Factors Associated With New-Onset Seizures Following Stereotactic Radiosurgery for Newly Diagnosed Brain Metastases

Lerner, Emily; Srinivasan, E.; Broadwater, Gloria; Haskell-Mendoza, Aden P.; Edwards, Ryan; Huie, David; Vaios, Eugene; Floyd, Scott R.; Adamson, Justus; Fecci, Peter E.

doi:10.1016/j.adro.2022.101054

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…In the current study, the incidence of ISEs was associated with maximum tumor volume, primary site, and pre-treatment neurological symptoms. This finding was consistent with those of Lerner et al [ 28 ] who reported that total tumor volume and pre-SRT neurological symptoms were associated with the development of seizures after SRT. However, one patient in the current study had a generalized seizure, despite having a single and relatively small lesion (0.24 cc).…”

Section: Discussionsupporting

confidence: 93%

Linear accelerator-based stereotactic radiotherapy for brain metastases, including multiple and large lesions, carries a low incidence of acute toxicities: a retrospective analysis

et al. 2023

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Background Data on acute toxicities after stereotactic radiotherapy (SRT) for brain metastases, including multiple and large lesions, are lacking. We aimed to evaluate the incidence and nature of toxicities immediately after SRT using a linear accelerator. Methods This retrospective study reviewed the medical records of 315 patients with brain metastases treated with SRT at our institution between May 2019 and February 2022. In total, 439 SRT sessions were performed for 2161 brain metastases. The outcome of interest was immediate side effects (ISEs), defined as new or worsening symptoms occurring during SRT or within 14 days after the end of SRT. Results Grade ≥ 2 and ≥ 3 ISEs occurred in 16 (3.6%) and 7 (1.6%) cases, respectively. Among 63 treatments for 10 or more lesions (range: 10–40), 1 (1.6%) ISE occurred. Among 22 treatments for lesions with a maximum tumor volume of > 10 cc, 2 (9.1%) ISEs occurred. Grade ≥ 3 ISEs included 1, 4, 1, and 1 cases of grade 3 nausea, grade 3 new-onset partial and generalized seizures, grade 3 obstructive hydrocephalus, and grade 5 intracranial hemorrhage, respectively. ISEs were more common in patients with a larger maximum tumor volume, primary sites other than lung and breast cancer, and pre-treatment neurological symptoms. Conclusion SRT using a linear accelerator for brain metastases, including multiple and large lesions, is safe, with a low incidence of ISEs. Serious complications immediately after SRT are rare but possible; therefore, careful follow-up is necessary after treatment initiation.

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Section: Discussionsupporting

confidence: 93%

Linear accelerator-based stereotactic radiotherapy for brain metastases, including multiple and large lesions, carries a low incidence of acute toxicities: a retrospective analysis

et al. 2023

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Association between tumor location and toxicity outcomes after stereotactic radiosurgery for brain metastases

Wang,

Bukowski,

Kaidar-Person

et al. 2024

J Neurooncol

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Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management

Avila,

Tobochnik,

Inati

et al. 2023

Neuro-Oncology

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Tumor-related epilepsy (TRE) is a frequent and major consequence of brain tumors. Management of TRE is required throughout the course of disease and a deep understanding of diagnosis and treatment is key to improving quality of life. Gross total resection is favored from both an oncologic and epilepsy perspective. Shared mechanisms of tumor growth and epilepsy exist, and emerging data will provide better targeted therapy options. Initial treatment with antiseizure medications (ASM) in conjunction with surgery and/or chemoradiotherapy is typical. The first choice of ASM is critical to optimize seizure control and tolerability considering the effects of the tumor itself. These agents carry a potential for drug–drug interactions and therefore knowledge of mechanisms of action and interactions is needed. A review of adverse effects is necessary to guide ASM adjustments and decision-making. This review highlights the essential aspects of diagnosis and treatment of TRE with ASMs, surgery, chemotherapy, and radiotherapy while indicating areas of uncertainty. Future studies should consider the use of a standardized method of seizure tracking and incorporating seizure outcomes as a primary endpoint of tumor treatment trials.

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Factors Associated With New-Onset Seizures Following Stereotactic Radiosurgery for Newly Diagnosed Brain Metastases

Cited by 3 publications

References 20 publications

Linear accelerator-based stereotactic radiotherapy for brain metastases, including multiple and large lesions, carries a low incidence of acute toxicities: a retrospective analysis

Linear accelerator-based stereotactic radiotherapy for brain metastases, including multiple and large lesions, carries a low incidence of acute toxicities: a retrospective analysis

Association between tumor location and toxicity outcomes after stereotactic radiosurgery for brain metastases

Brain tumor-related epilepsy management: A Society for Neuro-oncology (SNO) consensus review on current management

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