Radiosurgery for brain metastases: Relationship of dose and pattern of enhancement to local control

Shiau, Chung‐Wai; Sneed, Penny K.; Shu, Hui; Lamborn, Kathleen R.; McDermott, Michael W.; Chang, Susan M.; Nowak, Peter; Petti, Paula L.; Smith, Vernon; Ho, Maria Yi; Park, Elaine; Wara, William M.; Gutin, Philip H.; Larson, David A.

doi:10.1016/s0360-3016(96)00497-x

Cited by 250 publications

(119 citation statements)

References 17 publications

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“…However, being high doses more effective at killing radioresistant tumors, the number of fractions has to be kept fairly low. Hypofractionation is a treatment modality for lesions in critical regions, as brainstem, and for large volume targets ([10 cc); there is a strong correlation between the volume of normal brain receiving more than 10 Gy and side effects of radiosurgery [3,4]. Hypofractionation has the advantage of giving a large dose-more effective at killing radioresistant tumors-and at the same time has the radiobiological features of fractionation [17].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (HSRT) have become common due to their ability to deliver very high doses to a small volume and to obtain high tumor control rates [1]. It seems that from a biological point of view HSRT might have some advantage in comparison to SRS in terms of acute complications [2] and of tumor control rate for lesions larger than 10 cc (or more than 3 cm of diameter) [3,4].…”

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…Over the past decade, an increasing body of evidence has indicated that larger doses of radiation lead to better cures of AVM and brain metastases after STI [1,2,20,21]. In order to obtain a cure or local control of disease, coverage of the disease by at least 15…”

Section: Discussionmentioning

confidence: 99%

“…Gy has generally been considered necessary for AVM [1] and 18-20 Gy or more was recommended for brain metastases [20,21]. However, such treatment schedules are consistently accompanied by a 3-7% risk of developing radiation necrosis [1,2,3,4,20,21].…”

Section: Discussionmentioning

confidence: 99%

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Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography

Aoyama

Kamada

Shirato

et al. 2004

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To minimize the risk of neurological deficit following stereotactic irradiation, functional brain information was integrated into treatment planning.Materials and Methods: Twenty-one magnetoencephalography and 6 magnetic resonance axonographic images were made in 20 patients in order to evaluate the sensorimotor cortex (n=15 patients, including the corticospinal tract in 6), the visual cortex (n=4) and the Wernicke's area (n=2). One radiation oncologist was asked to formulate a treatment plan without the functional images at first, and then to modify the plan after seeing them. The pre-and post-modification values were compared for the volume of the functional area receiving 15 Gy or more (V15), and the volume of the PTV receiving more than 80% of the prescribed dose (V80-PTV).Results: Fifteen out of 21 plans (71%) were modified after seeing the functional images.After modification, V15 was significantly reduced compared to the values of pre-modification in those 15 sets of plans (p=0.03), whereas there was no significant difference in V80-PTV (p=0.99). During follow-up, a radiation-induced necrosis at the corticospinal tract caused minor motor deficit in one patient for whom MR-axonography was not available in the treatment planning. No other radiation-induced functional deficit was observed in the other patients. AOYAMA H, et al.,3 Conclusions: Integration of MEG and MR-axonography in treatment planning has the potential to reduce the risk of radiation-induced functional dysfunction without deterioration of the dose distribution in the target volume.

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Comparison of three treatment options for single brain metastasis from lung cancer

Suntharalingam

et al. 2000

Int. J. Cancer

137

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Whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and the combination of both treatment methods were used for the management of single brain metastasis from lung cancer. The purpose of this study is to compare these three different treatment options in terms of local response, survival, and quality of life. From June 1995 to July 1998, 70 lung cancer patients with new diagnosed single brain metastasis were treated with either WBRT alone (n = 29), or SRS alone (n = 23), or the combination of both methods (n = 18). Multiple endpoints, including survival, freedom from local progression (FFLP), freedom from new brain metastasis (FFNBM), local control, Karnofsky performance status (KPS), and causes of death, were measured from the date of treatment completion and compared using univariate and multivariate analyses. For patients treated with WBRT‐alone, SRS‐alone, and SRS+WBRT, the median survivals were 5.7, 9.3, and 10.6 months, the median FFLP were 4.0, 6.9, and 8.6 months, the median FFNBM were 4.1, 6.7, and 8.6 months, and the local response rates were 55.6, 87.0, and 88.9%, respectively. Four of the 29 patients treated with WBRT‐alone continued with progression of disease. The post treatment KPS showed improvement in 41.4, 82.6, and 88.9% of patients treated with WBRT‐alone, SRS‐alone, and SRS+WBRT, respectively. The progression of new and/or recurred metastatic brain tumor as the cause of death accounted for 51.7%, 50.0%, and 28.3% of the patients treated with WBRT‐alone, SRS‐alone, and SRS+WBRT, respectively. Univariate analyses showed that the significant differences among the three treatment arms were observed based on all of the above mentioned endpoints. However, the comparison between SRS‐alone and SRS+WBRT groups indicated that adding WBRT only improves FFNBM (P = 0.0392). Cox regression analyses revealed no significant difference in both of the KPS (P = 0.1082) and causes of death (P = 0.081) among the three arms. Both SRS alone and SRS+WBRT seem better in prolonging life and improving quality of life than WBRT alone for patients with single brain metastasis from lung cancer. But the combined therapy did not show significant advantage over SRS alone in improving survival, enhancing local control, and quality of life except for a more favorable FFNBM. Further investigation via a randomized trial is needed to access the value of adding WBRT to SRS in the management of this group of patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 37–45 (2000). © 2000 Wiley‐Liss, Inc.

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Radiosurgery for brain metastases: Relationship of dose and pattern of enhancement to local control

Cited by 250 publications

References 17 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

Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography

Comparison of three treatment options for single brain metastasis from lung cancer

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