Stereotactic Radiosurgery for Intraventricular Metastases: A Multicenter Study

Abstract

BACKGROUND:Intraventricular metastases (IVMs) are uncommon, and their optimal management remains debatable.OBJECTIVE:To define the safety and efficacy of stereotactic radiosurgery (SRS) in the treatment of IVMs.METHODS:This retrospective, multicenter study included patients managed with SRS for IVMs. SRS-induced adverse events, local tumor or intracranial progression, and the frequency of new-onset hydrocephalus or leptomeningeal spread were documented. Analyses of variables related to patient neuroimaging or clinical outcomes were also performed.RESULTS:The cohort included 160 patients from 11 centers who underwent SRS for treatment of 1045 intracranial metastases, of which 196 were IVMs. The median survival from SRS was 10 months. Of the 154 patients and 190 IVMs with imaging follow-up, 94 patients (61%) experienced distant intracranial disease progression and 16 IVMs (8.4%) progressed locally. The 12- and 24-month local IVM control rates were 91.4% and 86.1%, respectively. Sixteen (10%) and 27 (17.5%) patients developed hydrocephalus and leptomeningeal dissemination post-SRS, respectively. Adverse radiation effects were documented in 24 patients (15%). Eleven patients (6.9%) died because of intracranial disease progression.CONCLUSION:SRS is an effective treatment option for IVMs, with a local IVM control rate comparable with SRS for parenchymal brain metastases. Leptomeningeal spread and hydrocephalus in patients with IVM occur in a minority of patients, but these patients warrant careful follow-up to detect these changes.

Stereotactic Radiosurgery for Brain Metastases from Human Epidermal Receptor 2 Positive Breast Cancer: An International, Multi-center Study

“…Though SRS of brain metastases achieves high local tumor control, the six-and 12-months distant intracranial progression rate is high [3,7,9,31]. Overall intracranial progression occurred in 60% and leptomeningeal disease in 16.6% of the patients in our study.…”

“…The primary endpoint of this study was local tumor control, de ned as tumor stability or volumetric regression by over 20% at last imaging follow-up. [9] Secondary endpoints were progression-free and post-SRS survival.…”

“…The treatment plan (prescription dose, prescription isodose line, and fractionation) was decided by the local radiosurgery team usually comprised by a neurosurgeon, a radiation oncologist, and a medical physicist [9].…”

“…SRS alone has been established as a safe and effective local treatment of brain metastases. It is also used for adjuvant management after prior surgery or failed fractionated radiation therapy [7][8][9]. In this multi-center retrospective study, we evaluated the safety and e cacy of SRS for brain metastases from HER2positive primary breast cancer during an 18-year interval.…”

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

“…SRS is a highly conformal technique, able to deliver a high dose of radiation in a single fraction to a well-defined target. This ablative and focal strategy mimics the effect of surgical resection through a less invasive approach, representing the ideal solution for small-sized BMs and a valid alternative when surgery is not feasible (generally for unresectable lesions critically located in deep or eloquent brain areas [ 10 , 11 , 12 ] or patients inoperable due to comorbidities).…”