Three-Staged Stereotactic Radiotherapy Without Whole Brain Irradiation for Large Metastatic Brain Tumors

Higuchi, Yoshinori; Serizawa, Toru; Nagano, Osamu; Matsuda, Shinji; Ono, Junichi; Sato, Makoto; Iwadate, Yasuo; Saeki, Naokatsu

doi:10.1016/j.ijrobp.2008.10.035

Cited by 147 publications

(128 citation statements)

References 24 publications

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“…Thus, staged SRS may be appropriate for tumors with a likelihood of rapid volume changes. The staged SRS technique was introduced for large metastatic brain tumors, in which the time interval between fractions ranged from 2 weeks to 1 month [16, 17]. This technique has the advantage of delivering the optimal dose to the target using interval imaging before each SRS as well as reducing the irradiated volume of the shrunken tumor after the first fraction.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report

Roh¹,

Kim²,

Chong³

et al. 2019

Stereotact Funct Neurosurg

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For most fractionated stereotactic radiosurgery treatment plans, daily imaging is not routinely performed, because there is little expectation that lesions will change significantly in the short term. However, here, we present the case of an abrupt increase and decrease in tumor volume during fractionated gamma knife radiosurgery (GKRS) for metastatic brain cancer. A 65-year-old man with a history of nephrectomy due to renal cell carcinoma was admitted to our hospital because of mild cognitive disorder and gait disturbance. An initial MRI of the brain demonstrated a 5 × 3 × 4.5 cm-sized, heterogeneously well-enhanced tumor with a large cystic component compressing the left thalamus and corpus callosum near the lateral ventricle. Owing to its large size and proximity to critical structures, we decided to perform 3 fractionated GKRSs over 3 consecutive days. After the first fraction of 9 Gy with 50% isodose, follow-up MRI the next day revealed an unexpected increase in tumor volume up to 30%. Therefore, the radiosurgical plan was adjusted, and GKRS was performed again using the same dose for the second fraction. The image taken on the third day showed rapid shrinkage of the tumor volume. This case shows that a tumor may change its shape and volume unexpectedly even during the short period of a fractionated GKRS session. Hence, for optimal fractionated GKRS treatment of tumors with the likelihood of an abrupt change in the short term, interval imaging should be considered.

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Section: Discussionmentioning

confidence: 99%

Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report

Roh¹,

Kim²,

Chong³

et al. 2019

Stereotact Funct Neurosurg

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“…Tab. 4, [8,15,16,17,18]). Therefore, to improve the results of SRT of large brain metastases, FSRT is a logical step, enabling a higher tumor dose with a lower risk of neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…With FSRT 1-year local control rates >70% were reported [7,8]. However, a comparative study of SRT and FSRT for large brain metastases has not yet been published.…”

Section: A Single Centre Studymentioning

confidence: 99%

Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases

Wiggenraad¹,

Kanter²,

Mast³

et al. 2012

Strahlenther Onkol

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“…For example, Higuchi et al treated brain metastases up to 25 cm 3 in volume using 3-session GKS. 9 Using hypofractionated stereotactic radiotherapy, Jiang et al treated metastases up to 5.5 cm in diameter. 12 Nishizaki et al used multisession CyberKnife radiosurgery to treat brain metastases up to 53.2 cm 3 in volume.…”

Section: What Size Is "Too Big"?mentioning

confidence: 99%

Large intracranial metastatic tumors treated by Gamma Knife surgery: outcomes and prognostic factors

Lee

Yen

et al. 2014

JNS

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Object The use of radiosurgery has been well accepted for treating small to medium-size metastatic brain tumors (MBTs). However, its utility in treating large MBTs remains uncertain due to potentially unfavorable effects such as progressive perifocal brain edema and neurological deterioration. In this retrospective study the authors evaluated the local tumor control rate and analyzed possible factors affecting tumor and brain edema response. Methods The authors defined a large brain metastasis as one with a measurement of 3 cm or more in at least one of the 3 cardinal planes (coronal, axial, or sagittal). A consecutive series of 109 patients with 119 large intracranial metastatic lesions were treated with Gamma Knife surgery (GKS) between October 2000 and December 2012; the median tumor volume was 16.8 cm3 (range 6.0–74.8 cm3). The pre-GKS Karnofsky Performance Status (KPS) score for these patients ranged from 70 to 100. The most common tumors of origin were non–small cell lung cancers (29.4% of cases in this series). Thirty-six patients (33.0%) had previously undergone a craniotomy (1–3 times) for tumor resection. Forty-three patients (39.4%) underwent whole-brain radiotherapy (WBRT) before GKS. Patients were treated with GKS and followed clinically and radiographically at 2- to 3-month intervals thereafter. Results The median duration of imaging follow-up after GKS for patients with large MBTs in this series was 6.3 months. In the first follow-up MRI studies (performed within 3 months after GKS), 77 lesions (64.7%) had regressed, 24 (20.2%) were stable, and 18 (15.1%) were found to have grown. Peritumoral brain edema as defined on T2-weighted MRI sequences had decreased in 79 lesions (66.4%), was stable in 21 (17.6%), but had progressed in 19 (16.0%). In the group of patients who survived longer than 6 months (76 patients with 77 MBTs), 88.3% of the MBTs (68 of 77 lesions) had regressed or remained stable at the most recent imaging follow-up, and 89.6% (69 of 77 lesions) showed regression of perifocal brain edema volume or stable condition. The median duration of survival after GKS was 8.3 months for patients with large MBTs. Patients with small cell lung cancer and no previous WBRT had a significantly higher tumor control rate as well as better brain edema relief. Patients with a single metastasis, better KPS scores, and no previous radiosurgery or WBRT were more likely to decrease corticosteroid use after GKS. On the other hand, higher pre-GKS KPS score was the only factor that showed a statistically significant association with longer survival. Conclusions Treating large MBTs using either microsurgery or radiosurgery is a challenge for neurosurgeons. In selected patients with large brain metastases, radiosurgery offered a reasonable local tumor control rate and favorable functional preservation. Exacerbation of underlying edema was rare in this case series. Far more commonly, edema and steroid use were lessened after radiosurgery. Radiosurgery appears to be a reasonable option for some patients with large MBTs.

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Three-Staged Stereotactic Radiotherapy Without Whole Brain Irradiation for Large Metastatic Brain Tumors

Cited by 147 publications

References 24 publications

Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report

Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report

Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases

Large intracranial metastatic tumors treated by Gamma Knife surgery: outcomes and prognostic factors

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