Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival

Sallabanda, Morena; Garcia-Berrocal, M.I.; Romero, Jesús; García-Jarabo, V.; Exposito, M.J. Jimenez; Rincón, Diego; Zapata, I.; Magallón, María

doi:10.1007/s12094-020-02321-x

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Similar results were observed in some recent studies. Sallabanda et al [30] retrospectively reviewed 200 patients who were treated with SRS or HFSRT from 2010 − 2016. The median OS was 8 months, and the 1-and 2-year actuarial OS were 40% and 24.5%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study of hypofractionated stereotactic radiotherapy Combined with whole brain radiotherapy for Patients with Brain Metastases

Xie

Peng

Zhang

et al. 2022

Preprint

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Background and purpose To evaluate the clinical outcomes of hypofractionated stereotactic radiotherapy (HFSRT) combined with whole brain radiotherapy (WBRT) in patients with brain metastases (BMs). Materials and methods From May 2018 to July 2020, 50 patients (111 lesions) received HFSRT (18Gy/3F) + WBRT (40Gy/20F). The RECIST 1.1 and RANO-BM criteria were used to evaluate treatment efficacy. Five prognostic indexes (RPA, GPA, SIR, BS-BM, and GGS) were applied. The primary endpoint was intracranial local control (iLC). Secondary endpoints were overall survival (OS) and the safety of treatment. Results Intracranial objective response rates (iORR) using the RECIST 1.1 and RANO-BM criteria were 62.1% and 58.6%, respectively. The iLC rate was 93.1%, the 6- and 12-month iLC rates were 90.8% and 57.4%, respectively. The median intracranial progression-free survival (iPFS) was not reached (range 0 − 23 months). The 6-, 12-, and 24-month OS rates were 74.2%, 58.2%, and 22.9%, respectively. The KPS score showed statistical significance in univariate analysis of survival. The 6, 12, and 24 month OS rates for patients with KPS ≥ 70 were 83.8%, 70.5%, and 29.7%, respectively. The median survival time (MST) for all patients and for patients with KPS ≥ 70 were 13.6 and 16.5 months, respectively. Sex, KPS score, and gross tumor volume were significant factors in the multivariate analysis of survival. OS was significantly associated with RPA, SIR, BS-BM, and GGS classes. No acute toxicities of grade 3 or higher were noted. Conclusion HFSRT combined with WBRT is a safe and effective local treatment modality for BM patients.

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Section: Discussionmentioning

confidence: 99%

Retrospective Study of hypofractionated stereotactic radiotherapy Combined with whole brain radiotherapy for Patients with Brain Metastases

Xie

Peng

Zhang

et al. 2022

Preprint

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“…There is a lack of consensus regarding the optimal fractionation scheme for the treatment of brain metastases, with several recent clinical studies reporting similar toxicity levels in the healthy brain between singleand multi-fraction SRS. [18][19][20] Increasing the number of fractions is beneficial to improve the brain tolerance to high doses. However, the total physical dose must be increased to maintain tumor control, 21 and thereby the integral biologically effective dose (BED) delivered to the healthy brain is only slightly affected by the fractionation regimen.…”

Section: Spatiotemporal Fractionation Schemesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spatiotemporal fractionation schemes for stereotactic radiosurgery of multiple brain metastases

2023

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BackgroundStereotactic radiosurgery (SRS) is an established treatment for patients with brain metastases (BMs). However, damage to the healthy brain may limit the tumor dose for patients with multiple lesions.PurposeIn this study, we investigate the potential of spatiotemporal fractionation schemes to reduce the biological dose received by the healthy brain in SRS of multiple BMs, and also demonstrate a novel concept of spatiotemporal fractionation for polymetastatic cancer patients that faces less hurdles for clinical implementation.MethodsSpatiotemporal fractionation (STF) schemes aim at partial hypofractionation in the metastases along with more uniform fractionation in the healthy brain. This is achieved by delivering distinct dose distributions in different fractions, which are designed based on their cumulative biologically effective dose () such that each fraction contributes with high doses to complementary parts of the target volume, while similar dose baths are delivered to the normal tissue. For patients with multiple brain metastases, a novel constrained approach to spatiotemporal fractionation (cSTF) is proposed, which is more robust against setup and biological uncertainties. The approach aims at irradiating entire metastases with possibly different doses, but spatially similar dose distributions in every fraction, where the optimal dose contribution of every fraction to each metastasis is determined using a new planning objective to be added to the BED‐based treatment plan optimization problem. The benefits of spatiotemporal fractionation schemes are evaluated for three patients, each with >25 BMs.ResultsFor the same tumor BED10 and the same brain volume exposed to high doses in all plans, the mean brain BED2 can be reduced compared to uniformly fractionated plans by 9%–12% with the cSTF plans and by 13%–19% with the STF plans. In contrast to the STF plans, the cSTF plans avoid partial irradiation of the individual metastases and are less sensitive to misalignments of the fractional dose distributions when setup errors occur.ConclusionSpatiotemporal fractionation schemes represent an approach to lower the biological dose to the healthy brain in SRS‐based treatments of multiple BMs. Although cSTF cannot achieve the full BED reduction of STF, it improves on uniform fractionation and is more robust against both setup errors and biological uncertainties related to partial tumor irradiation.

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“…Nowadays, stereotactic radiosurgery (SRS) offers delivery of a precisely localized, high dose of radiation, while sparing healthy tissue in rest of the brain. SRS has better local tumor control and therefore a beneficial effect on NCF, compared to WBRT [ 5 – 12 ]. Nevertheless, SRS might still damage healthy brain tissue in the vicinity of the BM [ 8 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive functioning after Gamma Knife and LINAC stereotactic radiosurgery in patients with brain metastases

et al. 2022

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Purpose Brain metastases (BM) themselves and treatment with stereotactic radiosurgery (SRS) can influence neurocognitive functioning. This prospective study aimed to assess neurocognitive decline in patients with BM after SRS. Methods A neuropsychological test battery was assessed yielding ten test outcomes. Neurocognitive decline at 3 and 6 months post SRS was compared to measurement prior to Gamma Knife (GK) or linear accelerator (LINAC) SRS. Reliable change indices with correction for practice effects were calculated to determine the percentage of neurocognitive decline (defined as decline on ≥ 2 test outcomes). Risk factors of neurocognitive decline were analyzed with binary logistic regression. Results Of 194 patients pre-SRS, 40 GK and 29 LINAC patients had data accessible at 6 months. Compared to baseline, 38% of GK patients declined at 3 months, and 23% declined at 6 months. GK patients declined on attention, executive functioning, verbal memory, and fine motor skill. Of LINAC patients, 10% declined at 3 months, and 24% at 6 months. LINAC patients declined on executive functioning, verbal memory, and fine motor skills. Risk factors of neurocognitive decline at 3 months were high age, low education level and type of SRS (GK or LINAC). At 6 months, high age was a risk factor. Karnofsky Performance Scale, BM volume, number of BM, tumor progression and neurocognitive impairment pre-SRS were no risk factors. Conclusion Neurocognitive decline occurs in a considerable proportion of patients with BM treated with GK or LINAC SRS. Overall, high age appears to be a risk factor for neurocognitive decline after SRS. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04185-3.

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Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival

Cited by 10 publications

References 29 publications

Retrospective Study of hypofractionated stereotactic radiotherapy Combined with whole brain radiotherapy for Patients with Brain Metastases

Retrospective Study of hypofractionated stereotactic radiotherapy Combined with whole brain radiotherapy for Patients with Brain Metastases

Spatiotemporal fractionation schemes for stereotactic radiosurgery of multiple brain metastases

Neurocognitive functioning after Gamma Knife and LINAC stereotactic radiosurgery in patients with brain metastases

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