Radiosurgery Followed by Planned Observation in Patients with One to Three Brain Metastases

Lutterbach, Johannes; Cyron, Donatus; Henne, Karl; Ostertag, Christoph B.

doi:10.1093/neurosurgery/52.5.1066

Cited by 18 publications

(37 citation statements)

References 19 publications

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“…In a recent study, SRS alone was found to be as effective as resection plus WBRT in the treatment of one or two brain metastases for patients in RPA classes I and II. 14 Lutterbach et al 8 performed a prospective study using SRS alone for the initial management of brain metastases.…”

Section: Overall Survivalmentioning

confidence: 99%

“…7,8,[10][11][12][13][21][22][23][24][26][27]33,34,[37][38][39][40][49][50][51][52][53][54][55][56][57] Serizawa et al 26 reported from their experience, treating 1030 patients with GK SRS alone, that median survival was 2.2 years in class 1, 0.71 years in class 2, and 0.29 years in class 3, using the RTOG RPA classifi cation. Moreover, in another study by the same group, multivariate analysis revealed three signifi cant prognostic factors for survival in an analysis of more than 2000 patients treated with GK alone in a multi-institute study: sex (male), extracranial disease status (active), and initial KPS score (<70).…”

Section: Overall Survivalmentioning

confidence: 99%

“…26,30,33,37,42,50,56 However, we must pay attention to primary tumor type. Lutterbach et al 8 reported renal cancer to be associated with a reduced risk of death as compared with other primary tumor types. Furthermore, retrospective studies by Petrovich et al 38 demonstrated better survival for patients with metastatic breast cancer compared with other types of metastatic tumors.…”

Section: Overall Survivalmentioning

confidence: 99%

“…8,37,48,54 In general, the risk of new metastasis in patients with solitary tumors is approximately 37% (crude), but the actuarial risk is 50% at 1 year. 3,7,26,33,48 Sneed et al 54 reported a statistically signifi cant improvement in 1-year freedom from brain tumor progression in patients receiving WBRT + SRS boost (69%) compared to those treated with initial SRS only (28%).…”

Section: New Distant Lesionsmentioning

confidence: 99%

“…Studies have shown that SRS is very effective in controlling brain metastases and that it prevents neurological death and maintains good activities of daily life (ADL). [7][8][9][10][11][12][13][14][15][16][17][18] Moreover, SRS is minimally invasive and can be performed with a short hospitalization, important considerations for quality of life (QOL) and health care economics when compared with surgery. 19,20 On the other hand, we must understand the differences in SRS devices between GK and LINIAC, including the radiation beams, images for treatment planning, planning software, irradiation methods, set-up margin, frame fi xation, practitioners, the availability of fractionation, and limitations in lesion number and size to be irradiated in a single session, as shown in Table 1.…”

mentioning

confidence: 99%

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Radiosurgery for metastatic brain tumors

Serizawa

2009

Int J Clin Oncol

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Stereotactic radiosurgery (SRS) precisely delivers high-dose radiation to a small target (usually less than 3-4 cm in diameter), in a single session with steep dose-fall, employing various radiation methods. SRS provides good tumor control for small brain metastases from various primary cancers, with minimal untoward effects on surrounding normal brain. This excellent tumor control prevents neurological death and maintains good activity of daily life. Although surgery with whole-brain radiation therapy (WBRT) remains an important option for patients with a solitary brain metastasis, SRS with or without WBRT should be considered in patients with a limited number of small tumors and a good prognosis. Many reports, as well as both retrospective and prospective reviews, have shown WBRT before or after SRS to improve local control and reduce new distant lesion emergence. However, upfront WBRT does not improve survival. There are two major delivery techniques, Gamma Knife (GK; Elekta AB, Stockholm, Sweden) SRS and linear accelerator (LINIAC)-based SRS. They are based on quite different concepts, and have different techniques and clinical applications. These differences complicate the discussion of the limitations of and indications for SRS and the necessity for prophylactic WBRT. This review discusses numerous aspects of SRS, its value as compared with other treatment modalities, the necessity for prophylactic WBRT with SRS, the limitations of and indications for SRS, and the difference between GK and LINIAC SRS, based on the literature and our experience, and proposes a new strategy for the treatment of brain metastases in view of the available clinical data and experience.

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Section: Overall Survivalmentioning

confidence: 99%

Section: Overall Survivalmentioning

confidence: 99%

Section: Overall Survivalmentioning

confidence: 99%

Section: New Distant Lesionsmentioning

confidence: 99%

mentioning

confidence: 99%

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Radiosurgery for metastatic brain tumors

Serizawa

2009

Int J Clin Oncol

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Value of screening and follow‐up brain MRI scans in patients with metastatic melanoma

et al. 2021

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Background Novel treatments make long‐term survival possible for subsets of patients with melanoma brain metastases. Brain magnetic resonance imaging (MRI) may aid in early detection of brain metastases and inform treatment decisions. This study aimed to determine the impact of screening MRI scans in patients with metastatic melanoma and follow‐up MRI scans in patients with melanoma brain metastases. Methods This retrospective cohort study included patients diagnosed with metastatic melanoma or melanoma brain metastases between June 2015 and January 2018. The impact of screening MRI scans was evaluated in the first 2 years after metastatic melanoma diagnosis. The impact of follow‐up MRI scans was examined in the first year after brain metastases diagnosis. The number of MRI scans, scan indications, scan outcomes, and changes in treatment strategy were analyzed. Results In total, 116 patients had no brain metastases at the time of the metastatic melanoma diagnosis. Twenty‐eight of these patients (24%) were subsequently diagnosed with brain metastases. Screening MRI scans detected the brain metastases in 11/28 patients (39%), of which 8 were asymptomatic at diagnosis. In the 96 patients with melanoma brain metastases, treatment strategy changed after 75/168 follow‐up MRI scans (45%). In patients treated with immune checkpoint inhibitors, the number of treatment changes after follow‐up MRI scans was lower when patients had been treated longer. Conclusion(s) Screening MRI scans aid in early detection of melanoma brain metastases, and follow‐up MRI scans inform treatment strategy. In patients with brain metastases responding to immune checkpoint inhibitors, treatment changes were less frequently observed after follow‐up MRI scans. These results can inform the development of brain imaging protocols for patients with immune checkpoint inhibitor sensitive tumors.

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Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

Lester

Taksler

Kuremsky

et al. 2013

Cancer

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BACKGROUND:Insurers have started to deny reimbursement for routine brain surveillance with magnetic resonance imaging (MRI) after stereotactic radiosurgery (SRS) for brain metastases in favor of symptom-prompted imaging. The authors investigated the clinical and economic impact of symptomatic versus asymptomatic metastases and related these findings to the use of routine brain surveillance. METHODS: Between January 2000 and December 2010, 442 patients underwent upfront SRS for brain metastases. In total, 127 asymptomatic patients and 315 symptomatic patients were included. Medical records were used to determine the presenting symptoms, distant and local brain failure, retreatment, and need for hospital and rehabilitative care. Cost-of-care estimates were based on Medicare payment rates as of January 2013. RESULTS: Symptomatic patients had an increased hazard for all-cause mortality (hazard ratio, 1.448) and were more likely to experience neurologic death (42% vs 20%; P <.0001). Relative to asymptomatic patients, symptomatic patients required more craniotomies (43% vs 5%; P <.0001), had more prolonged hospitalization (2 vs 0 days; P <.0001), were more likely to have Radiation Therapy Oncology Group grade 3 and 4 post-treatment symptoms (24% vs 5%; P <.0001), and required $11,957 more on average to manage per patient. Accounting for all-cause mortality rates and the probability of diagnosis at each follow-up period, the authors estimated that insurers would save an average $1326 per patient by covering routine surveillance MRI after SRS to detect asymptomatic metastases. CONCLUSIONS: Patients who presented with symptomatic brain metastases had worse clinical outcomes and cost more to manage than asymptomatic patients. The current findings argue that routine brain surveillance after radiosurgery has clinical benefits and reduces the cost of care. Cancer 2014;120:433-41.

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Radiosurgery Followed by Planned Observation in Patients with One to Three Brain Metastases

Abstract: Recursive partitioning analysis classification successfully predicted survival. Radiosurgery alone yielded high local control. Overall brain FFP was highest in patients with an interval greater than 2 years between primary diagnosis and diagnosis of a single brain metastasis.

Cited by 18 publications

References 19 publications

Radiosurgery for metastatic brain tumors

Radiosurgery for metastatic brain tumors

Value of screening and follow‐up brain MRI scans in patients with metastatic melanoma

Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

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