Proton Stereotactic Radiosurgery for Brain Metastases: A Single-Institution Analysis of 370 Patients

Atkins, Katelyn M.; Pashtan, Itai; Bussière, Marc R.; Kang, Koo-Tae; Niemierko, Andrzej; Daly, Jillian E.; Botticello, Thomas; Hurd, Molly; Chapman, Paul H.; Oh, Kevin; Loeffler, Jay S.; Shih, Helen A.

doi:10.1016/j.ijrobp.2018.03.056

Cited by 37 publications

(36 citation statements)

References 36 publications

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“…Previous studies have suggested that techniques allowing selective avoidance of the hippocampal neural stem-cell compartment cause a lower degree of cognitive impairment relative to WBRT [13,48]. With the development of IMRT, volumetric-modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT), hippocampal-sparing WBRT has been increasingly used as an adjuvant to surgery in the treatment of primary brain neoplasms and in management of brain metastases [49][50][51]. The results of ongoing randomized clinical trials will help to clarify the role of hippocampal-sparing WBRT in cognitive preservation [45,46,52].…”

Section: Improvement Of Techniques In Radiation Therapymentioning

confidence: 99%

Neurocognitive Decline Following Radiotherapy: Mechanisms and Therapeutic Implications

Pazzaglia

Briganti

Mancuso

et al. 2020

Cancers

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The brain undergoes ionizing radiation (IR) exposure in many clinical situations, particularly during radiotherapy for malignant brain tumors. Cranial radiation therapy is related with the hazard of long-term neurocognitive decline. The detrimental ionizing radiation effects on the brain closely correlate with age at treatment, and younger age associates with harsher deficiencies. Radiation has been shown to induce damage in several cell populations of the mouse brain. Indeed, brain exposure causes a dysfunction of the neurogenic niche due to alterations in the neuronal and supporting cell progenitor signaling environment, particularly in the hippocampus—a region of the brain critical to memory and cognition. Consequent deficiencies in rates of generation of new neurons, neural differentiation and apoptotic cell death, lead to neuronal deterioration and lasting repercussions on neurocognitive functions. Besides neural stem cells, mature neural cells and glial cells are recognized IR targets. We will review the current knowledge about radiation-induced damage in stem cells of the brain and discuss potential treatment interventions and therapy methods to prevent and mitigate radiation related cognitive decline.

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Section: Improvement Of Techniques In Radiation Therapymentioning

confidence: 99%

Neurocognitive Decline Following Radiotherapy: Mechanisms and Therapeutic Implications

Pazzaglia

Briganti

Mancuso

et al. 2020

Cancers

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“…67 While comprehensive investigations are yet to be completed in the setting of atypical and anaplastic meningiomas, a comparison of proton SRS and photon SRS in the management of brain metastases has suggested that protons have minimal treatment-related toxicity and reduce the integral normal tissue radiation dose. 7 IMPT, as compared to the more common scattered proton therapy, offers increased modulation of radiation deposition proximal to the target and improved conformality of dosage application. 30 Moreover, IMPT administration in small patient cohorts has shown promising results.…”

Section: Ongoing Investigations Into Particle Therapy In High-risk Mementioning

confidence: 99%

Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review

Jin

Meola

et al. 2019

Neurosurgical Focus

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OBJECTIVEAdjuvant radiotherapy has become a common addition to the management of high-grade meningiomas, as immediate treatment with radiation following resection has been associated with significantly improved outcomes. Recent investigations into particle therapy have expanded into the management of high-risk meningiomas. Here, the authors systematically review studies on the efficacy and utility of particle-based radiotherapy in the management of high-grade meningioma.METHODSA literature search was developed by first defining the population, intervention, comparison, outcomes, and study design (PICOS). A search strategy was designed for each of three electronic databases: PubMed, Embase, and Scopus. Data extraction was conducted in accordance with the PRISMA guidelines. Outcomes of interest included local disease control, overall survival, and toxicity, which were compared with historical data on photon-based therapies.RESULTSEleven retrospective studies including 240 patients with atypical (WHO grade II) and anaplastic (WHO grade III) meningioma undergoing particle radiation therapy were identified. Five of the 11 studies included in this systematic review focused specifically on WHO grade II and III meningiomas; the others also included WHO grade I meningioma. Across all of the studies, the median follow-up ranged from 6 to 145 months. Local control rates for high-grade meningiomas ranged from 46.7% to 86% by the last follow-up or at 5 years. Overall survival rates ranged from 0% to 100% with better prognoses for atypical than for malignant meningiomas. Radiation necrosis was the most common adverse effect of treatment, occurring in 3.9% of specified cases.CONCLUSIONSDespite the lack of randomized prospective trials, this review of existing retrospective studies suggests that particle therapy, whether an adjuvant or a stand-alone treatment, confers survival benefit with a relatively low risk for severe treatment-derived toxicity compared to standard photon-based therapy. However, additional controlled studies are needed.

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“…It is worth mentioning proton beam therapy as an evolving radiotherapy modality with the dosimetric and physical advantages of reducing or eliminating the dose to the surrounding tissue and organs in comparison to the conventional photon radiotherapy. Proton SRS was proved feasible in the treatment of BMs [ 15 ], but its role and selective utility are still to be determined.…”

Section: Introductionmentioning

confidence: 99%

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

Jablonska

Bosch-Barrera

Serrano

et al. 2021

Cancers

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Approximately 20% patients with non-small cell lung cancer (NSCLC) present with CNS spread at the time of diagnosis and 25–50% are found to have brain metastases (BMs) during the course of the disease. The improvement in the diagnostic tools and screening, as well as the use of new systemic therapies have contributed to a more precise diagnosis and prolonged survival of lung cancer patients with more time for BMs development. In the past, most of the systemic therapies failed intracranially because of the inability to effectively cross the blood brain barrier. Some of the new targeted therapies, especially the group of tyrosine kinase inhibitors (TKIs) have shown durable CNS response. However, the use of ionizing radiation remains vital in the management of metastatic brain disease. Although a decrease in CNS-related deaths has been achieved over the past decade, many challenges arise from the need of multiple and repeated brain radiation treatments, which carry along not insignificant risks and toxicity. The combination of stereotactic radiotherapy and systemic treatments in terms of effectiveness and adverse effects, such as radionecrosis, remains a subject of ongoing investigation. This review discusses the challenges of the use of radiation therapy in NSCLC BMs in view of different systemic treatments such as chemotherapy, TKIs and immunotherapy. It also outlines the future perspectives and strategies for personalized BMs management.

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Proton Stereotactic Radiosurgery for Brain Metastases: A Single-Institution Analysis of 370 Patients

Cited by 37 publications

References 36 publications

Neurocognitive Decline Following Radiotherapy: Mechanisms and Therapeutic Implications

Neurocognitive Decline Following Radiotherapy: Mechanisms and Therapeutic Implications

Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

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