 0.001). Symptomatic radiation injury developed and required conservative treatment in 3 patients (5%).ConclusionsLong-term follow-up showed that two-session Gamma Knife SRS achieved durable tumor control rates as well as acceptable treatment-related morbidity. This treatment method may potentially merit being offered to patients with large BM who are in poor condition or are otherwise ineligible for standard care.

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Section: Discussionsupporting

confidence: 93%

A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery

Yomo

Hayashi²

2014

Radiat Oncol

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“…6 There is a paucity of data regarding the tumour response in the early period (<1 month) after stereotac-tic irradiation, even during FSRT, although the regression patterns 1-6 months after single-session radiosurgery have been described. 15,16 In this study, significant TDD was observed in 4 of 21 lesions over a period of 6-13 days (median 7.5 days) until the completion of planned FSRT, for all of which FSRT was Gross tumour volumes (GTVs) before and during treatment are contoured in the lower column as blue and yellow lines, respectively. In the image during treatment, the GTV contour before treatment is also shown for comparison.…”

Section: Discussionmentioning

confidence: 68%

Target volume geometric change and/or deviation from the cranium during fractionated stereotactic radiotherapy for brain metastases: Potential pitfalls in image guidance based on bony anatomy alignment

Ohtakara

Hoshi

2014

J Med Imag Rad Onc

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Target deformity and/or deviation can unexpectedly occur even during relatively short-course FSRT, inevitably leading to a gradual discrepancy between the planned and actually delivered doses to the tumour and surrounding tissue. To appropriately weigh the treatment outcome against the planned dose distribution, target deformity and/or deviation should also be considered in addition to the immobilisation accuracy, as image guidance with bony anatomy alignment does not necessarily guarantee accurate target localisation until completion of FSRT.

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“…In addition, we recognize our use of the early lesional response as a surrogate for treatment efficacy has limitations. Although some studies have suggested that a significant early lesional response to SRS translates into prolonged local control, ultimately, our results still need to be correlated with more traditional measures of clinical outcomes. Future studies could also examine the treatment response on the basis of changes in other magnetic resonance sequences and look at tumor hemorrhage, vascularity, cellularity, or perilesional edema.…”

Section: Discussionmentioning

confidence: 93%

Timing and type of immune checkpoint therapy affect the early radiographic response of melanoma brain metastases to stereotactic radiosurgery

Qian

Kluger

et al. 2016

Cancer

191

144

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Background Growing evidence suggests that immunotherapy and radiation therapy can be synergistic in the treatment of cancer. We sought to determine the effect of the relative timing and type of immune checkpoint therapy on response of melanoma brain metastases to treatment with stereotactic radiosurgery (SRS). Methods 75 melanoma patients with 566 brain metastases were treated with both SRS and immunotherapy between 2007 and 2015 at a single institution. Immunotherapy and radiosurgery treatment to any single lesion was considered concurrent if SRS was administered within four weeks of immunotherapy. The impact of timing and type of immunotherapy on lesional response was determined using the Wilcoxon rank sum test to compare median percent lesion volume change at 1.5 months, 3 months, and 6 months after SRS treatment, with significance determined by p=0.0167, per the Bonferroni correction for multiple comparisons. Results Concurrent use of immunotherapy and SRS resulted in significantly greater median percent reduction in lesion volume at 1.5 months (−63.1% vs −43.2%, p<0.0001), 3 months (−83.0% vs −52.8%, p<0.0001), and 6 months (−94.9% vs −66.2%, p<0.0001) compared to non-concurrent therapy. Median percent reduction in lesion volume was also significantly greater for anti-PD-1 than for anti-CTLA-4 at 1.5 months (−71.1% vs −48.2%, p<0.0001), 3 months (−89.3% vs −66.2%, p<0.0001), and 6 months (−95.1% vs −75.9%, p=0.0004). Conclusions Administration of immunotherapy within four weeks of SRS results in improved lesional response of melanoma brain metastases compared to treatment separated by greater than four weeks. Anti-PD-1 therapy also results in greater lesional response than anti-CTLA-4 after SRS.

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The Volumetric Response of Brain Metastases After Stereotactic Radiosurgery and Its Post-treatment Implications

Abstract: Significant volume reductions of brain metastases measured at either 6 or 12 weeks post-SRS were strongly associated with prolonged local control. Furthermore, early volume reduction was associated with less corticosteroid use and stable neurological symptoms.

Cited by 34 publications

References 20 publications

A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery

A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery

Target volume geometric change and/or deviation from the cranium during fractionated stereotactic radiotherapy for brain metastases: Potential pitfalls in image guidance based on bony anatomy alignment

Timing and type of immune checkpoint therapy affect the early radiographic response of melanoma brain metastases to stereotactic radiosurgery

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