Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases.

Pirzkall, Andrea; Debus, Jürgen; Lohr, Frank; Fuß, Martin; Rhein, B.; Engenhart‐Cabillic, Rita; Wannenmacher, M.

doi:10.1200/jco.1998.16.11.3563

Cited by 347 publications

(158 citation statements)

References 16 publications

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“…Long-term toxicity and survival were comparable to SRS results; on the contrary a relatively high incidence of acute/early complications after SRS has been reported in the literature [9][10][11]. The actuarial 1-year local tumor control rate (86.1%) after HSRT was equivalent to that obtained with SRS series (70-90%) in several reports [5][6][7][8][9][10][11][12].…”

Section: Discussionsupporting

confidence: 61%

“…They found no significant difference in the median overall survival time (P = 0, 42), while in terms of local and distant intracranial control patients receiving SRS plus WBRT had a better control rate (1-yr actuarial overall control rate 53,2% vs. 23,6; P \ 0,001) [20]. Several retrospective studies, despite the inherent biases, have shown that the omission of WBRT doesn't affect overall survival but has a negative impact on local and intracranial control [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Studies demonstrate that the use of up-front WBRT for newly disgnosed brain metastases decrease the risk of methacronous brain metastases in comparison with SRS alone [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Hypofractionated stereotactic radiotherapy in combination with whole brain radiotherapy for brain metastases

et al. 2008

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Background The efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) in combination with whole brain radiotherapy (WBRT), for the treatment of 1-4 brain metastases, using a non invasive fixation of the skull, was investigated. Methods Between 04/2001 and 01/2006 30 patients with 44 brain metastases underwent irradiation. Every patient received WBRT (10 9 3 Gy); 41/44 lesions received HSRT boost with a median dose fraction of 6 Gy, the fractionation schemes were 3 9 6 Gy and 4 9 8 Gy; a median total dose of 18 Gy was delivered to the tumor isocenter. Results The median survival period was 9.15 months, the actuarial 1-year overall survival and freedom from new brain metastases were 36.6% and 87.9%, respectively; at univariate analysis Karnofsky Performance Status (KPS) was statistically significant (P = 0.05); the actuarial 1-year local control for the 41/44 lesions was 86.1%. No patient had acute or late complications. Conclusions HSRT as a concomitant boost during WBRT is a safe and well tolerated treatment for selected patients with brain metastases.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Hypofractionated stereotactic radiotherapy in combination with whole brain radiotherapy for brain metastases

et al. 2008

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“…There is no difference in the clinical outcome whether radiotherapy or neurosurgery is used as an intervention. SRS is mainly advocated in situations with one to three metastases [6,27,38,41], while some studies allow up to five lesions [3,49]. Commonly, a single lesion is treated by a surgical approach.…”

Section: Metastasesmentioning

confidence: 99%

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

Münter

Welker

Jensen

et al. 2013

Innovative Neurosurgery

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Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are well established in a high number of neurooncological and neurological lesions. Modern technologies discussed in this review, especially the integration of multimodality imaging in the daily clinical routine, will further improve the results of SRS and SRT. Currently, the different technical methods used are comparable regarding the clinical results in different clinical indications. The technological advances allow high treatment flexibility, and therefore, new treatment indications can be established based on the new technologies. In the future, it has to be defined more clearly whether a single fraction, hypofractionated concepts, or fractionated stereotactic radiotherapy is more effective regarding the clinical results and side effects of the therapy. The main area of development for radiosurgery will be stereotactic body radiosurgery. More randomized clinical studies for all possible indications are needed in the next few decades in order to establish radiosurgery more precisely, and also to determine its true value, especially in normal-fractionated radiotherapy. In technological development, the next step has been completed and proton or particle based stereotactic radiosurgery may have increased use in the future.

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“…SRS offers the ability to tightly conform radiation to the target volume and spare substantial amounts of normal tissue. For properly selected patients, usually those with a limited number of lesions and controlled extracranial disease, many studies show that SRS is as effective as surgical resection for the management of BM, with local control rates as high as 94% [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

et al. 2016

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Brain metastases are the most common intracranial malignancy. Many approaches, including radiation therapy, surgery, and cytotoxic chemotherapy, have been used to treat patients with brain metastases depending on the patient's disease burden and symptoms. However, stereotactic surgery (SRS) has revolutionized local treatment of brain metastases. Likewise, targeted therapies, including small-molecule inhibitors and monoclonal antibodies that target cancer cell metabolism or angiogenesis, have transformed managing systemic disease. Prospective data on combining these treatments for synergistic effect are limited, but early data show favorable safety and efficacy profiles.The combination of SRS and targeted therapy will further individualize treatment, potentially obviating the need for cytotoxic chemotherapy or whole-brain radiation.There is a great need to pursue research into these exciting modalities and novel combinations to further improve the treatment of patients with brain metastases.This article discusses reported and ongoing clinical trials assessing the safety and efficacy of targeted therapy during SRS. The Oncologist 2016;21:244-251 Implications for Practice: Treatment of patients with brain metastases requires a multidisciplinary approach. Stereotactic radiosurgery is increasingly used in the upfront setting to treat new brain metastasis. Targeted therapies have revolutionized systemic treatment of many malignancies and may sometimes be used as initial treatment in metastatic patients. There is sparse literature regarding safety and efficacy of combining these two treatment modalities. This article summarizes the supporting literature and highlights ongoing clinical trials in combining radiosurgery with targeted therapy.

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Radiosurgery alone or in combination with whole-brain radiotherapy for brain metastases.

Cited by 347 publications

References 16 publications

Hypofractionated stereotactic radiotherapy in combination with whole brain radiotherapy for brain metastases

Hypofractionated stereotactic radiotherapy in combination with whole brain radiotherapy for brain metastases

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

The Rationale for Targeted Therapies and Stereotactic Radiosurgery in the Treatment of Brain Metastases

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