A matched-pair analysis comparing stereotactic radiosurgery with whole-brain radiotherapy for patients with multiple brain metastases

Shafie, Rami A El; Celik, Aylin; Weber, Dorothea; Schmitt, Daniela; Lang, Kristin; König, Laila; Bernhardt, Denise; Höne, Simon; Förster, Tobias; Nettelbladt, Bastian von; Adeberg, Sebastian; Debus, Jürgen; Rieken, Stefan

doi:10.1007/s11060-020-03447-2

Cited by 11 publications

(9 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, while use of SRT was restricted to patients with 1-3 metastases in the past, it is currently being extended with equivalent OS results for up to 10 BM, and its role for >10 BM is also being reappraised. 35 , 39 , 40 , 41 Emerging individualized concepts for extensive, polytopic brain involvement include SRT for the symptomatic, largest or fastest progressing lesions, in analogy to the concept of oligoprogression, 42 and control of the remaining BM by CNS-active systemic therapies. However, the exact workflows and patient selection criteria for application remain to be defined, ideally in the form of prospective clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer

et al. 2021

View full text Add to dashboard Cite

Background The improved efficacy of tyrosine kinase inhibitors (TKI) mandates reappraisal of local therapy (LT) for brain metastases (BM) of oncogene-driven non-small-cell lung cancer (NSCLC). Patients and methods This study included all epidermal growth factor receptor-mutated (EGFR + , n = 108) and anaplastic lymphoma kinase-rearranged (ALK + , n = 33) TKI-naive NSCLC patients diagnosed with BM in the Thoraxklinik Heidelberg between 2009 and 2019. Eighty-seven patients (62%) received early LT, while 54 (38%) received delayed ( n = 34; 24%) or no LT ( n = 20; 14%). LT comprised stereotactic (SRT; n = 40; 34%) or whole-brain radiotherapy (WBRT; n = 77; 66%), while neurosurgical resection was carried out in 19 cases. Results Median overall survival (OS) was 49.1 months for ALK + and 19.5 months for EGFR + patients ( P = 0.001), with similar median intracranial progression-free survival (icPFS) (15.7 versus 14.0 months, respectively; P = 0.80). Despite the larger and more symptomatic BM ( P < 0.001) of patients undergoing early LT, these experienced longer icPFS [hazard ratio (HR) 0.52; P = 0.024], but not OS (HR 1.63; P = 0.12), regardless of the radiotherapy technique (SRT versus WBRT) and number of lesions. High-risk oncogene variants, i.e. non-del19 EGFR mutations and ‘short’ EML4-ALK fusions (mainly variant 3, E6:A20), were associated with earlier intracranial progression (HR 2.97; P = 0.001). The longer icPFS with early LT was also evident in separate analyses of the EGFR + and ALK + subsets. Conclusions Despite preferential use for cases with poor prognostic factors, early LT prolongs the icPFS, but not OS, in TKI-treated EGFR + /ALK + NSCLC. Considering the lack of survival benefit, and the neurocognitive effects of WBRT, patients presenting with polytopic BM may benefit from delaying radiotherapy, or from radiosurgery of multiple or selected lesions. For SRT candidates, the improved tumor control with earlier radiotherapy should be weighed against the potential toxicity and the enhanced intracranial activity of newer TKI. High-risk EGFR / ALK variants are associated with earlier intracranial failure and identify patients who could benefit from more aggressive management.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Technological improvements have allowed the use of SRT treatment for multiple BM with acceptable treatment times, and SRT is no longer only suitable for patients with a limited number of BM (24). The first matched-pair analysis for potential prognostic factors, comparing SRT vs. WBRT for patients with multiple BM, confirmed these advantages, finding a median overall survival of 16 months (SRT) vs. 8 months (WBRT), while excellent clinical performance and extracranial tumor control were favorable prognostic factors (25).…”

Section: Discussionmentioning

confidence: 99%

Quality of life among patients with 4 to 10 brain metastases after treatment with whole-brain radiotherapy vs. stereotactic radiotherapy: a phase III, randomized, Dutch multicenter trial

et al. 2022

View full text Add to dashboard Cite

“…61 In the largest retrospective study to date, Ali et al 63 analyzed 5,750 patients treated with SRS for BM and recapitulated the findings reported by Yamamoto et al 62 Other studies have reported similar findings. 30 63 64 Moreover, in patients with more than 4 lesions, there is level 3 evidence for the use of SRS to improve overall survival when the cumulative volume is less than 7 mL. 60 These studies support consideration for SRS in the treatment of more than 4 BM in select circumstances.…”

Section: Number Of Brain Metastasesmentioning

confidence: 98%

“… 5 With the exception of highly radiation resistant tumors, such as melanomas and sarcomas, SRS is highly efficacious as a means of controlling BM growth. 29 30 Since SRS spares cerebrum unaffected with BM, there is a decreased likelihood of posttreatment neurocognitive decline relative to WBRT. 4 25 31 Moreover, because higher doses can typically be delivered through SRS, local control is improved relative to WBRT.…”

Section: Treatment Optionsmentioning

confidence: 99%

Stereotactic Radiosurgery as Treatment for Brain Metastases: An Update

Pena-Pino

Chen

2023

Asian J Neurosurg

View full text Add to dashboard Cite

Stereotactic radiosurgery (SRS) is a mainstay treatment option for brain metastasis (BM). While guidelines for SRS use have been outlined by professional societies, consideration of these guidelines should be weighed in the context of emerging literature, novel technology platforms, and contemporary treatment paradigms. Here, we review recent advances in prognostic scale development for SRS-treated BM patients and survival outcomes as a function of the number of BM and cumulative intracranial tumor volume. Focus is placed on the role of stereotactic laser thermal ablation in the management of BM that recur after SRS and the management of radiation necrosis. Neoadjuvant SRS prior to surgical resection as a means of minimizing leptomeningeal spread is also discussed.

show abstract

A matched-pair analysis comparing stereotactic radiosurgery with whole-brain radiotherapy for patients with multiple brain metastases

Cited by 11 publications

References 51 publications

Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer

Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer

Quality of life among patients with 4 to 10 brain metastases after treatment with whole-brain radiotherapy vs. stereotactic radiotherapy: a phase III, randomized, Dutch multicenter trial

Stereotactic Radiosurgery as Treatment for Brain Metastases: An Update

Contact Info

Product

Resources

About