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Loo M, Clavier JB, Attal Khalifa J, Moyal E, Khalifa J. Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review. Cancers (Basel) 2021; 13:cancers13236086. [PMID: 34885193 PMCID: PMC8657210 DOI: 10.3390/cancers13236086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Brain metastases are one of the most frequent complications for cancer patients. Stereotactic radiosurgery is considered a cornerstone treatment for patients with limited brain metastases and the ideal dose and fractionation schedule still remain unknown. The aim of this literature review is to discuss the dose-effect relation in brain metastases treated by stereotactic radiosurgery, accounting for fractionation and technical considerations. Abstract For more than two decades, stereotactic radiosurgery has been considered a cornerstone treatment for patients with limited brain metastases. Historically, radiosurgery in a single fraction has been the standard of care but recent technical advances have also enabled the delivery of hypofractionated stereotactic radiotherapy for dedicated situations. Only few studies have investigated the efficacy and toxicity profile of different hypofractionated schedules but, to date, the ideal dose and fractionation schedule still remains unknown. Moreover, the linear-quadratic model is being debated regarding high dose per fraction. Recent studies shown the radiation schedule is a critical factor in the immunomodulatory responses. The aim of this literature review was to discuss the dose–effect relation in brain metastases treated by stereotactic radiosurgery accounting for fractionation and technical considerations. Efficacy and toxicity data were analyzed in the light of recent published data. Only retrospective and heterogeneous data were available. We attempted to present the relevant data with caution. A BED10 of 40 to 50 Gy seems associated with a 12-month local control rate >70%. A BED10 of 50 to 60 Gy seems to achieve a 12-month local control rate at least of 80% at 12 months. In the brain metastases radiosurgery series, for single-fraction schedule, a V12 Gy < 5 to 10 cc was associated to 7.1–22.5% radionecrosis rate. For three-fractions schedule, V18 Gy < 26–30 cc, V21 Gy < 21 cc and V23 Gy < 5–7 cc were associated with about 0–14% radionecrosis rate. For five-fractions schedule, V30 Gy < 10–30 cc, V 28.8 Gy < 3–7 cc and V25 Gy < 16 cc were associated with about 2–14% symptomatic radionecrosis rate. There are still no prospective trials comparing radiosurgery to fractionated stereotactic irradiation.
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Affiliation(s)
- Maxime Loo
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
- Correspondence:
| | - Jean-Baptiste Clavier
- Radiotherapy Department, Strasbourg Europe Cancer Institute (ICANS), 67033 Strasbourg, France;
| | - Justine Attal Khalifa
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
| | - Elisabeth Moyal
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
| | - Jonathan Khalifa
- Radiotherapy Department, University Cancer Institute of Toulouse—Oncopôle, 31100 Toulouse, France; (J.A.K.); (E.M.); (J.K.)
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Rodrigues G, Yartsev S, Roberge D, MacRae R, Roa WH, Panet-Raymond V, Masucci GL, Yaremko BP, D'Souza D, Palma D, Sexton T, Yu E, Pantarotto J, Ahmad B, Fisher B, Dar AR, Lambert C, Pond G, Tay KY, Bauman G. A Phase II Multi-institutional Clinical Trial Assessing Fractionated Simultaneous In-Field Boost Radiotherapy for Brain Oligometastases. Cureus 2019; 11:e6394. [PMID: 31942264 PMCID: PMC6959838 DOI: 10.7759/cureus.6394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose/Objective Published preclinical and phase I clinical trial data suggest that fractionated lesional radiotherapy with 60 Gy in 10 fractions can serve as an alternative approach to single fraction radiosurgical boost for brain oligometastases. Methods and Materials A phase II clinical trial (NCT01543542) of a total of 60 Gy in 10 fractions of lesional (one to three) radiotherapy (given simultaneously with whole-brain helical tomotherapy with 30 Gy in 10 fractions) was conducted at five institutions. We hypothesized that fractionated radiotherapy would be considered unsuitable if the median overall survival (OS) was degraded by two months or if six-month intracranial control (ICC) and intracranial lesion (ILC) were inferior by 10% compared with the published RTOG 9508 results. Results A total of 87 patients were enrolled over a 4.5-year accrual period. Radiological lesion and extralesional central nervous system progression were documented in 15/87 (17%) and 11/87 (13%) patients, respectively. Median OS for all patients was 5.4 months. Six-month actuarial estimates of ICC and ILC were 78% and 89%, respectively. However, only the ILC estimate achieved statistical significance (p=0.02), demonstrating non-inferiority to the a priori historical controls (OS: p=0.09, ICC=0.31). Two patients developed suspected asymptomatic radionecrosis. Conclusions The phase II estimates of ILC were demonstrated to be non-inferior to the results of the RTOG 9508.
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Affiliation(s)
- George Rodrigues
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - Slav Yartsev
- Medical Physics, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - David Roberge
- Radiation Oncology, University of Montréal Health Centre, Montréal, CAN
| | - Robert MacRae
- Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, CAN
| | - Wilson H Roa
- Oncology, Cross Cancer Institute, University of Alberta, Edmonton, CAN
| | | | | | - Brian P Yaremko
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - David D'Souza
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - David Palma
- Radiation Oncology, Victoria Hospital, London Health Sciences Centre, London, CAN
| | - Tracy Sexton
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - Edward Yu
- Oncology, Schulich School of Medicine and Dentistry, Western University, London, CAN
| | | | - Belal Ahmad
- Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
| | - Barbara Fisher
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
| | - A Rashid Dar
- Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Carole Lambert
- Radiation Oncology, Centre hospitalier de l'université de Montréal (CHUM) - Hôpital Notre-Dame, Montréal, CAN
| | - Gregory Pond
- Epidemiology and Public Health, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Keng Yeow Tay
- Radiology, London Health Sciences Centre, London, CAN
| | - Glenn Bauman
- Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, CAN
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Park K, Kim JW, Chung HT, Paek SH, Kim DG. Single-Session versus Multisession Gamma Knife Radiosurgery for Large Brain Metastases from Non-Small Cell Lung Cancer: A Retrospective Analysis. Stereotact Funct Neurosurg 2019; 97:94-100. [PMID: 31117101 DOI: 10.1159/000496154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the efficacy of Gamma Knife radiosurgery (GKS) in patients with large brain metastases by comparing single-session radiosurgery (S-GKS) and multisession radiosurgery (M-GKS), we retrospectively analyzed the clinical outcomes of patients who underwent GKS for brain metastases from non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Between January 2010 and December 2016, 66 patients with 74 lesions ≥10 cm3 from large brain metastases from only NSCLC were included. Fifty-five patients with 60 lesions were treated with S-GKS; 11 patients with 14 lesions were treated with M-GKS. Median doses were 16 Gy (range, 11-18 Gy) for the S-GKS group and 8 Gy (range, 7-10 Gy) in three fractions for the M-GKS group. RESULTS With a mean follow-up period of 13.1 months (range, 1.3-76.4 months), the median survival duration was 21.1 months for all patients. Median tumor volume was 14.3 cm3 (range, 10.0-58.3 cm3). The local control rate was 77.0% and the progression-free survival rate was 73.6% at the last follow-up. There were no significant between-group differences in terms of local control rate (p = 0.10). Compared with S-GKS, M-GKS did not differ significantly in radiation-induced complications (38.1 vs. 45.4%, p =0.83). While 8 patients who underwent S-GKS experienced major complications of grade ≥3, no toxicity was observed in patients treated with M-GKS. CONCLUSIONS M-GKS may be an effective alternative for large brain metastases from NSCLC. Specifically, severe radiation-induced toxicity (≥grade 3) did not occur in M-GKS for large-volume metastases. Although the long-term effects and results from larger samples remain unclear, M-GKS may be a suitable palliative treatment for preserving neurological function.
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Affiliation(s)
- Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea,
| | - Hyun-Tai Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
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Romagna A, Alexander R, Schwartz C, Ladisich B, Hitzl W, Heidorn SC, Winkler PA, Muacevic A. CyberKnife Radiosurgery in Recurrent Brain Metastases: Do the Benefits Outweigh the Risks? Cureus 2018; 10:e3741. [PMID: 30800551 PMCID: PMC6384047 DOI: 10.7759/cureus.3741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Local treatment concepts are in high demand in the salvage treatment of recurrent brain metastases. Still, their risks and benefits are scarcely characterized. In this study, we analyzed the outcome and risk-/benefit-ratio of salvage CyberKnife (Accuray Incorporated, Sunnyvale, California, US) radiosurgery in the treatment of recurrent brain metastases after whole brain radiotherapy (WBRT). Materials and methods Seventy-six patients with 166 recurrent brain metastases and a multimodal pretreatment were retrospectively investigated. All patients underwent salvage CyberKnife radiosurgery (single fraction, reference dose: 17-22 Gy). Study endpoints were post-recurrence survival (PRS) after salvage treatment as well as local and distant tumor control rates. Central nervous system (CNS) toxicity was assessed according to the toxicity criteria of the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC)). Results The population was homogenous regarding its demographic parameters. All patients had a history of WBRT prior to salvage CyberKnife radiosurgery. PRS was 13.3 months (10.4 - 16.2 months), one-year local and distant tumor control rates were 87% (95% CI: 75-99) and 38% (95% CI: 23-52), respectively. Eighteen patients suffered from RTOG/EORTC grade I/II toxicity. No toxicity-related risk factors were identified. Discussion This study found indicative survival and tumor control rates as well as a favorable risk/benefit ratio regarding radiotoxicity in salvage CyberKnife radiosurgery. These results point to a proactive therapeutic strategy based on appropriate patient selection instead of therapeutic nihilism.
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Affiliation(s)
| | - Romagna Alexander
- Neurosurgery, Christian-Doppler-Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Christoph Schwartz
- Neurosurgery, Christian-Doppler-Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Barbara Ladisich
- Neurosurgery, Christian-Doppler-Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Wolfgang Hitzl
- Biostatistics, Christian-Doppler-Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | | | - Peter A Winkler
- Neurosurgery, Christian-Doppler-Medical Center, Paracelsus Private Medical University, Salzburg, AUT
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Ahmed KA, Sarangkasiri S, Chinnaiyan P, Sahebjam S, Yu HH, Etame AB, Rao NG. Outcomes Following Hypofractionated Stereotactic Radiotherapy in the Management of Brain Metastases. Am J Clin Oncol. 2016;39:379-383. [PMID: 24755663 DOI: 10.1097/coc.0000000000000076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the outcomes of patients treated with hypofractionated stereotactic radiotherapy (HSRT) for radiosensitive and radioresistant brain metastases. METHODS Between August 2006 and July 2013, a total of 56 lesions in 44 patients with brain metastases were treated with HSRT. Twenty-three (41.1%) lesions were radioresistant. Patients were treated to a total dose of 24 to 30 Gy in 3 to 5 fractions. Median planning target volume was 6.18 cm. The primary endpoint for this study was local control with secondary endpoints of overall survival, distant failure, performance status, and treatment toxicity. RESULTS The median follow-up for all patients was 5 months (range, 0.4 to 58.3 mo). Six- and 12-month Kaplan-Meier estimates of local control for all lesions were 85.6% and 79.4%, respectively. Radioresistant tumors had a 6- and 12-month local control rate of 87.0%, whereas radiosensitive tumors had a 6- and 12-month local control rate of 82.5% and 72.2%, respectively (P=0.41). Six- and 12-month distant brain control rates were 56.8% and 46.9%, respectively. Overall survival was significantly associated with recursive partitioning analysis classes I, II, and III (P=0.0003) and graded prognostic assessment classes 2 to 3 and 1 to 1.5 (P=0.041). CONCLUSIONS HSRT is a safe and feasible alternative to single-session stereotactic radiosurgery for brain metastases. No difference was observed in local control rates between radioresistant and radiosensitive tumors.
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Wegner RE, Leeman JE, Kabolizadeh P, Rwigema J, Mintz AH, Burton SA, Heron DE. Fractionated Stereotactic Radiosurgery for Large Brain Metastases. Am J Clin Oncol 2015; 38:135-9. [DOI: 10.1097/coc.0b013e31828aadac] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Recurrent or progressive brain metastases after initial treatment represent a common clinical entity mainly due to increased survival of cancer patients. From the various available treatment modalities, salvage stereotactic radiosurgery seems to be the most commonly used. Many clinical studies of class of evidence III have demonstrated satisfied results concerning the local brain control and survival of patients with relapsing brain disease. Also stereotactic radiosurgery is considered a relatively safe modality with low incidence of brain toxicity side effects. It is obvious that well-designed, randomized, prospective studies are necessary for the evaluation of the stereotactic radiosurgery as salvage treatment and for the establishment of guidelines for the selection of patients most suitable for this treatment option. The increasing number of patients with relapsing brain metastatic disease will act as a pressure to this direction.
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Affiliation(s)
- George Klironomos
- Department of surgery, University of Toronto, Clinical Fellow in Neuroncology and Skull Base Neurosurgery, 339 Bathurst Street, Toronto, ON M5T2S8, Canada
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Schackert G, Schmiedel K, Lindner C, Leimert M, Kirsch M. Surgery of recurrent brain metastases: retrospective analysis of 67 patients. Acta Neurochir (Wien) 2013; 155:1823-32. [PMID: 23913109 DOI: 10.1007/s00701-013-1821-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Treatment of patients with recurrent brain metastasis is one of the major challenges in neurooncology. Commonly, WBRT was applied after or as the initial treatment. Many patients received radiosurgery or their lesions were operated on. The question arises of what treatment modalities are appropriate and can be offered to the patients. In our retrospective analysis, we evaluated whether re-operation might be a useful measurement for the patients with respect to overall survival and quality of life. METHODS We included 67 patients who were treated between 1993 and 2008 in our department. The median age was 59 years. Metastases of 11 different primaries were diagnosed. The median OST was 7.5 months. RESULTS Statistically significant prognostic factors for OS were single lesions, completeness of resection, and time to recurrence, which was significantly influenced by WBRT after first operation. The one year survival rate correlated with the RPA classification: class I: 53.3 %, class II: 26.9 %, class III: 12.5 %. In 31.3 %, a second recurrence occurred which was treated by repeated surgery. Six patients survived as long-term survivors (25.7-132.2 months). CONCLUSION Surgery of recurrent brain metastasis is an important therapeutic option. A subgroup of patients, defined by prognostic factors, will profit with improvement of symptoms and prolongation of the overall survival time. Even long-term survivors can be expected.
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Seung SK, Larson DA, Galvin JM, Mehta MP, Potters L, Schultz CJ, Yajnik SV, Hartford AC, Rosenthal SA. American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS). Am J Clin Oncol 2013; 36:310-5. [PMID: 23681017 DOI: 10.1097/COC.0b013e31826e053d] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
American College of Radiology and American Society for Radiation Oncology Practice Guideline for the Performance of Stereotactic Radiosurgery (SRS). SRS is a safe and efficacious treatment option of a variety of benign and malignant disorders involving intracranial structures and selected extracranial lesions. SRS involves a high dose of ionizing radiation with a high degree of precision and spatial accuracy. A quality SRS program requires a multidisciplinary team involved in the patient management. Organization, appropriate staffing, and careful adherence to detail and to established SRS standards is important to ensure operational efficiency and to improve the likelihood of procedural success. A collaborative effort of the American College of Radiology and American Society for Therapeutic Radiation Oncology has produced a practice guideline for SRS. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, neurosurgeon, and qualified medical physicist. Quality assurance is essential for safe and accurate delivery of treatment with SRS. Quality assurance issues for the treatment unit, stereotactic accessories, medical imaging, and treatment-planning system are presented and discussed. Adherence to these practice guidelines can be part of ensuring quality and patient safety in a successful SRS program.
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Ruschin M, Komljenovic PT, Ansell S, Ménard C, Bootsma G, Cho YB, Chung C, Jaffray D. Cone Beam Computed Tomography Image Guidance System for a Dedicated Intracranial Radiosurgery Treatment Unit. Int J Radiat Oncol Biol Phys 2013; 85:243-50. [DOI: 10.1016/j.ijrobp.2012.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 10/27/2022]
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Rodrigues G, Warner A, Bauman G, Senan S, Lagerwaard F. Systematic review of fractionated brain metastases radiotherapy. ACTA ACUST UNITED AC 2014; 3:29-41. [DOI: 10.1007/s13566-012-0035-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Davey P, Schwartz M, O'Brien P, Gillies B. Dynamic radiosurgery at the Toronto - Bayview Regional Cancer Centre, 1988-2007. Can J Neurol Sci 2012; 39:299-303. [PMID: 22547508 DOI: 10.1017/s031716710001341x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dynamic radiosurgery was first developed in Montreal and was subsequently adopted at the Toronto-Bayview Regional Cancer Centre in 1988. At that time radiosurgery was in its infancy in Canada. The opportunity of offering highly conformal radiation treatments for intracranial targets presented numerous technical challenges notably in the area of quality assurance. This review chronicles the development of radiosurgery at the Toronto-Bayview Regional Cancer Centre and summarises the successes and failures of the program over the following two decades.
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Stanford J, Gardner S, Schwartz ML, Davey P. Does the surgical resection of a brain metastasis alter the planning and subsequent local control achieved with radiosurgery prescribed for recurrence at the operated site? Br J Neurosurg 2011; 25:488-91. [PMID: 21344978 DOI: 10.3109/02688697.2010.550659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multiple treatments may be used in the management of patients with brain metastases including surgical resection or radiosurgery. In order to determine whether initial surgical resection in any way prejudices the subsequent efficacy of radiosurgery for recurrence at the operated site, a retrospective review of patients undergoing radiosurgery at the time of relapse was undertaken. All patients had previously received whole brain irradiation as part of initial management. A comparison of radiosurgical planning technique was made for recurrent brain metastases occurring at sites of a previous surgical resection versus unresected recurrences. Although recurrences of tumour at a resected site were more likely to be treated radiosurgically using larger and multiple collimators, there was no significant difference in subsequent local control. Assuming that the recurrence of a brain metastasis at a previously resected site is considered treatable radiosurgically, subsequent local control is no different from that achieved in previously unresected recurrences.
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Affiliation(s)
- Julie Stanford
- Division of Radiation Oncology, Odette Cancer Centre & Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Noël G, Mazeron JJ. Réirradiation cérébrale des tumeurs primitives malignes ou secondaires. Cancer Radiother 2010; 14:421-37. [DOI: 10.1016/j.canrad.2010.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, Asher AL, Loeffler JS, Robinson PD, Andrews DW, Gaspar LE, Kondziolka D, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Patchell RA, Kalkanis SN. The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2009; 96:85-96. [PMID: 19957016 PMCID: PMC2808530 DOI: 10.1007/s11060-009-0055-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/08/2009] [Indexed: 12/19/2022]
Abstract
QUESTION What evidence is available regarding the use of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgical resection or chemotherapy for the treatment of recurrent/progressive brain metastases? TARGET POPULATION This recommendation applies to adults with recurrent/progressive brain metastases who have previously been treated with WBRT, surgical resection and/or radiosurgery. Recurrent/progressive brain metastases are defined as metastases that recur/progress anywhere in the brain (original and/or non-original sites) after initial therapy. RECOMMENDATION Level 3 Since there is insufficient evidence to make definitive treatment recommendations in patients with recurrent/progressive brain metastases, treatment should be individualized based on a patient's functional status, extent of disease, volume/number of metastases, recurrence or progression at original versus non-original site, previous treatment and type of primary cancer, and enrollment in clinical trials is encouraged. In this context, the following can be recommended depending on a patient's specific condition: no further treatment (supportive care), re-irradiation (either WBRT and/or SRS), surgical excision or, to a lesser extent, chemotherapy. Question If WBRT is used in the setting of recurrent/progressive brain metastases, what impact does tumor histopathology have on treatment outcomes? No studies were identified that met the eligibility criteria for this question.
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Affiliation(s)
- Mario Ammirati
- Department of Neurosurgery, Ohio State University Medical Center, Columbus, OH, USA
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Iwata H, Shibamoto Y, Murata R, Tomita N, Ayakawa S, Ogino H, Ito M. Estimation of Errors Associated With Use of Linear-Quadratic Formalism for Evaluation of Biologic Equivalence Between Single and Hypofractionated Radiation Doses: An In Vitro Study. Int J Radiat Oncol Biol Phys 2009; 75:482-8. [DOI: 10.1016/j.ijrobp.2008.12.093] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 12/15/2008] [Accepted: 12/19/2008] [Indexed: 12/25/2022]
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Molenaar R, Wiggenraad R, Verbeek-de Kanter A, Walchenbach R, Vecht C. Relationship between volume, dose and local control in stereotactic radiosurgery of brain metastasis. Br J Neurosurg 2009; 23:170-8. [PMID: 19306173 DOI: 10.1080/02688690902755613] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study is to analyse the efficacy of linear accelerator stereotactic radiosurgery (SRS) on prognostic factors, local control rate and survival in patients with brain metastasis. Patients with either a single metastasis or up to 4 multiple brain metastases with a maximum tumour diameter of 40 mm for each tumour and a Karnofsky Performance Status (KPS) > or = 70 were eligible for SRS. SRS was applied to 150 lesions in 86 consecutive patients with a median age of 60 years (median 1 and mean 1.7 lesions per patient, mean KPS 86). Median overall survival was 6.2 months after SRS and 9.7 months from diagnosis of brain metastasis. Multivariate analysis revealed that a KPS of 90 or more (p = 0.009) and female sex (p = 0.003) were associated with a longer survival. Radiation dose < or = 15 Gy (p = 0.017) and KPS < 90 (p = 0.013) were independent predictors of a shorter time to local failure. Five patients showed evidence of radionecrosis with a median survival of 14.8 months. Addition of WBRT neither led to improvement of survival nor to improvement of local control. Improved local control following SRS for brain metastases was associated with KPS > or =90, a radiation dose > 15 Gy and a PTV < 13 cc. The potential of hypofractionated stereotactic radiotherapy (SRT) for brain metastases of larger volume warrants further study.
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Affiliation(s)
- Richard Molenaar
- Neuro-Oncology Unit, Dept. of Neurology, Medical Center The Hague, The Hague, The Netherlands
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Nath SK, Lawson JD, Wang JZ, Simpson DR, Newman CB, Alksne JF, Mundt AJ, Murphy KT. Optically-guided frameless linac-based radiosurgery for brain metastases: clinical experience. J Neurooncol 2009; 97:67-72. [PMID: 19701719 PMCID: PMC2814046 DOI: 10.1007/s11060-009-9989-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 08/09/2009] [Indexed: 11/01/2022]
Abstract
The purpose of this study was to describe our clinical experience using optically-guided linear accelerator (linac)-based frameless stereotactic radiosurgery (SRS) for the treatment of brain metastases. Sixty-five patients (204 lesions) were treated between 2005 and 2008 with frameless SRS using an optically-guided bite-block system. Patients had a median of 2 lesions (range, 1-13). Prescription dose ranged from 14 to 22 Gy (median, 18 Gy) and was given in a single fraction. Clinical and radiographic evaluation occurred every 2-4 months following treatment. At a median follow-up of 6.2 months, actuarial survival at 12 months was 40% [95% confidence interval (CI), 28-52). Of 135 lesions that were evaluable for local control (LC), 119 lesions (88%) did not show evidence of progression. Actuarial 12 month LC was 76% (95% CI, 66-86). Tumors <or=2 cm in size had a better 12 month LC rate (81% vs. 36%, P = 0.017) than those >2 cm. Adverse events occurred in three patients (5%). Optically-guided linac-based frameless SRS can produce clinical outcomes that compare favorably to frame-based techniques. As this technique is convenient to use and allows for the uncomplicated delivery of hypofractionated radiotherapy, frameless SRS will likely have an increasingly important role in the management of brain metastases.
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Affiliation(s)
- Sameer K Nath
- Department of Radiation Oncology, Rebecca and John Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, CA 92093-0843, USA.
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Breneman JC, Steinmetz R, Smith A, Lamba M, Warnick RE. Frameless Image-Guided Intracranial Stereotactic Radiosurgery: Clinical Outcomes for Brain Metastases. Int J Radiat Oncol Biol Phys 2009; 74:702-6. [DOI: 10.1016/j.ijrobp.2008.11.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/03/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022]
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Coppa ND, Raper DMS, Zhang Y, Collins BT, Harter KW, Gagnon GJ, Collins SP, Jean WC. Treatment of malignant tumors of the skull base with multi-session radiosurgery. J Hematol Oncol 2009; 2:16. [PMID: 19341478 PMCID: PMC2678153 DOI: 10.1186/1756-8722-2-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 04/02/2009] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Malignant tumors that involve the skull base pose significant challenges to the clinician because of the proximity of critical neurovascular structures and limited effectiveness of surgical resection without major morbidity. The purpose of this study was to evaluate the efficacy and safety of multi-session radiosurgery in patients with malignancies of the skull base. METHODS Clinical and radiographic data for 37 patients treated with image-guided, multi-session radiosurgery between January 2002 and December 2007 were reviewed retrospectively. Lesions were classified according to involvement with the bones of the base of the skull and proximity to the cranial nerves. RESULTS Our cohort consisted of 37 patients. Six patients with follow-up periods less than four weeks were eliminated from statistical consideration, thus leaving the data from 31 patients to be analyzed. The median follow-up was 37 weeks. Ten patients (32%) were alive at the end of the follow-up period. At last follow-up, or the time of death from systemic disease, tumor regression or stable local disease was observed in 23 lesions, representing an overall tumor control rate of 74%. For the remainder of lesions, the median time to progression was 24 weeks. The median progression-free survival was 230 weeks. The median overall survival was 39 weeks. In the absence of tumor progression, there were no cranial nerve, brainstem or vascular complications referable specifically to CyberKnife radiosurgery. CONCLUSION Our experience suggests that multi-session radiosurgery for the treatment of malignant skull base tumors is comparable to other radiosurgical techniques in progression-free survival, local tumor control, and adverse effects.
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Affiliation(s)
- Nicholas D Coppa
- Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA.
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Current world literature. Trauma and rehabilitation. Curr Opin Neurol 2008; 21:762-4. [PMID: 18989123 DOI: 10.1097/WCO.0b013e32831cbb85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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