Second Re-irradiation of Brain Metastases: A Review of Studies Involving Stereotactic Radiosurgery

Abstract

Due to advances in the systemic and local treatment, e.g., targeted therapy, immune checkpoint inhibitors, and stereotactic radiotherapy, an increasing proportion of patients with brain metastases now survive for several years. However, long-term survival is not synonymous to permanent local control in the brain. Both local and distant brain relapse sometimes necessitate additional radiotherapy to prevent death from neurologic causes. Prescribing more than two courses of radiotherapy to the same target volume or, in this case, brain metastasis, is a controversial approach. The present review summarizes the results of clinical studies, that included patients treated with whole-brain radiotherapy (WBRT) and two courses of stereotactic radiotherapy to the same, locally recurrent metastasis, and with two courses of WBRT and an additional stereotactic radiotherapy.

Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents

“…Ideally, clinicians would be able to perform better patient selection at diagnosis, resulting in less need for sequential salvage radiotherapy. On the other hand, in the era of reduced WBRT utilization, sequential administration of several courses of focal radiotherapy has become increasingly accepted (Nieder et al 2018a ).…”

A Clinical Case of 5 Times Irradiated Recurrent Orbital Hemangiopericytoma

“…In 2020 Saeed et al [14] described 45 patients who underwent proton re-irradiation of glioblastomas, of whom only 4 patients had late toxicity. In 2018 Nieder et al [15] published a literature review of brain metastasis re-irradiation, which included eight studies involving 1-22 patients. Based on this analysis, the authors considered repeated SRS or SRT (2 or 3 times) after the whole-brain RT as an admissible salvage treatment for individual cases, although with an acceptable risk of brain necrosis.…”

Revisiting the Role of Surgical Resection for Brain Metastasis

“…Recurrent tumors can be considered salvage options after SRS or radiation therapy, re-irradiation, or surgical resection [ 34 35 36 ]. In previous studies, re-irradiation for recurrent BM showed a 2-year local control rate of more than 70% [ 35 36 37 ]. Although considering the short survival of patients with BM, long-term ARE may not be a significant problem.…”