Local control and radionecrosis of brain metastases from non-small-cell lung cancer treated by hypofractionated stereotactic radiotherapy: Evaluation of predictive factors

Leyrat, Brice; Khalill, Toufic; Lemaire, Jean‐Jacques; Casile, Mélanie; Molnar, Ioana; Dedieu, V.; Chassin, V.; Dupic, G.; Bellière, A.; Durando, Xavier; Lapeyre, M.; Verrelle, Pierre; Biau, J.

doi:10.1016/j.ctro.2022.05.008

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…Stereotactic radiotherapy is associated with 85%–95% local control at 1 year for lesions <2 cm ( 4 , 5 ) and very few adverse events ( 6 ). One of the major adverse events is brain radionecrosis.…”

Section: Introductionmentioning

confidence: 99%

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Lolli

Tessari²,

Berti³

et al. 2023

Front. Oncol.

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IntroductionRadionecrosis is a consequence of SRS (stereotactic radiosurgery) for brain metastases in 34% of cases, and if symptomatic (8%–16%), it requires therapy with corticosteroids and bevacizumab and, less frequently, surgery. Oncological indications are increasing and appropriate stereotactic adapted LINACs (linear accelerators) are becoming more widely available worldwide. Efforts are being made to treat brain radionecrosis in order to relieve symptoms and spare the use of active therapies.Case presentationHerein, we describe a 65-year-old female patient presenting with brain radionecrosis 6 months after stereotactic radiotherapy for two brain metastatic lesions. Being symptomatic with headache and slow cognitive-motor function, the patient received corticosteroids. Because of later lung progression, the patient took cabozantinib. An impressive reduction of the two brain radionecrosis areas was seen at the brain MRI 2 months after the initiation of the angiogenic drug.DiscussionThe high incidence of radionecrosis (2/2 treated lesions) can be interpreted by the combination of SRS and previous ipilimumab that is associated with increased risk of radionecrosis. The molecular mechanisms of brain radionecrosis, and its exact duration in time, are poorly understood. We hypothesize that the antiangiogenic effect of cabozantinib may have had a strong effect in reducing brain radionecrosis areas.ConclusionIn this clinical case, cabozantinib is associated with a fast and significant volume reduction of brain radionecrosis appearing after SRS and concomitant immunotherapy. This drug seems to show, like bevacizumab, clinical implications not only for its efficacy in systemic disease control but also in reducing brain radionecrosis. More research is needed to evaluate all molecular mechanisms of brain radionecrosis and their interaction with systemic therapies like third-generation TKIs.

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Section: Introductionmentioning

confidence: 99%

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Lolli

Tessari²,

Berti³

et al. 2023

Front. Oncol.

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“…Leyrat et al evaluated SRS/fSRS in NSCLC–BM patients, finding a median follow-up period of 12 months and a median OS of 14 months. 12 Minitti et al reported that OS was 15.2 months after SRS/fSRS in NSCLC–BM patients with a median follow-up period of 12 months. 13 In our study, ablative RT doses were applied to lesions considered oligometastatic.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery Results in Non-Small-Cell Lung Cancer Patients with Brain Metastases in the Era of Modern Systemic Treatment Agents

Dasgin,

Kargioglu,

Arslan

et al. 2023

Thoracic Research and Practice

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Objective: This study reports the results of stereotactic radiosurgery and fractionated stereotactic radiosurgery treatment for brain metastasis in non-small cell lung cancer patients treated with modern systemic treatment methods (immunotherapy, targeted agents, and current chemotherapy agents). Material and Methods: This study retrospectively analyzed patients diagnosed with non-small cell lung cancer and brain metastases who underwent stereotactic radiosurgery/fractionated stereotactic radiosurgery in the Radiation Oncology Clinic of Ankara Bilkent City Hospital between February 21, 2019, and August 15, 2022. The study’s primary endpoint was accepted as the lesions’ response status after stereotactic radiosurgery/fractionated stereotactic radiosurgery.The secondary endpoint was accepted as the patients’ intracranial progression-free survival and overall survival. Results: This study included 85 patients treated for 174 lesions. Their median follow-up was 6.6 (range: 1-42) months.Their median intracranial progression-free survival after radiotherapy was 5.3 (range: 1-33) months, and their median overall survival was 6.6 (range: 1-42) months. Concurrent immunotherapy was administered to 10 (11%) patients and targeted therapy to 8 (9%). Magnetic resonance imaging indicated that 14 (6%) patients had a complete response, 62 (35.6%) had a partial response, 10 (5.7%) had stable disease, and 23 (13.2%) had progressive disease. The complete response rate was significantly higher in patients receiving targeted therapy ( P < .001; odds ratio = 0.0025, 95% CI = 0.006-0.109). Intracranial recurrence was observed in 28 (32.9%) patients after stereotactic radiosurgery/fractionated stereotactic radiosurgery: 7 (8.2%) were inside the radiotherapy field, 13 (15.3%) were outside the radiotherapy field, and 8 (9.4%) overlapped the radiotherapy field. Intracranial progression-free survival was higher in patients receiving concomitant immunotherapy ( P = .028; hazard ratio = 0.107, 95% CI = 0.015-0.783). However, overall survival was higher in patients receiving targeted therapy ( P = .035; hazard ratio = 0.217, 95% CI = 0.053-0.897). Conclusion: Using current systemic agents with radiotherapy for brain metastasis significantly affected post-radiotherapy intracranial progression-free survival.

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The impact of local control on widespread progression and survival in oligometastasis-directed SBRT: Results from a large international database

Cao

Chen

Sahgal

et al. 2023

Radiotherapy and Oncology

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Local control and radionecrosis of brain metastases from non-small-cell lung cancer treated by hypofractionated stereotactic radiotherapy: Evaluation of predictive factors

Cited by 4 publications

References 41 publications

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Impressive reduction of brain metastasis radionecrosis after cabozantinib therapy in metastatic renal carcinoma: A case report and review of the literature

Stereotactic Radiosurgery Results in Non-Small-Cell Lung Cancer Patients with Brain Metastases in the Era of Modern Systemic Treatment Agents

The impact of local control on widespread progression and survival in oligometastasis-directed SBRT: Results from a large international database

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