Stereotactic radiosurgery for the treatment of brain metastases

Breneman, John C.; Warnick, Ronald E.; Albright, Robert E.; Kukiatinant, Noppakoon; Shaw, Richard; Armin, David; Tew, John M.

doi:10.1002/(sici)1097-0142(19970201)79:3<551::aid-cncr18>3.0.co;2-2

Cited by 154 publications

(49 citation statements)

References 26 publications

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“…All of the patients completed treatment on an outpatient setting and no toxicity was observed during or between treatment sessions. Long-term toxicity and survival were comparable to SRS results; on the contrary a relatively high incidence of acute/early complications after SRS has been reported in the literature [9][10][11]. The actuarial 1-year local tumor control rate (86.1%) after HSRT was equivalent to that obtained with SRS series (70-90%) in several reports [5][6][7][8][9][10][11][12].…”

Section: Discussionsupporting

confidence: 63%

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: Discussionsupporting

confidence: 63%

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

et al. 2008

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“…Experience from Cincinnati was reported by Breneman et al (1997). Eighty-four patients with 177 brain metastasis were treated with linac-based RS, seventynine (93%) of whom were treated at recurrence after previous whole brain radiation therapy.…”

Section: Resultsmentioning

confidence: 99%

“…To do so, reports containing information on the in¯uence of``activity of extracranial disease'' on overall survival were identi®ed in the English language literature using computer and manual search. During the search, it was recognised that while the majority of reports use this particular term (Alexander et al 1995;Auchter et al 1996;Engenhart et al 1993;Joseph et al 1996;Kim et al 1997;Mori et al 1998;Shiau et al 1997), others use similar terms, such as``extracranial disease'' or``extracranial tumour'' (Breneman et al 1997;Kocher et al 1998, Pirzkall et al 1998Shu et al 1996;Cho et al 1998) which may imply the addition of the activity of uncontrolled primary tumour, too. Whatever is meant by the latter two terms, for the purpose of this review it is assumed that the substantial part of that in¯uence is coming from wide-spread distant metastases, which would be equal to the term``extracranial metastases''.…”

Section: Methodsmentioning

confidence: 99%

Activity of extracranial metastases as a prognostic factor influencing survival after radiosurgery of brain metastases

Jeremić¹,

Becker²,

Plaßwilm³

et al. 2000

Journal of Cancer Research and Clinical Oncology

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Information about prognostic factors influencing survival have been only occasionally reported in studies on the use of radiosurgery in the treatment of patients with brain metastasis. To answer the question of whether activity of extracranial metastases is an independent prognostic factor influencing survival in radiosurgery of brain metastases, a review of the literature was performed. Fourteen studies were identified in the English language literature that dealt with this topic. Only three studies showed borderline insignificance of the influence of activity of extracranial metastases when analysed by univariate methods. When multivariate analysis was used to test for the independent influence of this factor on survival, of nine studies that used that statistical approach eight showed that it is an independent prognosticator influencing survival, most often being the strongest one. This review of literature supports the view that the "activity of extracranial metastases" is an independent prognostic factor influencing survival of these patients as documented in published reports. However, prospective randomised trials are necessary to definitely establish the independent influence of this prognostic factor.

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“…Various investigations have been published on the topic of predictive factors associated with lesion control in the context of SRS treatment [11][12][13][14][15][16][17][18]. Factors that have been shown in at least one publication to be a significant predictor of lesion control include lesion dose, lesion radiological characteristics (i.e., lesion aspect), lesion target volume, patient performance status, presence of extracranial disease, cancer histology, and inclusion of WBRT.…”

Section: Introductionmentioning

confidence: 99%

Recursive Partitioning Analysis for the Prediction of Stereotactic Radiosurgery Brain Metastases Lesion Control

et al. 2013

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Purpose. The objective of this investigation was to identify independent pretreatment factors that predict for control of local brain metastases (BM) in a large single-institution series of patients receiving stereotactic radiosurgery (SRS). Recursive partitioning analysis was used to potentially identify a class of patients with durable lesion control characteristics. Methods. A retrospective SRS database containing baseline characteristics, treatment details, and follow-up data of newly diagnosed patients with 1-3 BM (on magnetic resonance imaging) treated with linear accelerator-based SRS was created. Three study endpoints were used: time to progression (primary endpoint, individual lesion progression; n ϭ 536), time to first progression (secondary endpoint, first lesion progression on an individual patient basis; n ϭ 380), and overall survival (secondary endpoint; n ϭ 380). Recursive partitioning analysis (RPA) was performed to identify predictors of time to progression.Results. Multivariable analysis demonstrated that lesion aspect/phenotype and radiotherapy schedule were independent factors associated with both progression outcomes. Presence of tumor necrosis was found to be associated with a significant hazard of progression (hazard ratio Ͼ3), whereas use of the most intense radiotherapy fractionation schedule (21 Gy in one fraction) was associated with significant reductions in progression (hazard ratio Ͻ0.3). RPA using SRS dose and lesion aspect/phenotype was created and described three distinct prognostic groups. Conclusions. RPA of a large retrospective database of patients receiving SRS confirmed previous observations regarding the importance of SRS dose and lesion aspect/ phenotype in lesion control and overall survival. The SRS lesion analysis may help to stratify future clinical trials and better define patient care options and prognosis. The Oncologist 2013;18:330 -335 Implications for Practice: The importance of this work is primarily in the confirmation of previously reported associations between lesion dose and MRI phenotype with local lesion control after stereotactic radiosurgery. This manuscript extends these associations into a clinical useful risk stratification system to relate how lesion dose and MRI phenotype can relate to lesion control and overall survival. This new risk stratification system may assist in clinical care and clinical trial design by better defining expected treatment outcomes after stereotactic radiosurgery. INTRODUCTIONThe diagnosis of brain metastases (BM) is frequently related to the natural history of the spread of many primary tumors, including those arising in the lung, breast, colorectal, renal, and skin (i.e., melanoma) [1]. Development of metastatic disease in the brain can lead to clinically significant reductions in health-related quality of life, neurological/neurocognitive compromise, and life expectancy [2]. Treatment selection is highly dependent on pretreatment clinical factors, prognosis (as estimated by various published risk stratification p...

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Stereotactic radiosurgery for the treatment of brain metastases

Cited by 154 publications

References 26 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

Activity of extracranial metastases as a prognostic factor influencing survival after radiosurgery of brain metastases

Recursive Partitioning Analysis for the Prediction of Stereotactic Radiosurgery Brain Metastases Lesion Control

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