Radiosurgery for Single and Multiple Brain Metastases

Mehta, Minesh P.; Tremont‐Lukats, Ivo W.

doi:10.1002/9780470753064.ch9

Cited by 9 publications

(8 citation statements)

References 60 publications

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“…Brain metastases occur in 10% to 30% of all patients with cancer during the course of their disease 1. More than 150,000 new cases of brain metastases occur each year in the United States 2, 3…”

Section: Introductionmentioning

confidence: 99%

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Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

Rades

Panzner

Dziggel

et al. 2011

Cancer

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BACKGROUND: Patients with brain metastases who have a favorable survival prognosis may benefit from intensive treatments, including neurosurgery and radiosurgery. However, many patients cannot receive such treatments, and whole‐brain radiotherapy (WBRT) alone is their only option. The most common WBRT schedule is 30 grays (Gy) in 10 fractions. In this retrospective study, the authors investigated whether these patients benefit from a dose escalation beyond 30 Gy. METHODS: Data from 109 patients who received 30 Gy in 10 fractions were compared with 75 patients who received 40 Gy in 20 fractions. All patients had a favorable survival prognosis. Both groups were compared for local control (LC) and overall survival (OS). Subgroup analyses were performed for patients who had less radiosensitive tumors (N = 27) and for other patients (N = 157). RESULTS: The LC rate at 1 year was 28% after 30 Gy and 44% after 40 Gy (P = .064). On multivariate analysis, the 40 Gy dose was associated with improved LC (P = .047). The survival rate at 1 year was 50% after 30 Gy and 61% after 40 Gy (P = .007). On multivariate analysis, the 40 Gy dose was associated with improved OS (P = .008). On subgroup analysis of patients who had less radiosensitive tumors, the 1‐year LC rate was 7% after 30 Gy and 38% after 40 Gy (P = .031); and the 1‐year OS rate was 40% and 73%, respectively (P = .008). On subgroup analysis of patients who had other tumor types, the 1‐year LC rate was 31% after 30 Gy and 45% after 40 Gy (P = .26); and the 1‐year OS rate was 52% and 59%, respectively (P = .08). CONCLUSIONS: Escalation of the WBRT dose beyond 30 Gy resulted in better outcomes, particularly for patients who had less radiosensitive tumors. Cancer 2012. © 2011 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

“…1 More than 150,000 new cases of brain metastases occur each year in the United States. 2,3 Whole-brain radiotherapy (WBRT) alone is the most common treatment for these patients, in particular for those patients who have multiple lesions. Most patients with multiple brain metastases have a poor survival prognosis of only a few months.…”

Section: Introductionmentioning

confidence: 99%

Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

Rades

Panzner

Dziggel

et al. 2011

Cancer

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“…The annual incidence appears to be rising as a result of an aging population, improved treatment of systemic disease and the use of advanced imaging techniques such as magnetic resonance imaging to detect smaller metastases in asymptomatic patients [1]. Radiation therapy, administered in the form of large-field partial or whole brain irradiation (WBI), is the primary mode of treatment for brain metastases; over 170,000 patients will receive WBI/year in the US [3,4]. However, late delayed effects of brain irradiation characterized by a progressive cognitive impairment occur in up to 50% of brain tumor patients who are long-term survivors [5] (>6 months post-irradiation).…”

Section: Introductionmentioning

confidence: 99%

PPARα ligands inhibit radiation-induced microglial inflammatory responses by negatively regulating NF-κB and AP-1 pathways

Ramanan

Kooshki

Zhao

et al. 2008

Free Radical Biology and Medicine

139

100

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Whole-brain irradiation (WBI) can lead to cognitive impairment several months to years after irradiation. Studies on rodents have shown a rapid and sustained increase in activated microglia (brain macrophages) following brain irradiation, contributing to a chronic inflammatory response and a corresponding decrease in hippocampal neurogenesis. Thus, alleviating microglial activation following radiation represents a key strategy to minimize WBI-induced morbidity. We hypothesized that pre-treatment with peroxisomal proliferator-activated receptor (PPAR)α agonists would ameliorate the pro-inflammatory responses seen in the microglia following in vitro radiation. Irradiating BV-2 cells (a murine microglial cell line) with single doses (2-10 Gy) of 137 Cs γ-rays led to increases in 1] the gene expression of IL-1β and TNFα, 2] Cox-2 protein levels and 3] intracellular ROS generation. In addition, an increase in the DNA-binding activity of redox-regulated proinflammatory transcription factors AP-1 and NF-κB was observed. Pre-treating BV-2 cells with the PPARα agonists, GW7647 and Fenofibrate significantly inhibited the radiation-induced microglial pro-inflammatory response, in part, via decreasing i] the nuclear translocation of the NF-κB p65 subunit and ii] phosphorylation of the c-jun subunit of AP-1 in the nucleus. Taken together, these data support the hypothesis that activation of PPARα can modulate the radiation-induced microglial pro-inflammatory response.

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“…2,6,18 In an attempt to avoid late consequences of WBRT, SRS alone or in conjunction with WBRT has been used to treat brain metastases. [9][10][11][14][15][16]19,21 The results of the Radiation Therapy Oncology Group 9508 randomized trial and a recent study by Aoyama and colleagues 2 have shown that SRS and WBRT lead to better long-term intracranial disease control for many subgroups of patients. However, the sequence of these two treatments remains unclear.…”

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confidence: 99%