Stereotactic radiosurgery for large brain metastases

Ebner, Daniel K.; Rava, Paul; Gorovets, Daniel; Cielo, Deus; Hepel, Jaroslaw T.

doi:10.1016/j.jocn.2015.05.019

Cited by 33 publications

(19 citation statements)

References 29 publications

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“…Petrovich et al ( 30 ) concluded that 1 year LC of lesions <3 cc was greater (90%) when compared to that of lesions >3 cc (78%). Ebner et al ( 15 ) concluded that lesions measuring ≥3 cm had a worse LC at 1 year (68%) then lesions <3 cm (86%). It has been speculated that better LC could possibly be achieved with a higher prescribed dose ( 18 , 20 , 24 , 31 ).…”

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confidence: 99%

Hypofractionated Radiation Therapy for Large Brain Metastases

Masucci

2018

Front. Oncol.

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Single fraction radiosurgery (SRS) treatment is an effective and recognized alternative to whole brain radiation for brain metastasis. However, SRS is not always possible, especially in tumors of a larger diameter where the administration of high dose in a single fraction is limited by the possibility of acute and late side effects and the dose to the surrounding organs at risk. Hypofractionated radiation therapy allows the delivery of high doses of radiation per fraction while minimizing adverse events, all the while maintaining good local control of lesions. The optimal dose fractionation has however not been established. This overwiew presents available evidence and rationale supporting usage of hypofractionated radiation therapy in the treatment of large brain metastases.

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confidence: 99%

Hypofractionated Radiation Therapy for Large Brain Metastases

Masucci

2018

Front. Oncol.

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“…Tumors greater than 3 cm treated with SRS are correlated with limited local control rates and are, therefore, not treated solely with this radiation type. [ 5 ] Therefore, growth data in our report may provide meaningful information in regards to treatment timing, as lesions approach this 3 cm mark. In addition, our work based on three-dimensional modeling and volumetric analyses takes much more precise measurements of the overall lesional impact on surrounding brain tissue, in a manner that may have much greater clinical relevance than antiquated two-dimensional measurements.…”

Section: Discussionmentioning

confidence: 87%

Evaluating the natural growth rate of metastatic cancer to the brain

Kobets

Backus

Fluss

et al. 2020

Surgical Neurology International

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Background: Brain metastases are becoming increasingly more prevalent as cancer patients survive longer with both improved local and systemic therapy. Little is known, however, of the natural growth rates of brain metastases. This investigation aims to ascertain this growth rate of these lesions before the initiation of any CNS- directed therapy. Methods: A total of 700 patients were screened, identifying 18 cancer patients (13 breast and 5 lung) with 29 brain metastases that were serially imaged from 2011 to 2017 before treatment for their intracranial metastases. Growth rates were measured by contouring lesions serially across at least two MRI studies in iPlan software by independent raters. These values were then compared between primary (breast and lung) cancer cohorts. Results: The mean age at diagnosis was 53 and 95% were female. The interval between primary cancer diagnosis and brain metastases was 4.6 years and 1.2 years in the breast and lung cancer groups, respectively. Of the breast and lung cancer patients, 23% and 40% were deceased, with respective 5.08 cm3 and 2.44 cm3 initial tumor volumes. The average growth rate of lung and breast tumors was 0.018 and 0.040 cm3/day, respectively, with deceased patients having larger and faster growing tumors. Breast and lung metastases grew 2.39% and 1.14% of their total volumes daily and doubling times were 86 and 139 days, respectively. Conclusion: This investigation provides a unique perspective into the biological growth of metastatic brain lesions. It is our hope that this study guides timing of treatment and informs both clinicians and patients of tumor growth kinetics before initiating treatment for intracranial metastases.

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“…LBM are typically treated with resection followed by adjuvant radiation. 16,26,29,34,48,51,62,69 However, when surgical options are not appropriate or not desired, radiation becomes the primary modality in the management of these patients. Historically, WBRT was considered the standard of care for managing patients with LBM who were not surgical candidates; 33,45 however, both modest LC and concerns regarding toxicities related to the use of WBRT 3,9,11,13,14,58,66 have generated substantial interest in potentially treating brain metastases with focal radiation options.…”

Section: Discussionmentioning

confidence: 99%

“…15,18,27,34,42,76 However, optimal treatment paradigms with radiosurgery remain unclear and controversial and are associated with a relatively inferior control rate compared with smaller lesions. 6,16,18,22,32,40,41,44,57,70,76 Furthermore, potential significant treatment-associated toxicities, most notably adverse effects (AEs) of radiation, 1,56,60 and their management remain concerning in patients with LBM.…”

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confidence: 99%

Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm

Angelov

Mohammadi

Bennett

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Stereotactic radiosurgery (SRS) is the primary modality for treating brain metastases. However, effective radiosurgical control of brain metastases ≥ 2 cm in maximum diameter remains challenging and is associated with suboptimal local control (LC) rates of 37%-62% and an increased risk of treatment-related toxicity. To enhance LC while limiting adverse effects (AEs) of radiation in these patients, a dose-dense treatment regimen using 2-staged SRS (2-SSRS) was used. The objective of this study was to evaluate the efficacy and toxicity of this treatment strategy. METHODS Fifty-four patients (with 63 brain metastases ≥ 2 cm) treated with 2-SSRS were evaluated as part of an institutional review board-approved retrospective review. Volumetric measurements at first-stage stereotactic radiosurgery (first SSRS) and second-stage SRS (second SSRS) treatments and on follow-up imaging studies were determined. In addition to patient demographic data and tumor characteristics, the study evaluated 3 primary outcomes: 1) response at first follow-up MRI, 2) time to local progression (TTP), and 3) overall survival (OS) with 2-SSRS. Response was analyzed using methods for binary data, TTP was analyzed using competing-risks methods to account for patients who died without disease progression, and OS was analyzed using conventional time-to-event methods. When needed, analyses accounted for multiple lesions in the same patient. RESULTS Among 54 patients, 46 (85%) had 1 brain metastasis treated with 2-SSRS, 7 patients (13%) had 2 brain metastases concurrently treated with 2-SSRS, and 1 patient underwent 2-SSRS for 3 concurrent brain metastases ≥ 2 cm. The median age was 63 years (range 23-83 years), 23 patients (43%) had non-small cell lung cancer, and 14 patients (26%) had radioresistant tumors (renal or melanoma). The median doses at first and second SSRS were 15 Gy (range 12-18 Gy) and 15 Gy (range 12-15 Gy), respectively. The median duration between stages was 34 days, and median tumor volumes at the first and second SSRS were 10.5 cm (range 2.4-31.3 cm) and 7.0 cm (range 1.0-29.7 cm). Three-month follow-up imaging results were available for 43 lesions; the median volume was 4.0 cm (range 0.1-23.1 cm). The median change in volume compared with baseline was a decrease of 54.9% (range -98.2% to 66.1%; p < 0.001). Overall, 9 lesions (14.3%) demonstrated local progression, with a median of 5.2 months (range 1.3-7.4 months), and 7 (11.1%) demonstrated AEs (6.4% Grade 1 and 2 toxicity; 4.8% Grade 3). The estimated cumulative incidence of local progression at 6 months was 12% ± 4%, corresponding to an LC rate of 88%. Shorter TTP was associated with greater tumor volume at baseline (p = 0.01) and smaller absolute (p = 0.006) and relative (p = 0.05) decreases in tumor volume from baseline to second SSRS. Estimated OS rates at 6 and 12 months were 65% ± 7% and 49% ± 8%, respectively. CONCLUSIONS 2-SSRS is an effective treatment modality that resulted in significant reduction of brain metastases ≥ 2 cm, with excellent 3-month (95%) ...

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Stereotactic radiosurgery for large brain metastases

Cited by 33 publications

References 29 publications

Hypofractionated Radiation Therapy for Large Brain Metastases

Hypofractionated Radiation Therapy for Large Brain Metastases

Evaluating the natural growth rate of metastatic cancer to the brain

Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm

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