scholarly journals First follow-up radiographic response is one of the predictors of local tumor progression and radiation necrosis after stereotactic radiosurgery for brain metastases

2017 ◽  
Vol 6 (9) ◽  
pp. 2076-2086 ◽  
Author(s):  
Mayur Sharma ◽  
Xuefei Jia ◽  
Manmeet Ahluwalia ◽  
Gene H. Barnett ◽  
Michael A. Vogelbaum ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Local Tumor Progression ◽  
Local Tumor ◽  
Radiographic Response

Local tumor progression treated with Gamma Knife radiosurgery: differences between patients with 2–4 versus 5–10 brain metastases based on an update of a multi-institutional prospective observational study (JLGK0901)

2020 ◽  
Vol 132 (5) ◽  
pp. 1480-1489 ◽  
Author(s):  
Toru Serizawa ◽  
Masaaki Yamamoto ◽  
Yoshinori Higuchi ◽  
Yasunori Sato ◽  
Takashi Shuto ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Gamma Knife ◽  
Tumor Recurrence ◽  
Prospective Observational Study ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Local Tumor Progression ◽  
Local Tumor ◽  
Data Set

OBJECTIVEThe Japanese Leksell Gamma Knife (JLGK)0901 study proved the efficacy of Gamma Knife radiosurgery (GKRS) in patients with 5–10 brain metastases (BMs) as compared to those with 2–4, showing noninferiority in overall survival and other secondary endpoints. However, the difference in local tumor progression between patients with 2–4 and those with 5–10 BMs has not been sufficiently examined for this data set. Thus, the authors reappraised this issue, employing the updated JLGK0901 data set with detailed observation via enhanced MRI. They applied sophisticated statistical methods to analyze the data.METHODSThis was a prospective observational study of 1194 patients harboring 1–10 BMs treated with GKRS alone. Patients were categorized into groups A (single BM, 455 cases), B (2–4 BMs, 531 cases), and C (5–10 BMs, 208 cases). Local tumor progression was defined as a 20% increase in the maximum diameter of the enhanced lesion as compared to its smallest documented maximum diameter on enhanced MRI. The authors compared cumulative incidence differences determined by competing risk analysis and also conducted propensity score matching.RESULTSLocal tumor progression was observed in 212 patients (17.8% overall, groups A/B/C: 93/89/30 patients). Cumulative incidences of local tumor progression in groups A, B, and C were 15.2%, 10.6%, and 8.7% at 1 year after GKRS; 20.1%, 16.9%, and 13.5% at 3 years; and 21.4%, 17.4%, and not available at 5 years, respectively. There were no significant differences in local tumor progression between groups B and C. Local tumor progression was classified as tumor recurrence in 139 patients (groups A/B/C: 68/53/18 patients), radiation necrosis in 67 (24/31/12), and mixed/undetermined lesions in 6 (1/5/0). There were no significant differences in tumor recurrence or radiation necrosis between groups B and C. Multivariate analysis using the Fine-Gray proportional hazards model revealed age < 65 years, neurological symptoms, tumor volume ≥ 1 cm3, and prescription dose < 22 Gy to be significant poor prognostic factors for local tumor progression. In the subset of 558 case-matched patients (186 in each group), there were no significant differences between groups B and C in local tumor progression, nor in tumor recurrence or radiation necrosis.CONCLUSIONSLocal tumor progression incidences did not differ between groups B and C. This study proved that tumor progression after GKRS without whole-brain radiation therapy for patients with 5–10 BMs was satisfactorily treated with the doses prescribed according to the JLGK0901 study protocol and that results were not inferior to those in patients with a single or 2–4 BMs.Clinical trial registration no.: UMIN000001812 (umin.ac.jp)

scholarly journals The centrally restricted diffusion sign on MRI for assessment of radiation necrosis in metastases treated with stereotactic radiosurgery

2021 ◽  
Author(s):  
Nicolin Hainc ◽  
Noor Alsafwani ◽  
Andrew Gao ◽  
Philip J. O’Halloran ◽  
Paul Kongkham ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Interobserver Agreement ◽  
Radiation Necrosis ◽  
Restricted Diffusion ◽  
Post Contrast ◽  
Primary Tumors ◽  
Increased Susceptibility ◽  
Subsequent Intervention

Abstract Purpose Differentiation of radiation necrosis from tumor progression in brain metastases treated with stereotactic radiosurgery (SRS) is challenging. For this, we assessed the performance of the centrally restricted diffusion sign. Methods Patients with brain metastases treated with SRS who underwent a subsequent intervention (biopsy/resection) for a ring-enhancing lesion on preoperative MRI between 2000 and 2020 were included. Excluded were lesions containing increased susceptibility limiting assessment of DWI. Two neuroradiologists classified the location of the diffusion restriction with respect to the post-contrast T1 images as centrally within the ring-enhancement (the centrally restricted diffusion sign), peripherally correlating to the rim of contrast enhancement, both locations, or none. Measures of diagnostic accuracy and 95% CI were calculated for the centrally restricted diffusion sign. Cohen's kappa was calculated to identify the interobserver agreement. Results Fifty-nine patients (36 female; mean age 59, range 40 to 80) were included, 36 with tumor progression and 23 with radiation necrosis based on histopathology. Primary tumors included 34 lung, 12 breast, 5 melanoma, 3 colorectal, 2 esophagus, 1 head and neck, 1 endometrium, and 1 thyroid. The centrally restricted diffusion sign was seen in 19/23 radiation necrosis cases (sensitivity 83% (95% CI 63 to 93%), specificity 64% (95% CI 48 to 78%), PPV 59% (95% CI 42 to 74%), NPV 85% (95% CI 68 to 94%)) and 13/36 tumor progression cases (difference p < 0.001). Interobserver agreement was substantial, at 0.61 (95% CI 0.45 to 70.8). Conclusion We found a low probability of radiation necrosis in the absence of the centrally restricted diffusion sign.

scholarly journals Percutaneous radiofrequency ablation with a multiple-electrode switching system for medium-sized hepatocellular carcinomas

2020 ◽  
Author(s):  
Yunhua Tan ◽  
Xuesong Li ◽  
Qiang Wang ◽  
Kun Li ◽  
Kuansheng Ma
Keyword(s):  
Radiofrequency Ablation ◽  
Tumor Progression ◽  
Local Tumor Progression ◽  
Switching System ◽  
Local Tumor ◽  
Short Term ◽  
Ablation Volume ◽  
Hepatocellular Carcinomas ◽  
Multiple Electrode

OBJECTIVE: To retrospectively evaluate the safety and short-term therapeutic efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) to treat medium-sized (3.1-5.0 cm) hepatocellular carcinomas (HCCs). SUMMARY OF BACKGROUND DATA: Conventional monopolar RFA is limited in achieving local control for tumors larger than 3 cm. Therefore, MESS-RFA was developed, and can create a sufficiently large ablation volume including the target tumor and a 5−10 mm safety margin in medium-sized tumors METHODS: We performed a total of 168 RFAs with a MESS on 166 patients. The patients were treated under ultrasonographic guidance by percutaneous switching system RFA with a multichannel RF generator and two or three internally cooled electrodes. Technical effectiveness, local progression, and remote recurrence of HCC were determined. RESULTS: For the 166 isolated HCC tumors, the complete ablation rate of MESS-RFA was 98.79% (164/166). Mean ablation time per procedure was 12.33±3.01 min; mean ablation diameter was 5.79±0.61 cm. The complication rate was 2.41%. During follow-up (averaging 16.54 months), local tumor progression occurred in 15/166 patients (9.03%) with technical effectiveness, while new HCCs were detected in 40/166 patients (24.09%). Multivariate analyses revealed that local tumor progression was only associated with serum AFP levels above 100 ng/ml as a risk factor. CONCLUSION: MESS-RFA for achieving sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up in the treatment of medium-sized HCCs.

Imaging changes over 18 months following stereotactic radiosurgery for brain metastases: both late radiation necrosis and tumor progression can occur

2017 ◽  
Vol 136 (1) ◽  
pp. 207-212 ◽  
Author(s):  
Dylann Fujimoto ◽  
Rie von Eyben ◽  
Iris C. Gibbs ◽  
Steven D. Chang ◽  
Gordon Li ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis

scholarly journals RADI-25. REPEAT STEREOTACTIC RADIOSURGERY FOR RECURRENT BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i26-i26
Author(s):  
Daria Krivosheya ◽  
Hamid Borghei-Razavi ◽  
Matthew Grabowski ◽  
Lilyana Angelov ◽  
Gene Barnett ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Post Treatment ◽  
Average Dose ◽  
Single Fraction ◽  
Perfusion Studies

Abstract INTRODUCTION: Mainstream modality of treatment of oligo-metastatic disease is stereotactic radiosurgery (SRS). While the local control rate is nearing 90%, 7% of lesions and 10 to 15% of patients develop radiation necrosis post treatment. In the face of increasing lesion size and evidence of recurrence, re-treatment of the enlarging lesion with radiosurgery can be attempted. The aim of the project is to evaluate outcomes of lesions treated with repeat SRS. METHODS: We conducted a retrospective review of all patients that were treated with Gamma Knife radiosurgery at our institution from 2000 to 2018. Fifty-one lesions in 39 patients were identified that had recurrence during follow-up period and were treated with a second single-fraction SRS. RESULTS: A combination of imaging studies, such as PET and/or perfusion studies, lesion biopsy, and clinical course were used to make the diagnosis of lesion recurrence. The average radiation dose at first treatment was 21 Gy, and the average dose at second treatment was 19 Gy. The median time between treatments was 16.8 months, ranging from 2.5 to 75.3 months, and the median follow-up after second treatment was 10.2 months. Of 51 lesions that received two SRS treatments, 49% (25 lesions) continued to progress at a median interval of 4.8 months post treatment, of which 35% (18 lesions) were diagnosed as radiation necrosis based on biopsy results or advanced brain imaging. The overall rate of radiation necrosis post second SRS treatment was determined to be 16% per lesion and 21% per patient. CONCLUSION: Recurrent brain metastases that are re-treated with single fraction SRS are associated with a higher risk of radiation necrosis. Alternative treatment strategies, including fractionation of subsequent SRS treatments, radiation dose reduction, and combination with laser ablation could be considered to ensure symptom and disease control to reduce the rate of subsequent radiation necrosis.

scholarly journals Long-term metabolic evolution of brain metastases with suspected radiation necrosis following stereotactic radiosurgery: longitudinal assessment by F-DOPA PET

2020 ◽  
Author(s):  
Francesco Cicone ◽  
Luciano Carideo ◽  
Claudia Scaringi ◽  
Andrea Romano ◽  
Marcelo Mamede ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Standardized Uptake Value ◽  
Longitudinal Assessment ◽  
Metabolic Evolution ◽  
Local Progression ◽  
Pet Ct

Abstract Background The evolution of radiation necrosis (RN) varies depending on the combination of radionecrotic tissue and active tumor cells. In this study, we characterized the long-term metabolic evolution of RN by sequential PET/CT imaging with 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (F-DOPA) in patients with brain metastases following stereotactic radiosurgery (SRS). Methods Thirty consecutive patients with 34 suspected radionecrotic brain metastases following SRS repeated F-DOPA PET/CT every 6 months or yearly in addition to standard MRI monitoring. Diagnoses of local progression (LP) or RN were confirmed histologically or by clinical follow-up. Semi-quantitative parameters of F-DOPA uptake were extracted at different time points, and their diagnostic performances were compared with those of corresponding contrast-enhanced MRI. Results Ninety-nine F-DOPA PET scans were acquired over a median period of 18 (range: 12–66) months. Median follow-up from the baseline F-DOPA PET/CT was 48 (range 21–95) months. Overall, 24 (70.6%) and 10 (29.4%) lesions were classified as RN and LP, respectively. LP occurred after a median of 18 (range: 12–30) months from baseline PET. F-DOPA tumor-to-brain ratio (TBR) and relative standardized uptake value (rSUV) increased significantly over time in LP lesions, while remaining stable in RN lesions. The parameter showing the best diagnostic performance was rSUV (accuracy = 94.1% for the optimal threshold of 1.92). In contrast, variations of the longest tumor dimension measured on contrast-enhancing MRI did not distinguish between RN and LP. Conclusion F-DOPA PET has a high diagnostic accuracy for assessing the long-term evolution of brain metastases following SRS.

scholarly journals Comparative Analysis of Radiofrequency Ablation and Microwave Ablation for Critically Located Hepatocellular Carcinomas Smaller than 5 cm

2021 ◽  
Author(s):  
Ravindran Ramalingam ◽  
Amar Mukund ◽  
Karan Manoj Anandpara ◽  
Yashwant Patidar ◽  
Shiv Kumar Sarin
Keyword(s):  
Radiofrequency Ablation ◽  
Tumor Progression ◽  
Microwave Ablation ◽  
Treatment Effectiveness ◽  
Local Tumor Progression ◽  
Local Tumor ◽  
Hepatocellular Carcinomas ◽  
Critical Location ◽  
Critical Locations

Abstract Purpose To compare the safety and efficacy of radiofrequency ablation (RFA) versus microwave ablation (MWA) for hepatocellular carcinomas (HCC) smaller than 5 cm in critical locations. Methods Single-center retrospective study of all patients who underwent RFA/MWA for HCC from July 2015 to Dec 2019. Critical location includes exophytic tumors, tumors ≤ 5 mm from the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, and ≤ 10 mm from large vessels with caliber of ≥ 3 mm. Treatment effectiveness, local tumor progression, and complication rates were evaluated. Results Out of 119 patients with 147 HCC nodules in critical location, 65 (M:F = 49:16; mean age–61.7) were included in RFA group and 54 (M:F =43:11; mean age–60.5) in MWA group. Mean follow-up period was 16.5 and 14.8 months, respectively. At first follow-up imaging, 66/78 tumors in RFA group and 57/69 tumors in MWA group showed complete ablation with primary treatment effectiveness rates of 84.6% and 82.6%, respectively (p = 0.741). Local tumor progression (LTP) rate was 21.8% (17/78) and 20.3% (14/69), respectively (p = 0.826). Median time to LTP was 12 and 13.5 months, respectively. Fourteen tumors in RFA group and 12 in MWA group underwent reablation with a secondary treatment effectiveness rates of 78.6% (14/17) and 83.3% (12/14), respectively (p = 0.757). Mean LTP-free survival was 37.2 and 28.1 months, respectively. The total complication rate was 36.9% and 31.5%, respectively (p = 0.535) with no major complications in both the groups. Conclusion Our data suggest that both MWA and RFA are equally safe and effective for treating HCCs < 5 cm in critical locations.

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