Radiosurgery and whole brain therapy in the treatment of brainstem metastases

Samblás, J.; Sallabanda, Kita; Bustos, J.C.; Gutiérrez-Díaz, José A.; Peraza, Carmen; Beltrán, César; Samper, Pilar

doi:10.1007/s12094-009-0423-x

Cited by 15 publications

(14 citation statements)

References 10 publications

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“…(Table 4) and our overall survival was comparable to other studies. Relative to other studies that reported WBRT doses up to 45 Gy combined with SRS to the brainstem, the WBRT doses employed in our study were lower and hypofractionated [11, 12, 17–19, 22, 23], but outcomes were similar to published series. The impact of WBRT dose on local control and toxicity when used in conjunction with brainstem SRS has not been investigated or reported previously.…”

Section: Discussionsupporting

confidence: 65%

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

et al. 2016

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ObjectiveThe objective of this study was to investigate outcomes for patients with brainstem metastases treated with stereotactic radiosurgery (SRS).MethodsPatients with brainstem metastases treated with SRS between April 2006 and June 2012 were identified from a prospective database. Patient and treatment-related factors were recorded. Kaplan-Meier analysis was used to calculate survival and freedom from local and distant brain progression. Univariate and multivariate Cox regression was used to identify factors important for overall survival.ResultsIn total, 44 patients received SRS for 48 brainstem metastases of whom 33 (75 %) also received whole brain radiotherapy (WBRT): 23 patients (52 %) WBRT prior to SRS, 6 (13.6 %) WBRT concurrently with SRS and 4 (9.0 %) WBRT after SRS. Eight patients received a second course of WBRT at further progression. Median target volume was 1.33 cc (range 0.04–12.17) and median prescribed marginal dose was 15 Gy (range 10–22). There were four cases of local failure, and 6-month and 1-year freedom from local failure was 84.6 and 76.9 %, respectively. Median overall survival (OS) was 5.4 months. There were four cases of radionecrosis, 2 (4.8 %) of which were symptomatic. The absence of external beam brain radiotherapy (predominantly WBRT) showed a trend towards improved OS on univariate analysis. Neither local nor distant brain failure significantly impacted OS.ConclusionThis retrospective series of patients treated with SRS for brainstem metastases, largely in combination with at least one course of WBRT, demonstrates that this approach is safe and results in good local control. In this cohort, no variables significantly impacted OS, including intracranial control.Electronic supplementary materialThe online version of this article (doi:10.1007/s13566-016-0281-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 65%

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

et al. 2016

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“…To date, 14 series (a linear accelerator system was used in 5 series and a Gamma Knife in 9 series) have demonstrated the clinical efficacy of SRS for the treatment of brainstem metastases (Table 3). 4,7,8,10,[13][14][15][16]18,22,25,28,33,34 To the best of our knowledge, this is the first report based on a relatively large number of patients to describe GKS for brainstem metastases in which the focus was on neurological and qualitative survivals. These issues are crucial and should be given consideration in the management of patients with brain metastasis.…”

Section: Discussionmentioning

confidence: 95%

“…Although brainstem metastases have generally been regarded as a poor prognostic factor, some authors reported MSTs of more than 12 months-longer than those usually expected in patients with brain metastases. 4,22 Recent advances in cancer treatment, as well as in SRS, which allow radical treatment of brain metastases, may have contributed greatly to prolonged overall survival. Nowadays, approximately 90% of patients with brain metastasis die as a result of progression of the systemic disease.…”

Section: Overall Survivalmentioning

confidence: 99%

“…There are several reports detailing causes of death. 4,22,33,34 The rates of death caused by brain tumor progression range from 14% to 50%, and the rates of death from brainstem tumor progression range from 4% to 13%. In our series, the rate of death caused by brain tumor progression was 10.9% (19/175 patients), and the rate of brainstem tumor progression was 2.3% (4/175 patients)-rates somewhat lower than those in previous reports.…”

Section: Neurological and Qualitative Survivalsmentioning

confidence: 99%

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Gamma Knife surgery for patients with brainstem metastases

Kawabe

Yamamoto

Sato

et al. 2012

JNS

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Object Because brainstem metastases are not deemed resectable, stereotactic radiosurgery (SRS) is the only treatment modality expected to achieve a radical cure. The authors describe their treatment results, focusing particularly on how long patients can survive without neurological deterioration following SRS for brainstem metastases. Methods This was an institutional review board–approved, retrospective cohort study in which the authors pulled from their database information on 2553 consecutive patients with brain metastases who underwent Gamma Knife surgery (GKS) at the Mito GammaHouse between July 1998 and July 2011. Among the 2553 patients, excluding cases in which there was meningeal dissemination, 200 cases of brainstem metastases (78 women and 122 men with a mean age of 64 years [range 36–86 years]) were identified and analyzed. The most common primary site was the lung (137 patients) followed by the gastrointestinal tract (24 patients), breast (17 patients), kidney (12 patients), and others (10 patients). Among the 200 patients, 15 patients (7.5%) harbored at least 2 tumors in the brainstem: 11 patients had 2 tumors, 2 patients had 3 tumors, and 1 patient each had 4 or 5 tumors. Therefore, a total of 222 tumors were irradiated. These 222 tumors were located in the pons (121 lesions), the midbrain (65 lesions), and the medulla oblongata (36 lesions). The mean and median tumor volumes were 1.3 and 0.2 cm3 (range 0.005–10.7 cm3), and the median peripheral radiation dose was 18.0 Gy (range 12.0–25.0 Gy). Results The overall median survival time (MST) was 6.0 months. Distribution of MSTs across Recursive Partitioning Analysis (RPA) classes showed that the MSTs were 9.4 months in Class I (20 patients), 6.0 months in Class II (171 patients), and 1.9 months in Class III (9 patients). Better Karnofsky Performance Scale score, single metastasis, and well-controlled primary tumor were significant predictive factors for longer survival. The neurological and qualitative survival rates were 90.8% and 89.2%, respectively, at 24 months post-GKS. Better KPS score and smaller tumor volume tended to be associated with prolonged qualitative survival. Follow-up imaging studies were available for 129 patients (64.5%). The tumor control rate was 81.8% at 24 months post-GKS. Smaller tumor volume tended to contribute to tumor control. Conclusions The present results indicate that GKS is effective in the treatment of brainstem metastases, particularly from the viewpoint of maintaining a good neurological condition in the patient.

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“…A number of reports have described the treatment of brainstem metastasis, including pontine metastasis ( 1 – 11 ). The most common site of primary malignancy in patients with metastases to the brainstem is the lungs; the majority of such malignancies are adenocarcinomas ( 6 , 7 , 9 , 10 ) and, less commonly, squamous cell carcinomas ( 8 ). SRS is the preferred treatment option for brainstem metastases due to its provision of adequate local control with low morbidity.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report

Wang

et al. 2015

Oncology Letters

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Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm3) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm3 over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm3 of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

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Radiosurgery and whole brain therapy in the treatment of brainstem metastases

Cited by 15 publications

References 10 publications

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

Radiosurgery for brainstem metastases with and without whole brain radiotherapy: clinical series and literature review

Gamma Knife surgery for patients with brainstem metastases

Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report

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