Whole-Brain Radiation Therapy Versus Stereotactic Radiosurgery for Cerebral Metastases

Perlow, Haley K.; Dibs, Khaled; Liu, Kevin; Jiang, William; Rajappa, Prajwal; Blakaj, Dukagjin; Palmer, Joshua D.; Raval, Raju R.

doi:10.1016/j.nec.2020.06.006

Cited by 10 publications

(11 citation statements)

References 60 publications

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“…When discussing the abscopal effect for brain tumors, it appears that both SRS and WBRT are able to induce an abscopal effect for extracranial metastases. 32 , 33 These findings are consistent with the results of other systematic reviews on the abscopal effect; Macki et al 34 , demonstrated that the abscopal effect for spine metastases was most common in patients with high doses of radiotherapy and on immunomodulatory therapy. Other reviews across multiple primary cancer subtypes and multiple metastatic locations have demonstrated the abscopal effect in similar populations and across similar cancers as our study, and similar to Macki et al 35 , 36 , postulated that higher dosages may have an increased abscopal effect.…”

Section: Discussionsupporting

confidence: 83%

The abscopal effect: systematic review in patients with brain and spine metastases

Pangal

Yarovinsky

Cardinal

et al. 2022

Neuro-Oncology Advances

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Introduction The abscopal effect is a rare phenomenon whereby local radiation induces a proposed immune-mediated anti-tumor effect at distant sites. Given the growing use of immunotherapies and systemic immune checkpoint inhibitors in neuro-oncologic practice, we aimed to review prior studies pertaining to this phenomenon in the context of tumor shrinkage both within the central nervous system as well as distant disease sites. Methods A systematic review in accordance with the PRISMA guidelines was conducted to identify all studies which assessed the abscopal effect in patients with treated metastatic cancer to the brain and/or spine. Articles were included if they reported the abscopal effect in patients (case studies) or if the abscopal effect was explicitly analyzed in case series with cohorts of patients with metastatic brain or spine tumors. Laboratory investigations and clinical trials investigating new therapies were excluded. Results Twenty reports met inclusion criteria [16 case reports, 4 case series (n=160), total n=174]. Case reports of the abscopal effect were in relation to the following cancers: melanoma (6 patients), breast cancer (3), lung adenocarcinoma (2), non-small-cell lung cancer (2), hepatocellular carcinoma (1), and renal cell carcinoma (1). Eleven patients had irradiation to the brain and 2 to the spine. Patients undergoing whole brain radiotherapy (6) had an average dose of 33.6 Gy over 8-15 fractions, and those undergoing stereotactic radiosurgery (5) had an average dose of 21.5 Gy over 1-5 fractions. One patient had radiation to the body and an intracranial abscopal effect was observed. Most common sites of extracranial tumor reduction were lung and lymph nodes. Ten case studies (57%) showed complete resolution of extra-CNS tumor burden. Median progression free survival was 13 months following radiation. Four papers investigated incidence of abscopal effects in patients with metastatic melanoma to the brain who received immune checkpoint inhibitor therapy (n=160); two papers found an abscopal effect in 35% and 52% of patients (n=16, 21 respectively), and two papers found no evidence of abscopal effects (n=61, 62). Conclusions Abscopal effects can occur following radiotherapy in patients with brain or spine metastases and is thought to be a result of increased anti-tumor immunity. The potential for immune checkpoint inhibitor therapy to be used in combination with radiotherapy to induce an abscopal effect is an area of active investigation.

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Section: Discussionsupporting

confidence: 83%

The abscopal effect: systematic review in patients with brain and spine metastases

Pangal

Yarovinsky

Cardinal

et al. 2022

Neuro-Oncology Advances

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“…In contrast to the concentrated nature of SRS, whole brain radiation therapy (WBRT) is an exposure of the entire cranium to radiation. [87] WBRT is the current standard for treatment of BrMs from NSCLC in patients with multiple metastases. [88] Although WBRT is being replaced with SRS for other forms of BrMs, it remains the standard for NSCLC and SCLC metastases.…”

Section: Radiationmentioning

confidence: 99%

Principles of Lung Cancer Metastasis to Brain

Goeckeritz

Cerillo

Sanghadia

et al. 2022

JSS

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Lung cancer is a disease associated with significant morbidity and mortality on a global setting. This form of cancer commonly gives raise to metastatic lesions the brain, which can further worsen outcomes. In this focused review, we discuss an overview of lung cancers that metastasize to the brain: known risk factors; means of detection and diagnosis; and options for treatment including a comparison between surgical resection, stereotactic radiosurgery, and whole-brain radiation therapy. These interventions are still being assessed by clinical trials and continue to be modified through evidence-based practice.

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“…Single-fraction SRT is performed with a Gamma Knife (Elekta AB, Stockholm, Sweden) or linear accelerators that are equipped with micro multi-leaf collimators and a high-dose rate or with a CyberKnife (Accuray, Sunnyvale, CA, USA). Linear accelerators are also used for fractionated treatments [15][16]. For simulation purposes, the patient is placed in a supine position and a stereotactic frame is applied to the head using local anaesthesia for Gamma Knife SRT.…”

Section: Imaging For Staging and Treatment Planningmentioning

confidence: 99%

“…Increasingly popular options are single-fraction and fractionated stereotactic radiotherapy (SRT), with both providing satisfactory local control rates and a low risk of radiation necrosis [15]. Single-fraction SRT is used to treat patients with a good performance status and up to 4 lesions with a diameter of 30 mm or less [16][17] that are distant from crucial brain function areas.…”

Section: Introductionmentioning

confidence: 99%