Impact of adjuvant fractionated stereotactic radiotherapy dose on local control of brain metastases

Musunuru, Hima Bindu; Witt, Jacob S.; Yadav, Poonam; Francis, David M.; Kuczmarska-Haas, Aleksandra; Labby, Zacariah E.; Bassetti, M.; Howard, Steven; Baschnagel, Andrew M.

doi:10.1007/s11060-019-03308-7

Cited by 17 publications

(8 citation statements)

References 16 publications

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“…The use of BED is determining the curative effect of SRS is debatable [33], but is usually applied in determining the curative effect of FSRT treatment. Several divide-up radiotherapy plans have been suggested [8][9][10]. One review summarized and compared the curative effect of different BED values, and concluded that BED12 values greater than 40Gy (which equals to BED10 greater than 48Gy) achieved a higher local control rate [34].…”

Section: Discussionmentioning

confidence: 99%

“…Current studies on prognostic factors for oligo-metastasis patients treated with FSRT focus on the size of metastatic tumor and radiation dose. However, there is still no standard evaluation method for tumor size, radiation dose and fractionation scheme, with different studies suggesting different radiotherapy biologically effective dose (BED) [8][9][10]. Therefore, there is need to develop and enhance predictive indexes indicating the e cacy and survival of NSCLC patients with brain oligo-metastasis receiving FSRT.…”

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confidence: 99%

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Pretreatment lymphocyte-to-monocyte ratio as a prognostic factor and influence on dose-effect in fractionated stereotactic radiotherapy for oligometastatic brain metastases in non-small cell lung cancer patients

Chen

Tang

Zhou

et al. 2023

Preprint

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Background Studies on the prognostic factors for patients with brain oligo-metastasis treated with fractionated stereotactic radiotherapy (FSRT) usually focus on the size of metastatic tumor and radiation dose. Some inflammatory indicators have predictive value in non-small cell lung cancer (NSCLC) with brain metastasis receiving stereotactic radiotherapy. However, the prognostic value of inflammatory indicators in NSCLC patients with brain oligo-metastasis treated with FSRT, and their effect on radiotherapy dose is unknown.Methods A total of 95 advanced NSCLC patients with brain oligo-metastasis who had undergone FSRT treatment at Ningbo Medical Center Lihuili Hospital between January 2015 and April 2022 were enrolled into the study. Neutrophil to lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), tumor diameter and biologically effective dose (BED10) were analyzed using Chi-square test. Univariate and multivariate Cox regressions were used to identify predictors of survival.Results Tumor diameter (< 2 cm), BED10 (≥ 48Gy) and LMR (≥ 4) were found to be independently associated with good intracranial local control survival (i-LCS) through multivariate analysis. The median i-LCS was longer in patients with 2 independent risk factors (tumor diameter ≥ 2 and LMR < 4) administered with BED10 > 53.6Gy compared with patients administered with BED10 ≤ 53.6Gy (20.7 months vs 12.0 months, P = 0.042). LMR ≥ 4 and positivity for driver gene mutations were independently associated with better overall survival (OS).Conclusions LMR is an independent prognostic factor of i-LCS and OS in NSCLC patients with brain oligo-metastasis treated with FSRT. Patients with tumor diameter ≥ 2 and LMR < 4 should be treated with BED10 greater than 53.6Gy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pretreatment lymphocyte-to-monocyte ratio as a prognostic factor and influence on dose-effect in fractionated stereotactic radiotherapy for oligometastatic brain metastases in non-small cell lung cancer patients

Chen

Tang

Zhou

et al. 2023

Preprint

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“…However, it can only be postulated that the lower doses delivered are actually the reason for this. Larger cavity size has been found to be associated with higher local failure rates in some retrospective analyses [ 29 , 32 , 34 ]. The rather broad dose corridors allowed within the study represent a potential limitation of the study, yet this issue will be addressed in a predefined subgroup analysis, as well as the cavity size.…”

Section: Discussionmentioning

confidence: 99%

“…There are a couple of analyses [ 24 , 28 , 29 ] showing a significant impact of delivered dose on LC. As 48 Gy BED10 has been demonstrated as cut-off value in two independent data sets [ 28 , 29 ], this threshold is also used in the subgroup analysis.…”

Section: Methodsmentioning

confidence: 99%

Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiosurgery (SRS) to the resection cavity of brain metastases after surgical resection (SATURNUS): study protocol for a randomized phase III trial

et al. 2023

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Background The brain is a common site for cancer metastases. In case of large and/or symptomatic brain metastases, neurosurgical resection is performed. Adjuvant radiotherapy is a standard procedure to minimize the risk of local recurrence and is increasingly performed as local stereotactic radiotherapy to the resection cavity. Both hypofractionated stereotactic radiotherapy (HFSRT) and single fraction stereotactic radiosurgery (SRS) can be applied in this case. Although adjuvant stereotactic radiotherapy to the resection cavity is widely used in clinical routine and recommended in international guidelines, the optimal fractionation scheme still remains unclear. The SATURNUS trial prospectively compares adjuvant HFSRT with SRS and seeks to detect the superiority of HFSRT over SRS in terms of local tumor control. Methods In this single center two-armed randomized phase III trial, adjuvant radiotherapy to the resection cavity of brain metastases with HFSRT (6 – 7 × 5 Gy prescribed to the surrounding isodose) is compared to SRS (1 × 12–20 Gy prescribed to the surrounding isodose). Patients are randomized 1:1 into the two different treatment arms. The primary endpoint of the trial is local control at the resected site at 12 months. The trial is based on the hypothesis that HFSRT is superior to SRS in terms of local tumor control. Discussion Although adjuvant stereotactic radiotherapy after resection of brain metastases is considered standard of care treatment, there is a need for further prospective research to determine the optimal fractionation scheme. To the best of our knowledge, the SATURNUS study is the only randomized phase III study comparing different regimes of postoperative stereotactic radiotherapy to the resection cavity adequately powered to detect the superiority of HFSRT regarding local control. Trial registration The study was retrospectively registered with ClinicalTrials.gov, number NCT05160818, on December 16, 2021. The trial registry record is available on https://clinicaltrials.gov/study/NCT05160818. The presented protocol refers to version V1.3 from March 21, 2021.

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“…In the post-operative setting, high dose HF-SRS provided greater local control (LC)defined as radiographic evidence of stable disease, partial response, or complete response, as compared to lower biological effective dose (BED) regimens (95% vs. 59%) [24]. For example, 25 Gy in 5 fractions (BED10 of 37.5 Gy) was not adequate to control microscopic disease as compared to 30 Gy in 5 fractions (BED10 > 48 Gy) which had excellent tumor bed control.…”

Section: Modern Role For Stereotactic Radiosurgerymentioning

confidence: 99%

Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases

Tonse

Tom

Mehta

et al. 2021

Cancers

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Brain metastasis (BM) represents a common complication of cancer, and in the modern era requires multi-modal management approaches and multi-disciplinary care. Traditionally, due to the limited efficacy of cytotoxic chemotherapy, treatment strategies are focused on local treatments alone, such as whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and resection. However, the increased availability of molecular-based therapies with central nervous system (CNS) penetration now permits the individualized selection of tailored systemic therapies to be used alongside local treatments. Moreover, the introduction of immune checkpoint inhibitors (ICIs), with demonstrated CNS activity has further revolutionized the management of BM patients. The rapid introduction of these cancer therapeutics into clinical practice, however, has led to a significant dearth in the published literature about the optimal timing, sequencing, and combination of these systemic therapies along with SRS. This manuscript reviews the impact of tumor biology and molecular profiles on the management paradigm for BM patients and critically analyzes the current landscape of SRS, with a specific focus on integration with systemic therapy. We also discuss emerging treatment strategies combining SRS and ICIs, the impact of timing and the sequencing of these therapies around SRS, the effect of corticosteroids, and review post-treatment imaging findings, including pseudo-progression and radiation necrosis.

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Impact of adjuvant fractionated stereotactic radiotherapy dose on local control of brain metastases

Cited by 17 publications

References 16 publications

Pretreatment lymphocyte-to-monocyte ratio as a prognostic factor and influence on dose-effect in fractionated stereotactic radiotherapy for oligometastatic brain metastases in non-small cell lung cancer patients

Pretreatment lymphocyte-to-monocyte ratio as a prognostic factor and influence on dose-effect in fractionated stereotactic radiotherapy for oligometastatic brain metastases in non-small cell lung cancer patients

Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiosurgery (SRS) to the resection cavity of brain metastases after surgical resection (SATURNUS): study protocol for a randomized phase III trial

Integration of Systemic Therapy and Stereotactic Radiosurgery for Brain Metastases

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