Tumor Control Probability of Radiosurgery and Fractionated Stereotactic Radiosurgery for Brain Metastases

Redmond, Kristin J.; Gui, Chengcheng; Benedict, Stanley H; Milano, Michael T.; Grimm, Jimm; Vargo, John A.; Soltys, Scott G.; Yorke, Ellen; Jackson, Andrew; Naqa, Issam El; Marks, Lawrence B.; Xue, Jinyu; Heron, Dwight E.; Kleinberg, Lawrence

doi:10.1016/j.ijrobp.2020.10.034

Cited by 82 publications

(119 citation statements)

References 90 publications

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“…SRS is an important, minimally invasive strategy for patients with newly diagnosed or recurrent metastatic cancer to the brain, with local brain tumor control rates at one year after SRS that vary between 80 to 95% [9][10][11]. Compared to conventional WBRT, SRS results in improved local tumor control, long-term survival, and neurocognition preservation in patients with metastatic melanoma [12].…”

Section: Discussionmentioning

confidence: 99%

Aggressive Stereotactic Radiosurgery Coupled With Immune and Targeted Therapy for Recurrent Melanoma Brain Metastases: A Case Report and Literature Review

Wei¹,

Waite²,

Deng³

et al. 2022

Cureus

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Melanoma is a complex disease with a high propensity for brain metastatic spread. Stereotactic radiosurgery (SRS) is a minimally invasive procedure to treat intracranial metastasis with a high rate of local tumor control. In this report, we describe the ongoing management of a patient with interval development of both new and recurrent brain metastases that required seven SRS procedures for a total of 48 brain metastases during a two-year interval while receiving concurrent immunotherapy with ipilimumab and nivolumab. The most recent imaging of the patient showed three brain areas of likely tumor progression despite maintenance nivolumab, and the treatment was recently changed to encorafenib and binimetinib. Combined management with immunotherapy, initial craniotomy, and repeated SRS for new brain metastases resulted in extended survival while preserving neurological function and reducing adverse treatment effects in a patient with advanced metastatic brain melanoma.

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Section: Discussionmentioning

confidence: 99%

Aggressive Stereotactic Radiosurgery Coupled With Immune and Targeted Therapy for Recurrent Melanoma Brain Metastases: A Case Report and Literature Review

Wei¹,

Waite²,

Deng³

et al. 2022

Cureus

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“…Minniti et al analyzed the clinical outcome of 289 patients with large (> 2.0 cm) BM who received SRS or FSRT, with the results revealing that FSRT showed a better 1-year cumulative local control rate (91% versus 77%, P = 0.01) and a reduced risk of RN (8% versus 20%, P = 0.004) [ 20 ]. On the other hand, it has been reported that stereotactic radiotherapy alone deteriorates local control rate as the tumor size increases [ 21 , 22 ]. A recent systematic review estimates the 2-year local control rate of 69% for large (31–40 mm) BM treated with FSRT (30 Gy in five fractions) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients

et al. 2021

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Background The safety and effectiveness of neoadjuvant fractionated stereotactic radiotherapy (FSRT) before piecemeal resection of brain metastasis (BM) remains unknown. Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy (n = 11) or 35 Gy (n = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.

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“…Data on Tumor Control Probability (TCP), considered as the probability of LC ( 30 ) and Normal Tissue Complication Probability (NTCP), considered as the risk of RN ( 31 ), were recently published as Organ-Specific Papers from the international collaborative project “HYTEC” (Hypofractionated Treatment Effects in the Clinic), to guide dose and fractionation choices for SRS/SRT in BMs. The authors concluded that single-fraction SRS with doses of 18-24 Gy should be the first choice for tumors ≤ 2 cm, guaranteeing an estimated LC of 85%-95% at 12 months, while SRT should be preferred for lesion >2 cm ( 30 ). The risk of RN is modeled on dose/volume parameters.…”

Section: Upfront Focal Rtmentioning

confidence: 99%

“…The prescribed dose of SRT usually ranges 24-30 Gy in 3-5 fractions in the published series ( 41 , 46 ). Based on the available data, the HYTEC TCP and NTCP papers provide useful indications on doses and constraints to orientate in the clinical practice, as previously done for the radical and upfront setting ( 30 , 31 ). The validation of these results in a randomized setting are awaited from the ongoing Alliance trial (NCT04114981), which is randomizing ≥2 cm-sized-operated brain lesions with post-surgical cavities smaller than 5 cm to be irradiated with single fraction SRS or 3-5 fractions SRT ( Table 1 ).…”

Section: Rt Complementary To Surgerymentioning

confidence: 99%

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

et al. 2021

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Brain metastases (BMs) represent the most frequent event during the course of Non-Small Cell Lung Cancer (NSCLC) disease. Recent advancements in the diagnostic and therapeutic procedures result in increased incidence and earlier diagnosis of BMs, with an emerging need to optimize the prognosis of these patients through the adoption of tailored treatment solutions. Nowadays a personalized and multidisciplinary approach should rely on several clinical and molecular factors like patient’s performance status, extent and location of brain involvement, extracranial disease control and the presence of any “druggable” molecular target. Radiation therapy (RT), in all its focal (radiosurgery and fractionated stereotactic radiotherapy) or extended (whole brain radiotherapy) declinations, is a cornerstone of BMs management, either alone or combined with surgery and systemic therapies. Our review aims to provide an overview of the many modern RT solutions available for the treatment of BMs from NSCLC in the different clinical scenarios (single lesion, oligo and poly-metastasis, leptomeningeal carcinomatosis). This includes a detailed review of the current standard of care in each setting, with a presentation of the literature data and of the possible technical solutions to offer a “state-of-art” treatment to these patients. In addition to the validated treatment options, we will also discuss the future perspectives on emerging RT technical strategies (e.g., hippocampal avoidance whole brain RT, simultaneous integrated boost, radiosurgery for multiple lesions), and present the innovative and promising findings regarding the combination of novel targeted agents such as tyrosine kinase inhibitors and immune checkpoint inhibitors with brain irradiation.

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Tumor Control Probability of Radiosurgery and Fractionated Stereotactic Radiosurgery for Brain Metastases

Cited by 82 publications

References 90 publications

Aggressive Stereotactic Radiosurgery Coupled With Immune and Targeted Therapy for Recurrent Melanoma Brain Metastases: A Case Report and Literature Review

Aggressive Stereotactic Radiosurgery Coupled With Immune and Targeted Therapy for Recurrent Melanoma Brain Metastases: A Case Report and Literature Review

Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients

Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions

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