Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

Hasegawa, Toshinori; Kondziolka, Douglas; Flíckinger, John C.; Germanwala, Anand V.; Lunsford, L. Dade

doi:10.1227/01.neu.0000064569.18914.de

Cited by 206 publications

(88 citation statements)

References 41 publications

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“…The degree of neurotoxicity resulting from WBRT correlates with the total dose received and with the time-dose-fractionation scheme [3]. Because of the concern about leukoencephalopathy resulting from WBRT, treatment strategies relying on SRS alone have been increasingly used [4][5][6][7]. On the other hand, it has been pointed out that the omission of WBRT from the initial brain management results in a significant increase in brain tumor recurrence [6,7].…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Aoyama¹,

Tago²,

Kato³

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

501

304

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PURPOSEIt is not well known how the omission of whole-brain radiotherapy (WBRT) affects the neurocognitive function of patients with 1-4 brain metastases who are treated with stereotactic radiosurgery (SRS). MATERIALS AND METHODSIn a prospective randomized trial between WBRT+SRS and SRS-alone in patients with 1-4 brain metastases, neurocognitive function was assessed by the Mini-Mental Score Examination (MMSE). Among 132 enrolled patients, MMSE scores were available for 110 patients. RESULTSIn the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and KPS. Among 92 patients who received follow-up MMSE, 39 patients had a baseline MMSE of 27 or lower (17 in the WBRT+SRS group, 22 in the SRS-alone group).Improvements of >=3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (P=0.85) were observed. Among 82 patients who had baseline MMSEs >=27 or whose baseline MMSEs were <=26 but improved to >=27 after the initial brain treatment, the 12-, 24-, and 36-month actuarial free Aoyama H et al. 4 rates of the 3-point drop in MMSE were 76.1%, 68.5%, and 14.7% in the WBRT+SRS group, and were 59.3%, 51.9%, and 51.9% in the SRS-alone group.The average duration until deterioration was 16.5 months in WBRT+SRS and 7.6 months in SRS-alone patients (P=0.05). CONCLUSIONSThe current study revealed that, for the majority of brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effect of WBRT on neurocognitive function may not be negligible.

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Section: Introductionmentioning

confidence: 99%

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Aoyama¹,

Tago²,

Kato³

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

501

304

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“…Stereotactic radiosurgery leads to tumor control in 70%-90% of metastatic brain tumors. 1,3,4,8,10 The clinical effectiveness of radiosurgery relates in part to the histological tumor source. Tumor control is adequate if serial imaging after radiosurgery reveals stable or reduced tumor volumes.…”

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confidence: 99%

Volumetric response to radiosurgery for brain metastasis varies by cell of origin

Iyer

Harrison

Kano³

et al. 2014

JNS

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T he imaging response of brain metastases after stereotactic radiosurgery is complex and dynamic. Stereotactic radiosurgery leads to tumor control in 70%-90% of metastatic brain tumors. 1,3,4,8,10 The clinical effectiveness of radiosurgery relates in part to the histological tumor source. Tumor control is adequate if serial imaging after radiosurgery reveals stable or reduced tumor volumes. A transient increase in tumor volume may not preclude the possibility of long-term tumor inactivation 5 and is inadequate to predict the eventual radiosurgical response at a single follow-up imaging time point. In an effort to better define the effect of radiosurgery on different tumor pathologies, we evaluated the quantitative volumetric response of lung, breast, and melanoma metastases in the brain following Gamma Knife radiosurgery (GKRS). We then correlated this response to patient survival. MethodsInstitutional review board approval was acquired at the University of Pittsburgh for data review and presentation. We conducted a retrospective review of patients who had undergone GKRS for brain metastases from nonsmall cell lung cancer (NSCLC), breast cancer, and melanoma between 2002 and 2010 at our institution. To be included in the study, patients had to have undergone follow-up imaging at our institution so that volumetric measurements could be made on the same imaging software. Object. The aim of this study was to evaluate the imaging response of brain metastases after radiosurgery and to correlate the response with tumor type and patient survival.Methods. The authors conducted a retrospective review of patients who had undergone Gamma Knife radiosurgery for brain metastases from non-small cell lung cancer (NSCLC), breast cancer, or melanoma. The imaging volumetric response by tumor type was plotted at 3-month intervals and classified as a sustained decrease in tumor volume (Type A), a transient decrease followed by a delayed increase in tumor volume (Type B), or a sustained increase in tumor volume (Type C). These imaging responses were then compared with patient survival and tumor type.Results. Two hundred thirty-three patients with metastases from NSCLC (96 patients), breast cancer (98 patients), and melanoma (39 patients) were eligible for inclusion in this study. The patients with NSCLC were most likely to exhibit a Type A response; those with breast cancer, a Type B response; and those with melanoma, a Type C response. Among patients with NSCLC, the median overall survival was 11.2 months for those with a Type A response (76 patients), 8.6 months for those with a Type B response (6 patients), and 10.5 months for those with a Type C response (14 patients). Among patients with breast cancer, the median overall survival was 16.6 months in those with a Type A response (65 patients), 18.1 months in those with a Type B response (20 patients), and 7.5 months in those with a Type C response (13 patients). For patients with melanoma, the median overall survival was 5.2 months in those with a Type A response (26 patients) an...

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“…No influence on survival of the primary tumor have been reported (Lorenzoni, 2004;Nam, 2005;Rades, 2007;Frazier, 2010), on the other hand other studies have demonstrated significant association of this variable with survival: Hasegawa (Hasegawa, 2003), in the multivariate analysis found significant lower survival in patients harboring malignant melanoma. In multivariate studies Simonová (Simonová, 2000) reported better survival in patients with breast or renal cancer, Petrovich (Petrovich, 2002) found worse survival in patients with Melanoma and colon cancer and better survival in patients with breast cancer.…”

Section: Location or Histology Of The Primary Tumormentioning

confidence: 91%

“…Considering the systemic "extracranial" cancer status, there is also predominance of multivariate analysis proving its positive influence on survival (Petrovich, 2002;Serizawa, 2005;Mathiew, 2007;Kondziolka, 2011;Liew, 2011). In univariate studies 3 communications show this influence too (Hasegawa, 2003;Yu, 2005;Karlsson , 2009). Just one publication (Hernández 2002) found no influence of this variable on survival; this is a publication reporting 29 patients with renal cell carcinoma.…”

Section: Systemic Cancer Control Statusmentioning

confidence: 99%

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

Lorenzoni¹,

Zarate²,

Ramón³

et al. 2011

Gamma Knife Radiosurgery

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Brain Metastases Treated with Radiosurgery Alone: An Alternative to Whole Brain Radiotherapy?

Cited by 206 publications

References 41 publications

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Volumetric response to radiosurgery for brain metastasis varies by cell of origin

Gamma Knife Treatment for Patient Harboring Brain Metastases: How to Estimate Patient Eligibility and Survival?

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