Toxicity of Radiosurgery for Brainstem Metastases

Patel, Abhinav; Dong, Tuo; Ansari, Shaheryar F.; Cohen-Gadol, Aaron; Watson, Gordon A.; Moraes, Fábio Ynoe de; Nakamura, Masaki; Murovic, Judith A.; Chang, Steven D.; Hatiboğlu, Mustafa Aziz; Chung, Caroline; Miller, James C.; Lautenschlaeger, Tim

doi:10.1016/j.wneu.2018.07.263

Cited by 13 publications

(8 citation statements)

References 41 publications

(91 reference statements)

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“… 59 , 60 In a systematic review of radiosurgical toxicity, grade 3 toxicity or greater (Common Terminology Criteria for Adverse Events) was 3.4% ± 2.9% with the majority of toxicities occurring before 9 months. 61 While SRS and fractionated radiation therapy both exhibit good local control rates for meningioma, fractionated radiotherapy is associated with a lower risk of treatment-related edema. 62 …”

Section: Hrqol After Radiotherapymentioning

confidence: 99%

Health-related quality of life in meningioma

Haider

Taphoorn

Drummond

et al. 2021

Neuro-Oncology Advances

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Meningiomas are the most common primary intracranial tumor in adults. Although frequently histologically benign, the clinical severity of a lesion may range from being asymptomatic to causing severe impairment of global function and well-being. The diversity of intracranial locations and clinical phenotypes poses a challenge when studying functional impairments, however, more recent attention to patient-reported outcomes and health-related quality of life (HRQOL) have helped to improve our understanding of how meningioma may impact a patient’s life. Treatment strategies such as observation, surgery, radiation, or a combination thereof have been examined to ascertain their contributions to symptoms, physical and cognitive functioning, disability, and general aspects of daily functioning. This review explores the multidimensional nature of HRQOL and how patients may be influenced by meningiomas and their treatment. Overall, treatment of symptomatic meningiomas is associated with improved HRQOL, cognitive functioning, and seizure control while tumor size, location, histologic grade, and epileptic burden are associated with worse HRQOL.

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Section: Hrqol After Radiotherapymentioning

confidence: 99%

Health-related quality of life in meningioma

Haider

Taphoorn

Drummond

et al. 2021

Neuro-Oncology Advances

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“…Stereotactic radiotherapy is associated with 85%–95% local control at 1 year for lesions <2 cm ( 4 , 5 ) and very few adverse events ( 6 ). One of the major adverse events is brain radionecrosis.…”

Section: Introductionmentioning

confidence: 99%

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Lolli

Tessari²,

Berti³

et al. 2023

Front. Oncol.

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IntroductionRadionecrosis is a consequence of SRS (stereotactic radiosurgery) for brain metastases in 34% of cases, and if symptomatic (8%–16%), it requires therapy with corticosteroids and bevacizumab and, less frequently, surgery. Oncological indications are increasing and appropriate stereotactic adapted LINACs (linear accelerators) are becoming more widely available worldwide. Efforts are being made to treat brain radionecrosis in order to relieve symptoms and spare the use of active therapies.Case presentationHerein, we describe a 65-year-old female patient presenting with brain radionecrosis 6 months after stereotactic radiotherapy for two brain metastatic lesions. Being symptomatic with headache and slow cognitive-motor function, the patient received corticosteroids. Because of later lung progression, the patient took cabozantinib. An impressive reduction of the two brain radionecrosis areas was seen at the brain MRI 2 months after the initiation of the angiogenic drug.DiscussionThe high incidence of radionecrosis (2/2 treated lesions) can be interpreted by the combination of SRS and previous ipilimumab that is associated with increased risk of radionecrosis. The molecular mechanisms of brain radionecrosis, and its exact duration in time, are poorly understood. We hypothesize that the antiangiogenic effect of cabozantinib may have had a strong effect in reducing brain radionecrosis areas.ConclusionIn this clinical case, cabozantinib is associated with a fast and significant volume reduction of brain radionecrosis appearing after SRS and concomitant immunotherapy. This drug seems to show, like bevacizumab, clinical implications not only for its efficacy in systemic disease control but also in reducing brain radionecrosis. More research is needed to evaluate all molecular mechanisms of brain radionecrosis and their interaction with systemic therapies like third-generation TKIs.

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“…The incidence of treatment-associated toxicity following SRS and FSRT for BSM appears to be low, with grade 3 or higher toxicities observed in approximately 2.4% of cases, ranging from 0% to 12%. 6,26 Correspondingly to the dose-volume relation in the radiation of brain metastases, higher toxicity in the treatment of BSM is more likely in larger tumor volumes and higher margin doses. 6,24,27 Moreover, the risk of toxicity after BSM radiation might increase with malignant melanoma as a primary histology and after WBRT.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery and radiotherapy for brainstem metastases: An international multicenter analysis

Ehret,

Rueß,

Blanck

et al. 2024

Intl Journal of Cancer

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Brainstem metastases (BSM) present a significant neuro‐oncological challenge, resulting in profound neurological deficits and poor survival outcomes. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) offer promising therapeutic avenues for BSM despite their precarious location. This international multicenter study investigates the efficacy and safety of SRS and FSRT in 136 patients with 144 BSM treated at nine institutions from 2005 to 2022. The median radiographic and clinical follow‐up periods were 6.8 and 9.4 months, respectively. Predominantly, patients with BSM were managed with SRS (69.4%). The median prescription dose and isodose line for SRS were 18 Gy and 65%, respectively, while for FSRT, the median prescription dose was 21 Gy with a median isodose line of 70%. The 12‐, 24‐, and 36‐month local control (LC) rates were 82.9%, 71.4%, and 61.2%, respectively. Corresponding overall survival rates at these time points were 61.1%, 34.7%, and 19.3%. In the multivariable Cox regression analysis for LC, only the minimum biologically effective dose was significantly associated with LC, favoring higher doses for improved control (in Gy, hazard ratio [HR]: 0.86, p < .01). Regarding overall survival, good performance status (Karnofsky performance status, ≥90%; HR: 0.43, p < .01) and prior whole brain radiotherapy (HR: 2.52, p < .01) emerged as associated factors. In 14 BSM (9.7%), treatment‐related adverse events were noted, with a total of five (3.4%) radiation necrosis. SRS and FSRT for BSM exhibit efficacy and safety, making them suitable treatment options for affected patients.

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Toxicity of Radiosurgery for Brainstem Metastases

Cited by 13 publications

References 41 publications

Health-related quality of life in meningioma

Health-related quality of life in meningioma

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Stereotactic radiosurgery and radiotherapy for brainstem metastases: An international multicenter analysis

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