The role of radiosurgery for multiple brain metastases

A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases

BACKGROUND

The study aimed to investigate the prognostic factors for patients with brain metastases undergoing radiosurgical treatment and to introduce a simple and practical scoring system for the prediction of survival time.

METHODS

We retrospectively analyzed data for 311 patients treated with Gamma Knife radiosurgery at a single institute. The mean age at time of treatment was 60 years (range 23-86 years), and the median Karnofsky performance status (KPS) score was 90 (range 60-100). Using a new prognostic index, the prognostic index for brain metastases (PIBM), the patients were categorized into 3 groups according to the primary tumor status and KPS score. We performed survival analysis and compared the prognostic ability of the PIBM with other published indices.

RESULTS

During the median follow-up duration of 8.2 months (range 0.1-109 months), the median overall survival time was 9.1 months. Stable primary tumor status (hazard ratio [HR] 0.497, 95% confidence interval [CI] 0.321-0.769, p = 0.002) and KPS score ≥90 (HR 1.407, 95% CI 1.018-1.946, p = 0.039) significantly predicted longer overall survival. The PIBM showed the lowest Akaike information criterion value and the highest integrated area under the curve value compared with other prognostic indices.

CONCLUSIONS

The PIBM may be a more accurate prognostic indicator than other published indices. Although this new and practical prognostic index requires further validation in larger cohort studies, we suggest that the PIBM could be useful to predict survival time and inform appropriate management of patients with brain metastases.

Long-term outcome of gamma knife radiosurgery for metastatic brain tumors originating from lung cancer

Background:

Gamma knife radiosurgery (GKRS) has emerged as an important treatment option for metastasis brain tumors (MBTs). However, the long-term outcome of GKRS on MBTs originating from lung carcinoma is not well understood. The treatment of MBTs derived from lung cancer with GKRS at our institution is reviewed.

Methods:

We performed a retrospective review (2000-2013) of 173 patients with MBTs from lung cancer who received GKRS. Out of 173 patients, 38 patients had recurrent tumors after microsurgical resection and whole brain radiotherapy (WBT).

Results:

GKRS in MBTs metastasized from lung carcinoma showed significant variations in tumor growth control (decreased in 79 [45.7%] patients, arrested growth in 54 [31.2%] patients, and increased tumor size in 40 [23.1%] patients). The median survival in the study population was 14 months. Overall survival after 3 years was 25%, whereas progression-free survival after 3 years was 45%. The predictive factors for improving survival in the patients with MBTs were recursive partitioning analysis (RPA) class I (P = 0.005), absence of hydrocephalus (P = 0.001), Karnofsky performance scale (KPS) >70 (P = 0.007), age ≤65 (P = 0.041), tumor size ≤3 cm (P = 0.023), controlled primary tumor (P = 0.049), and single number of MBTS (P = 0.044).

Conclusion:

Long-term follow-up revealed that GKRS offers a high rate of tumor control and good overall survival period in both new and recurrent patients with MBTs originating from lung carcinoma. Thus, GKRS is an effective treatment option for new patients with MBTs from lung cancer, as well as an adjuvant therapy in patients with recurrent MBTs derived from lung cancer.

Long term outcome of Gamma Knife radiosurgery for metastatic brain tumors

Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) has emerged as an important treatment option for metastatic brain tumors (MBT). However, the long term outcome of GKRS on MBT is not well understood. We reviewed the treatment of MBT with GKRS at our institution. We performed a retrospective review (2000-2013) of 298 patients with MBT who received GKRS. The study population was monitored clinically and radiographically after GKRS treatment. Survival benefits and predictive factors of the outcome were analyzed using the Kaplan-Meier test and Cox regression model, respectively. GKRS in MBT showed significant variation in tumor growth control (decreased in 135 [45%] patients, arrested growth in 91 [37%] patients and increased tumor size in 72 [24%] patients). The median survival in the study population was 17 months. Overall and progression free survival after 3 years were 25% and 45%, respectively. The predictive factors for improving survival in the patients with MBT were recursive partitioning analysis class I (p<0.0001), absence of hydrocephalus (p<0.0001), Karnofsky Performance Status (KPS) >80 (p=0.007) and absence of recurrent MBT (p=0.01). Forty (12%), 15 (4.3%) and two (0.6%) patients required GKRS, resection and whole brain radiation, respectively, after initial GKRS due to tumor progression and worsening of signs and symptoms. Our findings revealed that GKRS offers a high rate of tumor control and good survival benefits in both new and recurrent patients with MBT. Thus, GKRS is an effective treatment option for new patients with MBT, as well as an adjuvant therapy in patients with recurrent MBT.

[Dosimetric stereotactic radiosurgical accident: Study of 33 patients treated for brain metastases]

The consequences of a dosimetric radiosurgery accident are not the same as a conventional radiotherapy accident. The objective of this study was to estimate the clinical and radiological outcome of patients treated by radiosurgery for metastasis during the period of the overexposure accident that occurred in the Toulouse Radiosurgery Unit. Between April 2006 and March 2007, 33 patients with 57 metastases were treated in the Toulouse Radiosurgery Unit (Novalis(®), BrainLab). An initial error in the estimation of the scatter factors led to an overexposure to radiation. The median age was 55 years [range, 35-85]. Twenty-one patients (64%) harbored a single metastasis. The primary tumor location was lung (16 cases), kidney (nine cases), breast (four cases), and others (four cases). The mean tumoral volume was 3.2cm(3) [0.04-14.07]. The mean prescribed dose at the isocenter was 20 Gy [range, 10-23], the mean delivered dose was 31.5 Gy [range, 13-52], and the mean overdose was 61.2% [range, 5.6-226.8]. In order to evaluate the consequences of the overdose, three parameters were analyzed: a risk index using dose and volume, the volume of parenchyma that received more than 12 Gy, and the mean dose in a sphere of 20cm(3) surrounding the target volume. Median actuarial survival was 14.1 months, the survival rate was 79.4 % at six months, 59.1% at 12 months, and 27.2% at 24 months. The rate of tumor control was 80.7%. No morbidity was observed. There was no correlation between death and the parameters studied. The survival rates and times observed in our study of the patients treated for brain metastases by radiosurgery and overexposed were among the good results of the international literature. Deaths were not related to the overdose and no side effect was noted. This dosimetric accident has not had worse consequences in this population.

Stereotactic radiosurgical treatment of brain metastases in older patients

BACKGROUND

This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged > or =75 years who presented with brain metastasis.

METHODS

The authors analyzed the data from 44 consecutive patients treated with SRS for > or =1 brain metastasis. The median age at the time of treatment for brain metastases was 79.3 years (range, 75 years-86 years), and the median Karnofsky performance status was 80 (range, 50-100). At the time of SRS, 31 patients were treated for a single metastasis, and the remaining 13 patients were treated for > or =2 lesions (n = 74 lesions). The median tumor volume was 1.2 cm(3) (range, 0.007 cm(3)-22.5 cm(3)). The median maximal and marginal doses were 36 grays (Gy) (range, 18.8 Gy-48.2 Gy) and 20 Gy (range, 10 Gy-24 Gy), respectively.

RESULTS

Median survival was 7.3 +/- 1.65 months (range, 1.6 months-38.9 months) from the time of diagnosis of brain metastasis. Median survival of the patients with a single brain metastasis (10.1 +/- 1.92 months) was longer than that of the patients with > or =2 metastases (6.6 +/- 1.28 months) (P <.02). A single lesion was found to be an independent favorable prognostic factor (P +/- = +/- .017; odds ratio, 2.385 [95% confidence interval, 1.167-4.874]) in univariate and multivariate analysis. Patients with nonsmall cell lung cancer fared worse than patients with other tumor types (survival of 6.5 +/- 0.70 months vs 10.1 +/- 2.33 months [P<.05]).

CONCLUSIONS

SRS for patients aged > or =75 years with brain metastases is an effective and safe treatment modality that appears to improve survival, with outcomes that compare favorably with those reported for younger patients in an appropriately selected population.

Management Strategies for Patients with Brain Metastases: Has Radiosurgery Made a Difference?

BACKGROUND

Brain metastases develop in up to 50% of all patients with cancer. The purpose of this retrospective study was to compare the outcomes for brain metastases patients treated with adjuvant whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS).

METHODS

Between 1990 and 1995, 86 patients with brain metastases received external beam WBRT with a megavoltage beam at our center. Between January 2000 and July 2001, 48 patients with 84 tumors diagnosed as cerebral metastases were treated with SRS using the Leksell Gamma Knife. A comparative analysis of the outcomes in the two different groups was made to determine a possible statistically significant difference in survival.

RESULTS

In the WBRT group, the median follow-up was 11 months. Thirty-nine patients (45.3%) experienced an improvement in neurologic status. The median overall survival was 5 months (range, 1-40 months). In the SRS group, the median follow-up for this group was 9 months. Thirty-four patients experienced an improvement in their neurologic signs and symptoms. The median survival was 12 months (range, 1-16 months).

CONCLUSION

SRS appears to be a safe and effective treatment option for those patients with a limited number of brain metastases and in patients with controlled or limited systemic disease.