Early clinical outcomes for 3 radiation techniques for brain metastases: focal versus whole-brain

Vargo, John A.; Plants, B; Mihailidis, Dimitris; Mallah, J; plants, M; Welch, Christine A.; Clark, Grant M.; Farinash, L; Raja, P; Harmon, M; Whaley, L

doi:10.1016/j.prro.2011.03.005

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…SIB-WBRT has advantages over localized brain metastasis irradiation regimens in reducing the incidence of new lesions. Localized brain metastasis irradiation is more likely to result in the development of new brain metastases in patients with brain metastases treated with this regimen because no prophylactic irradiation of other normal brain tissue is performed.A 2013 retrospective study from the U.S. compared the e cacy of three modalities of radiation therapy for brain metastases, SIB-WBRT, WBRT, and localized brain metastasis irradiation.A total of 92 patients were analyzed in this study (75 Gy/10-15 sessions in the SIB-WBRT group, 30-37.5 Gy/10-15 sessions in the WBRT group, and 30 Gy/5 sessions in the localized brain metastasis irradiation group), and the analyzed results showed that the rate of new brain metastatic lesions in the SIB-WBRT group was signi cantly lower than that in the localized brain metastasis irradiation group (18% vs. 33%) (19,20). Our data showed similar results, with a median value of 7.3 months for the appearance of new intracranial lesions in the patients in our study, which is longer than that of other non-whole-brain irradiation (e.g., SRS) previously reported in the literature (5.6 months) (21).…”

Section: Discussionmentioning

confidence: 75%

Efficacy of Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost (SIB-WBRT) for brain metastases

BI,

LIAN,

SHEN

et al. 2023

Preprint

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Objective: To investigate the outcomes of SIB-WBRT in patients with brain metastases and analyze the impact of some factors on prognosis. Methods: This single-arm retrospective study analyzed patients with brain metastases treated with received SIB-WBRT (40 Gy/20 doses of whole brain tissue and tumor tissue pushed to 56-60 Gy/20 doses) at Peking Union Medical College Hospital from September 2015 to December 2021. The primary endpoint was intracranial progression free survival (iPFS). Secondary endpoints included overall survival (OS), intracranial new foci, and tumor control. The Kaplan-Meier method was then used to depict and estimate iPFS, OS, intracranial new incidence, and tumor control. Finally, the Cox model was used to analyze the association between some relevant factors and outcomes. Results: A total of 107 patients were included and the median iPFS in these patients treated with SIB-WBRT was 13.4 (95% CI: 4.2-22.6) months, with 66.3% (95% CI: 56.0%-77.0%) and 48.5% (95% CI: 36.0%-61.0%) iPFS at 6- and 12-months. The median local control was 37.6 (95% CI: 28.3-46.8) months, with local control rates of 83.9% (95% CI: 80.0%-88.0%) and 72.6% (95% CI: 67.0%-78.0%) at 6- and 12-months. The median time to appearance of new intracranial foci was 17.4 (95% CI: 17.1-20.8) months, and the 6- and 12-month control rates were 72.6% (95% CI: 62.0%-83.0%) and 58.8% (95% CI: 46.0%-72.0%). The number of brain metastases in patients before treatment was significantly associated with iPFS (HR=0.4, 95% CI: 0.1-0.9, P=0.0430). Conclusions: The iPFS, local control, and intracranial new foci of patients with brain metastases after treatment with SIB-WBRT were acceptable. In addition, the number of brain metastases in patients before treatment may be associated with iPFS.

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Section: Discussionmentioning

confidence: 75%

Efficacy of Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost (SIB-WBRT) for brain metastases

BI,

LIAN,

SHEN

et al. 2023

Preprint

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“…In addition to demonstrating the feasibility of WBRT+SIB, several studies have shown that this approach leads to local and intra-cerebral control rates at least comparable to other radiation approaches, namely WBRT alone, stereotactic radiotherapy alone, or WBRT plus stereotactic radiotherapy [ 6 , 16 , 17 , 18 , 19 ]. Some data suggests that WBRT+SIB may be superior to WBRT with or without stereotactic radiosurgery [ 7 , 20 , 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a study from 2022, even the combination of WBRT+SIB and the tyrosine kinase inhibitor apatinib appeared safe [ 15 ]. Moreover, in several studies, WBRT+SIB was similarly effective as stereotactic radiotherapy, WBRT, or a combination of both with respect to local control or intra-cerebral control [ 6 , 16 , 17 , 18 , 19 ]. Some studies even suggested that WBRT+SIB resulted in improved outcomes compared to WBRT with or without stereotactic radiosurgery [ 7 , 20 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

The First Survival Score for Patients Treated with Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost for Brain Metastases

Rades

JOHANNWERNER

Werner

et al. 2023

Biology

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A modern approach for brain metastases includes whole-brain radiotherapy plus simultaneous boost (WBRT+SIB). We developed a survival score in 128 patients treated with WBRT+SIB. Three models, each including three prognostic groups, were created. Positive predictive values (PPVs) for death ≤6 and survival ≥6 months were calculated. On multivariate analyses, performance score (KPS) and the number of brain metastases were significantly associated with survival. On univariate analyses, age showed a strong trend, and extra-cerebral cranial metastases a trend. In Model 1 (KPS, number of lesions), compared groups had 6-month survival rates of 15%, 38% and 57%. In Model 2 (KPS, lesions, age), rates were 17%, 33% and 75%, and in Model 3 (KPS, lesions, age, extra-cerebral metastases), 14%, 34% and 78%. PPVs for death ≤6 and survival ≥6 months were 85% and 57% (Model 1), 83% and 75% (Model 2), and 86% and 78% (Model 3). Thus, all models were accurate in predicting death ≤ 6 months; poor-prognosis patients may not benefit from SIB. Models 2 and 3 were superior in predicting survival ≥ 6 months. Given that Model 3 requires more data (including extensive staging), Model 2 is considered favorable for many patients. If extra-cerebral metastases are already known or extensive staging has been performed, Model 3 can also be used.

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“…In a systematic review of the literature on brain metastases treated with hypofractionated SRT, Rodrigues et al [ 56 ] reported local control at 6 months ranging from 67 to 97%, at 1 year from 59 to 91% and at 2 years from 45 to 83%, for

ranging from 24 to 100.8 Gy in the series excluding previous whole-brain irradiation [ 19 , 52 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. All series combined, a direct correlation was observed between

and local control, with a Pearson score of 0.57 for local control at 6 months and 0.62 for local control at 12 months.…”

Section: Dose-effect Relationmentioning

confidence: 99%

Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review

Loo

Clavier

Khalifa

et al. 2021

Cancers

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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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Early clinical outcomes for 3 radiation techniques for brain metastases: focal versus whole-brain

Cited by 8 publications

References 30 publications

Efficacy of Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost (SIB-WBRT) for brain metastases

Efficacy of Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost (SIB-WBRT) for brain metastases

The First Survival Score for Patients Treated with Whole-Brain Radiotherapy Plus Simultaneous Integrated Boost for Brain Metastases

Dose-Response Effect and Dose-Toxicity in Stereotactic Radiotherapy for Brain Metastases: A Review

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