Metastatic Neoplasm Volume Kinetics Following 2-Stage Stereotactic Radiosurgery

Damron, E.P.; Dono, Antonio; Chafi, Hatim; Martir, Magda; Yu, Tse-Kuan; Khwaja, Shariq S.; Amsbaugh, Mark J.; Tandon, Nitin; Esquenazi, Yoshua; Blanco, Angel I.

doi:10.1016/j.wneu.2022.01.109

Cited by 9 publications

(11 citation statements)

References 31 publications

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“…Furthermore, Damron E.P. corroborated the e cacy and safety of 2-SRS as a therapeutic approach for LBM patients [17].…”

Section: The Side Effects Of Combined Anti-vascular Therapymentioning

confidence: 69%

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

Zhu,

Zhou,

Chen

et al. 2024

Preprint

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Stereotactic radiosurgery poses a significant risk when treating brain metastases in close proximity to the brainstem. To address this issue, a novel approach known as "combined anti-vascular therapy" has been devised for these metastases. This treatment regimen involves a one-week course of two-staged stereotactic radiosurgery (2-SSRS), supplemented with the administration of the anti-vascular agent bevacizumab during the radiosurgery interval. The objective of this study is to assess the efficacy and safety of a combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression. A retrospective analysis was conducted on patients treated at five gamma knife treatment centers to assess changes in tumor size and peritumoral edema volume. Clinical symptom changes were evaluated using the Headache Scale (VAS), Dizziness Disorder Inventory (DHI), Vomiting Scale (VS), and Glasgow Coma Scale (GCS). The Karnofsky Task Scale (KPS) and Barthel Index (BI) were used to assess overall physical fitness and physical activity rehabilitation. Tumor local control (TLC) and overall survival (OS) rate were also calculated for the patients. Among the 36 patients with brain metastases with brainstem compression, 36 received combined anti-vascular therapy. Both edema volume and tumor volume significantly decreased during the treatment period and post-treatment 3 months (p < 0.01). Clinical symptoms, as indicated by median scores of VAS, DHI, VS, and GCS, showed significant improvement during treatment and at the 3-month follow-up (p < 0.01). Median changes in KPS and BI, reflecting overall physical fitness and physical activity rehabilitation, were also similar and statistically significant (p < 0.01). The patient cohort exhibited a median overall survival of 14.2 months, with corresponding 6-month and 12-month survival rates of 91.7% and 80.0%, respectively. Tumor local control rates at 6 and 12 months were 94.7% and 78.9%, respectively.The combination of anti-vascular therapy with 2-SSRS demonstrates safety and efficacy in treating patients with brain metastases with brainstem compression. This approach rapidly alleviates patient symptoms, effectively manages tumor progression, extends overall survival, and exhibits manageable adverse effects.

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“…Furthermore, Damron E.P. corroborated the e cacy and safety of 2-SRS as a therapeutic approach for LBM patients [17].…”

Section: The Side Effects Of Combined Anti-vascular Therapymentioning

confidence: 69%

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

Zhu,

Zhou,

Chen

et al. 2024

Preprint

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“…The study of Damron et al in 2022 also supports the effectiveness and safety of 2-SSRS for BM patients. 30 According to the results of these studies, 2-SSRS for the BM treatment is satisfactory and local control failure rate is low. Table 3 listed 8 studies that adopted 2-SSRS strategy for BM.…”

Section: Discussionmentioning

confidence: 89%

Multi-institutional study of ‘Sandwich treatment’ for motor area large brain metastases (LBM) with diameter over 3 cm

Wang,

Chen,

Chen

et al. 2024

Radiology and Oncology

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Background The objective of the present study was to explore the effectiveness and safety of ‘Sandwich treatment’ strategy for large brain metastases (LBM) with diameter over 3 cm (minimum volume >= 15 cm3) located in motor area. Patients and methods Patients from four gamma knife center that received ‘Sandwich treatment’ were retrospectively studied from January 2016 to March 2023. The strategy was one-week treatment course including 2 stages of stereotactic radiosurgery (SRS) and using bevacizumab once during SRS gap. The tumor volume and peri-tumor edema changes were analyzed before and after ‘Sandwich treatment’. Manual muscle testing (MMT) score and Barthel Index (BI) score were used to evaluate the changes of patients’ movement and physical strength rehabilitation. The patients’ overall survival (OS) and tumor local control (TLC) rate was calculated. Cox regression model was used to analyze the risk factors that related to TLC. Results 61 patients with 72 lesions received the ‘Sandwich treatment’. The median prescription dose was 13.0 Gy and 12.5 Gy at the first- and second-stage SRS. The mean tumor volume at the time of ‘Sandwich treatment’ and 3 months later was 20.1 cm3 and 12.3, respectively (P < 0.01). The mean peri-tumor edema volume at the first- and second-stage SRS was 12.6 cm3 and 5.2 cm3, respectively (P < 0.01). Patients’ median MMT score improved from 6 at the beginning to 8 at the end of ‘Sandwich treatment’ (P < 0.01), BI score was also greatly improved from 45 at the time of ‘Sandwich treatment’ to 95 after 3 months (P < 0.01). Patients’ median OS was 14.0 months, and the 3, 6, 12 months OS rate was 92.0%, 86.0% and 66.0%, respectively. The TLC rate at 3, 6, 12 months was 98.4%, 93.4%, and 85.3%, respectively. Patients with lung cancer had lower risk of tumor relapse. The cumulative incidence of patient’s hemorrhage and radiation necrosis was 4.92% (3/61) and 13.11% (8/61) after ‘Sandwich treatment’. Conclusions ‘Sandwich treatment’ strategy is safe and effective for LBM located in motor area. The strategy could rapidly improve the patients’ movement and enhance their physical strength rehabilitation.

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“…Thus, a higher final BED on the tumor is achievable, while simultaneously maintaining a lower risk of RN. Despite the promising results of preliminary reports [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], further evidence is awaited before there is wide adoption of SSRS in clinical practice. Most studies included patients with BMs from different primary tumors, with NSCLC representing the most frequent (30–100%) histology.…”

Section: Stereotactic Radiosurgery (Srs)mentioning

confidence: 99%

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Levis,

Gastino,

De Giorgi

et al. 2023

Cancers

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Brain metastases (BMs) represent the most frequent metastatic event in the course of lung cancer patients, occurring in approximately 50% of patients with non-small-cell lung cancer (NSCLC) and in up to 70% in patients with small-cell lung cancer (SCLC). Thus far, many advances have been made in the diagnostic and therapeutic procedures, allowing improvements in the prognosis of these patients. The modern approach relies on the integration of several factors, such as accurate histological and molecular profiling, comprehensive assessment of clinical parameters and precise definition of the extent of intracranial and extracranial disease involvement. The combination of these factors is pivotal to guide the multidisciplinary discussion and to offer the most appropriate treatment to these patients based on a personalized approach. Focal radiotherapy (RT), in all its modalities (radiosurgery (SRS), fractionated stereotactic radiotherapy (SRT), adjuvant stereotactic radiotherapy (aSRT)), is the cornerstone of BM management, either alone or in combination with surgery and systemic therapies. We review the modern therapeutic strategies available to treat lung cancer patients with brain involvement. This includes an accurate review of the different technical solutions which can be exploited to provide a “state-of-art” focal RT and also a detailed description of the systemic agents available as effective alternatives to SRS/SRT when a targetable molecular driver is present. In addition to the validated treatment options, we also discuss the future perspective for focal RT, based on emerging clinical reports (e.g., SRS for patients with many BMs from NSCLC or SRS for BMs from SCLC), together with a presentation of innovative and promising findings in translational research and the combination of novel targeted agents with SRS/SRT.

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Metastatic Neoplasm Volume Kinetics Following 2-Stage Stereotactic Radiosurgery

Cited by 9 publications

References 31 publications

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

Efficacy and safety of combined anti-vascular and two-staged stereotactic radiosurgery therapy for brain metastases with brainstem compression: a retrospective multicenter study

Multi-institutional study of ‘Sandwich treatment’ for motor area large brain metastases (LBM) with diameter over 3 cm

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

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