Surgical Resection Followed by Whole Brain Radiotherapy Versus Whole Brain Radiotherapy Alone for Single Brain Metastasis

Rades, Dirk; Kieckebusch, Susanne; Haatanen, Tiina; Lohynská, Radka; Dunst, Juergen; Schild, Steven E.

doi:10.1016/j.ijrobp.2007.08.009

Cited by 44 publications

(21 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The increased use of surgery or SRS in the United States and Canada has probably resulted in improved survival in patients who were eligible for such treatment. This hypothesis is in accordance with evidence from randomized trials of WBRT alone vs. WBRT plus additional surgery [10] or SRS [11] and case-control studies [12,13]. Recent guidelines for the management of single brain metastases recommend surgery or SRS for most scenarios, whereas their role is less well defined in patients with more than one brain metastasis [14–17].…”

Section: Discussionsupporting

confidence: 76%

Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries

et al. 2012

View full text Add to dashboard Cite

SummaryBackgroundAssessment of cancer- and host-related prognostic factors has a long tradition in patients with brain metastases. In continuation of large-scale studies performed by the Radiation Therapy Oncology Group (RTOG) in the United States, the 4-tiered diagnosis-specific graded prognostic assessment (DS-GPA) score has been developed. It stratifies patients with common primary tumours metastasizing to the brain (malignant melanoma, lung, breast, kidney and gastrointestinal cancers) into subgroups with different prognoses. However, many patients in the DS-GPA study were treated with surgical resection or radiosurgery (SRS). The present multi-institutional analysis examined for the first time whether DS-GPA is a valid score in European patients managed in routine clinical practice.Material/MethodsThis was a retrospective analysis of 412 patients with primary malignant melanoma, lung, breast, kidney or gastrointestinal cancers. Survival was evaluated in uni- and multivariate tests.ResultsDS-GPA significantly predicted survival and outperformed initial GPA, a score that is not diagnosis-specific. Median survival by DS-GPA strata (all 412 patients) was 2.7, 3.6, 7.0 and 11.3 months in the 4 groups with 0–1, 1.5–2, 2.5–3 and 3.5–4 points, respectively. The previously published survival data (median 7.2 months for all patients) could not be replicated in this cohort (median 3.6 months).ConclusionsDS-GPA is a valid prognostic score that might improve shared decision making as well as patient stratification in prospective clinical trials.

show abstract

Section: Discussionsupporting

confidence: 76%

Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries

et al. 2012

View full text Add to dashboard Cite

show abstract

“…At 1-2 years, these occur in 20-72% of cases (4,(7)(8)(9). In our own experience of 69 patients treated from 2000-2005, the 2-year actuarial rate of local recurrence after surgeon-reported gross total resection and WBRT was 67% (10).…”

Section: Introductionmentioning

confidence: 97%

Tumor Bed Radiosurgery following Resection of Brain Metastases: A Review

Roberge

Souhami

2010

Technol Cancer Res Treat

View full text Add to dashboard Cite

There is a growing interest in adjuvant radiosurgery following resection of hematogenous brain metastases. We have identified 12 series reporting on a total of 480 patients treated to a tumor bed following microsurgery. These cases fall into 3 paradigms: adjuvant radiosurgery as an alternative to whole-brain radiotherapy (WBRT), radiosurgery as an intensification of adjuvant WBRT and adjuvant radiosurgery for patients having failed prior WBRT. For these paradigms the reported crude local control rates are 79%, 92% and 95%, respectively. The procedure appears well tolerate with approximately a 5% risk of late radiation necrosis. Prospective data is lagging behind clinical practice and plans for prospective trials are discussed.

show abstract

“…In the present cohort, the group of patients that underwent surgical resection was very small. Several reports in the literature focused on the comparison of local therapy (surgery/radiosurgery) of BM in combination with WBRT vs. WBRT alone; a survival benefit was observed for selected patients treated with combinations of local therapy and WBRT (24,25). In addition, the application of local therapy alone may be justified.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

Kühnöl

Vordermark

2016

Oncology Letters

View full text Add to dashboard Cite

Abstract. Brain metastases (BM) from breast cancer are associated with high morbidity and a poor prognosis. The aim of this study was to analyse the role of radiotherapy in treatment of BM from breast cancer in the context of modern local therapy modalities, current systemic treatment options and prognostic factors. A retrospective analysis of 86 consecutive female patients treated with radiotherapy for BM from breast cancer between 2000 and 2010 was conducted. Patient and treatment characteristics were registered and survival data calculated. All patients received whole-brain radiotherapy (WBRT) with a median dose of 36 Gy, and 19 patients were treated with an additional boost; this included fractionated schemes (median dose, 18 Gy) and radiosurgery (5 and 17 Gy). The median overall survival time from the start of WBRT was 4.1 months in the present cohort. Patients receiving a boost survived 19.7 months in comparison to 3.1 months for patients treated with WBRT alone (P<0.001). Other factors that improved overall survival, based on a univariate analysis, were dose of WBRT and number of BM. There was no statistical evidence for the influence of the human epidermal growth factor receptor 2 status on survival in the current study. The administration of boost treatment following WBRT was also identified as a significant factor influencing survival on multivariate analysis (P=0.030). In conclusion, radiotherapy affects the survival time of patients with BM from breast cancer. In particular, the implementation of boost treatment following WBRT in selected patients seems to extend survival time. IntroductionThe most common brain tumours are intracranial metastases (1). Over 20% of patients with solid malignant tumours develop brain metastases (BM); patients with small-cell lung cancer (45%), melanomas (45%), non-small-cell lung cancer (30%), breast cancer and renal cancer (20%) have the highest risk for the occurrence of intracranial metastases (2). The incidence of clinically detected BM in patients with metastatic breast cancer is 16-20%, and autopsy studies suggest a prevalence of BM of up to 34% (3-6). A number of risk factors for cerebral metastases in breast cancer patients have been reported in the literature; in addition to young age (<35 years), large primary tumour size (>2 cm)and negative estrogen receptor (ER) status, the overexpression of human epidermal growth factor receptor 2 (HER2) has been demonstrated to be associated with a higher risk of BM (7-10).The management of BM includes radiotherapeutic, surgical and medical options. Consideration of a local treatment modality depends on the number of intracranial metastases and potential local complications resulting from their location and size. Patients with multiple BM typically receive whole-brain radiotherapy (WBRT), whilst neurosurgery or stereotactic radiosurgery (SRS) are possible treatment options for patients with a single BM. The application of intrathecal chemotherapy may be selected as the therapeutic regime in cases with meningeal involvement...

show abstract

Surgical Resection Followed by Whole Brain Radiotherapy Versus Whole Brain Radiotherapy Alone for Single Brain Metastasis

Cited by 44 publications

References 9 publications

Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries

Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries

Tumor Bed Radiosurgery following Resection of Brain Metastases: A Review

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

Contact Info

Product

Resources

About