scholarly journals Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients

2021 ◽  
Author(s):  
Shoichi Deguchi ◽  
Koichi Mitsuya ◽  
Kazuaki Yasui ◽  
Keisuke Kimura ◽  
Tsuyoshi Onoe ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Stereotactic Radiotherapy ◽  
Prospective Trial ◽  
Case Series ◽  
Distant Recurrence ◽  
Fractionated Stereotactic Radiotherapy ◽  
Maximum Diameter ◽  
Leptomeningeal Disease ◽  
Total Removal ◽  
Piecemeal Resection

Abstract Background The safety and effectiveness of neoadjuvant fractionated stereotactic radiotherapy (FSRT) before piecemeal resection of brain metastasis (BM) remains unknown. Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy (n = 11) or 35 Gy (n = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.

scholarly journals MET-6 Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection for metastatic brain tumor

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi26-vi26
Author(s):  
Koichi Mitsuya ◽  
Shoichi Deguchi ◽  
Manabu Muto ◽  
Kazuaki Yasui ◽  
Tsuyoshi Onoe ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Progression Free Survival ◽  
Lesion Size ◽  
Fractionated Stereotactic Radiotherapy ◽  
Tumor Diameter ◽  
Whole Brain Radiation ◽  
Large Brain ◽  
Piecemeal Resection

Abstract BACKGROUND: Large brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative stereotactic radiosurgery (SRS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (Na-SRS) followed by surgery was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation necrosis (RN). We treated with neoadjuvant fractionated stereotactic radiotherapy (Na-fSRT) followed by surgery for large brain metastasis with piecemeal resection. METHODS: Twelve patients received Na-fSRT followed by surgery between July 2019 and April 2021. Na-fSRT dose was based on lesion size and was standard dosing. Surgery generally followed within 7 days after radiotherapy. RESULTS: The mean age was 68 years (51–79). Sixteen men and five women. Mean follow-up period was 8.5 months (1–24.9). Primary were lung; 10 (NSCLC; 9, SCLC (recurrence); 1), esophagus; 3, colon; 2, melanoma; 2, kidney; 2 (recurrence1), uterus body; 1, and liver; 1. The median maximum tumor diameter was 3.6 cm (2.6–4.9). Median PTV, GTV volume were 21.7ml, 15.5ml, respectively. The median fSRT dose was 30Gy/5fr, and the median time from fSRT to surgery was 4 days (1–7). As preoperative adverse event, intracranial hypertension and partial seizure grade 2 (CTCAE ver.5) were occurred, but controlled with steroid and osmotic diuretics and anticonvulsant. Grade 3 and more adverse events were not occurred. Gross total removal was performed in 95.2%. Event cumulative incidence as follows: cavity local recurrence 4.8% (subtotal removal case); distant brain failure 33%; LMD 4.8%; and symptomatic RN 0%. The median intracranial progression free survival was 7 months, and median overall survival was 8.4 months. CONCLUSIONS: Na-fSRT followed by piecemeal resection is safety and feasible, and may have therapeutic value for deep large brain metastasis and eloquent lesion. Further prospective investigations in multi-institutional settings are warranted.

scholarly journals Linac-based fractionated stereotactic radiotherapy with a micro-multileaf collimator for large brain metastasis unsuitable for surgical resection

2020 ◽  
Vol 61 (4) ◽  
pp. 546-553
Author(s):  
Ryosuke Matsuda ◽  
Tetsuro Tamamoto ◽  
Tadashi Sugimoto ◽  
Shigeto Hontsu ◽  
Kaori Yamaki ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Surgical Resection ◽  
Stereotactic Radiotherapy ◽  
Karnofsky Performance Status ◽  
Magnetic Resonance Images ◽  
Fractionated Stereotactic Radiotherapy ◽  
Multileaf Collimator ◽  
Maximal Diameter ◽  
Local Progression ◽  
Large Brain

Abstract The aim of this study was to assess clinical outcomes using linac-based, fractionated, stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for large brain metastasis (LBM) unsuitable for surgical resection. Between January 2009 and October 2018 we treated 21 patients with LBM using linac-based fSRT. LBM was defined as a tumor with ≥30 mm maximal diameter in gadolinium-enhanced magnetic resonance images. LBMs originated from the lung (n = 17, 81%), ovary (n = 2, 9.5%), rectum (n = 1, 4.8%) and esophagus (n = 1, 4.8%). The median pretreatment Karnofsky performance status was 50 (range: 50–80). Recursive partition analysis (RPA) was as follows: Classes 2 and 3 were 7 and 14 patients, respectively. The median follow-up was 5 months (range: 1–86 months). The range of tumor volume was 8.7–26.5 cm3 (median: 17.1 cm3). All patients were basically treated with 35Gy in 5 fractions, except in three cases. The progression-free survival was 3.0 months. The median survival time was 7.0 months. There was no permanent radiation injury in any of the patients. Radiation-caused central nervous system necrosis, according to the Common Terminology Criteria for Adverse Events version 4.0, occurred in one patient (grade 3). One patients received bevacizumab for radiation necrosis. Two patients underwent additional surgical resection due to local progression and cyst formation. For patients with LBM unsuitable for surgical resection, linac-based fSRT is a promising therapeutic alternative.

scholarly journals RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i22-i22
Author(s):  
Jameson Mendel ◽  
Ankur Patel ◽  
Toral Patel ◽  
Robert Timmerman ◽  
Tu Dan ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Local Control ◽  
Stereotactic Radiotherapy ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Local Failure ◽  
Fractionated Stereotactic Radiotherapy

Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume >7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors >7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.

scholarly journals A retrospective case series on the usefulness of fractionated stereotactic radiotherapy for benign intracranial tumors

2019 ◽  
Vol 16 ◽  
pp. 123-128 ◽  
Author(s):  
Mario Ammirati ◽  
Roberto Colasanti ◽  
Tariq Lamki ◽  
Al-Rahim Abbasali Tailor ◽  
Andrew Kalnin ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Case Series ◽  
Fractionated Stereotactic Radiotherapy ◽  
Intracranial Tumors ◽  
Retrospective Case ◽  
Retrospective Case Series

scholarly journals MET-01 Linac-based fractionated stereotactic radiotherapy with micro-multileaf collimeter for large brain metastasis unsuitable for surgical resection

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii18-ii18
Author(s):  
Ryosuke Matsuda ◽  
Tetsuro Tamamoto ◽  
Takayuki Morimoto ◽  
Yasuhiro Takeshima ◽  
Kentaro Tamura ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Surgical Resection ◽  
Stereotactic Radiotherapy ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Magnetic Resonance Images ◽  
Fractionated Stereotactic Radiotherapy ◽  
Maximal Diameter ◽  
Local Progression ◽  
Large Brain

Abstract To assess clinical outcomes using linac-based, fractionated, stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for large brain metastasis (LBM) unsuitable for surgical resection. Between January 2009 and October 2018, we treated 21 patients with LBM using linac-based fSRT. LBM was defined as a tumor >30mm maximal diameter in gadolinium-enhanced magnetic resonance images. LBMs originated from the lung (n=17, 81%), ovary (n=2, 9.5%), rectum (n =1, 4.8%), and esophagus (n=1, 4.8%). The median pretreatment Karnofsky Performance Status was 50 (range: 50~80). Recursive partition analysis (RPA) was as follows: Classes 2 and 3 were 7 and 14 patients, respectively. The median follow-up was 5 months (range: 1~86 months). The range of tumor volume was 8.7~26.5 cm3 (median: 17.1 cm3). All patients were basically treated with fSRT ranged from 35 Gy with 7 Gy daily fractions, except in three cases. The progression-free survival was 3.0 months. The median survival time was 7.0 months. There was no permanent radiation injury in any of the patients. Radiation-caused central nervous system necrosis, according to the Common Terminology Criteria for Adverse Events version 4.0, occurred in one patient (grade 3). One patients received bevacizumab for radiation necrosis. Two patients underwent additional surgical resection due to local progression and cyst formation. For patients with LBM unsuitable for surgical resection, linac-based fSRT is a promising therapeutic alternative.

Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption

2003 ◽  
Vol 99 (4) ◽  
pp. 685-692 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroki Shirato ◽  
Touru Sakamoto ◽  
Hidefumi Aoyama ◽  
Keishiro Suzuki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Stereotactic Radiotherapy ◽  
Hearing Preservation ◽  
Fractionated Stereotactic Radiotherapy ◽  
Maximum Diameter ◽  
Tumor Control ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Fine Print

Object. The goal of this study was to investigate outcomes in patients with vestibular schwannoma (VS) who were treated with fractionated stereotactic radiotherapy (SRT). Methods. One hundred one patients with VS were treated with fractionated SRT at a radiation level of 40 to 50 Gy administered in 20 to 25 fractions over a 5- to 6-week period. The median tumor size in these patients was 19 mm (range 3–40 mm), and 27 tumors were larger than 25 mm. Patients were consistently followed up using magnetic resonance imaging every 6 months for 5 years in principle. The median follow-up period was 45 months. The actuarial 5-year rate of tumor control (no growth > 2 mm and no requirement for salvage surgery) was 91.4% (95% confidence interval 85.2–97.6%). Three patients with progressive tumors underwent salvage tumor resection. The actuarial 5-year rate of useful hearing preservation (Gardner—Robertson Class I or II) was 71%. The observed complications of fractionated SRT included transient facial nerve palsy (4% of patients), trigeminal neuropathy (14% of patients), and balance disturbance (17% of patients). No new permanent facial weakness occurred after fractionated SRT. Eleven patients (11%) who had progressive communicating hydrocephalus (cerebrospinal fluid malabsorption) and no evidence of tumor growth after fractionated SRT required a shunt. The symptoms of this type of hydrocephalus were similar to those of normal-pressure hydrocephalus and occurred 4 to 20 months (median 12 months) after fractionated SRT. The mean size (± standard deviation) of tumors causing symptomatic hydrocephalus (25.5 ± 7.8 mm) was significantly larger than that of other tumors (18.2 ± 8.7 mm) (p = 0.011). Only four of the 72 patients with tumors smaller than 25 mm in maximum diameter received a shunt. Conclusions. Fractionated SRT resulted in an excellent tumor control rate, even for relatively large tumors, and produced a high rate of hearing preservation that was comparable to the best results of single-fraction radiosurgery. The progression of communicating hydrocephalus should be monitored closely, particularly in patients harboring a large VS.

scholarly journals MET-02 Neoadjuvant fractionated stereotactic radiotherapy followed by surgery for large brain metastasis with difficulty in en-block resection

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii19-ii19
Author(s):  
Koichi Mitsuya ◽  
Shoichi Deguchi ◽  
Tsuyoshi Onoe ◽  
Kazuaki Yasui ◽  
Hirofumi Ogawa ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Small Cell Lung Cancer ◽  
Stereotactic Radiosurgery ◽  
Cell Lung Cancer ◽  
Stereotactic Radiotherapy ◽  
Small Cell ◽  
Fractionated Stereotactic Radiotherapy ◽  
Small Cell Lung ◽  
Large Brain

Abstract BACKGROUND: Large brain metastases which require resection are treated with surgery followed by whole brain radiation therapy or postoperative stereotactic radiosurgery (SRS). Recently a novel strategy using neoadjuvant stereotactic radiosurgery (Na-SRS) followed by surgery was reported, demonstrating lower rates of postoperative leptomeningeal dissemination (LMD) and symptomatic radiation necrosis (sRN). However, local control rate was not significantly improved. We treated with neoadjuvant fractionated stereotactic radiotherapy (Na-frSRT) followed by surgery for large brain metastasis with difficulty in en-block resection. METHODS: Nine patients received Na-frSRT followed by surgery between July 2019 and June 2020. Na-frSRT dose was based on lesion size and was standard dosing. Surgery generally followed within 7 days after radiotherapy. RESULTS: The mean age was 64 years (55–78). Eight men and one woman. Median follow-up period was 5.3 months (1.7–12.5). Primary cancers were non-small cell lung cancer 2, esophageal cancer 2, colon cancer 1, melanoma 1, hepato-cellular carcinoma 1 and recurrence of BM from small cell lung cancer and renal cell cancer. The median maximum tumor diameter was 4.3cm (2.6–4.9). The median SRT dose was 30Gy/5fr, and the median time from SRT to surgery was 4 days (1–7). Median PTV was 15.4ml (5.6–49.7), and median GTV was 21.7ml (8.6–61.4). As preoperative adverse event, intracranial hypertension grade2 (CTCAE ver.4.0) was occurred one patient, but controlled with steroid and osmotic diuretics. Grade 3 and more adverse events were not occurred. Gross total resection with intra-tumoral decompression and piece-meal technique was performed in all cases as planning. Event cumulative incidence as follows: surgical site recurrence 0%; local recurrence 11.1%; distant brain failure 11.1%; LMD 0%; and sRN 0%. The median overall survival was not reached. CONCLUSIONS: Na-frSRT followed by surgery is safety and feasible, and may have therapeutic value for large brain metastasis. Further prospective investigations in multi-institutional settings are warranted.

scholarly journals The Developments of Innovative Technologies of Focal Radiotherapy a Viable, Safe, and Effective Option of Treatment

2018 ◽  
Vol 1 (1) ◽  
pp. 01-05
Author(s):  
Hajira Mojdeh ◽  
Imamatullah Hamidi
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Survival Rates ◽  
Distant Recurrence ◽  
Local Control Rate ◽  
Fractionated Stereotactic Radiotherapy ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Distant Failure ◽  
Set Up

Objectives: To determine if the postoperative delivery of fractionated stereotactic radiotherapy (FSRT) for resection cavity for patients with single and resectable brain metastases is safe and effective. Methods: A prospective feasibility protocol was set up to include patients with single and resectable brain metastases who underwent surgery and had low risk profile according to RPA classification. Fractionated stereotactic radiotherapy was applied. Single dose: 3.8 Gy, total dose: 41.8 or 49.6 Gy. Results: There was no case of break due to clinical problems. There was no case of delay of FSRT. The onset acute toxicity was observed in 40 cases (76.9%), no grade 3 and more was seen. Local recurrence free survival was 32.6 months, local control rate at 6, 12, 18 and 24 months were 85%, 77.9%, 65.9% and 65.9%. Overall local failure occurred in 34.1% of patients. Overall survival rates at 6, 12, 18 and 24 months were 90.3%, 63.9%, 47.7% and 31.6%. Median survival was 18.3 months (13.8-22.8) and overall 17.3% were living at the time of last analysis. Distant control rates at 6, 12, 18 and 24 months were 49.4%, 38.2%, 25.5% and 22.3%. Median distant recurrence free survival was 6 months (0-12.0) with overall distant failure in 77.7% of patients. Conclusion: FSRT for surgical cavity might be one possible option in treatment of single and resectable brain metastases.

scholarly journals Neuro-Oncology Practice Clinical Debate: stereotactic radiosurgery or fractionated stereotactic radiotherapy following surgical resection for brain metastasis

2019 ◽  
Vol 7 (3) ◽  
pp. 263-267
Author(s):  
Joshua D Palmer ◽  
Jeffrey Greenspoon ◽  
Paul D Brown ◽  
Derek R Johnson ◽  
David Roberge
Keyword(s):  
Brain Metastasis ◽  
Stereotactic Radiosurgery ◽  
Stereotactic Radiotherapy ◽  
Whole Brain Radiotherapy ◽  
Standard Of Care ◽  
Fractionated Stereotactic Radiotherapy ◽  
Tumor Bed ◽  
Brain Radiotherapy ◽  
Resected Tumor ◽  
Oncology Practice

Abstract The treatment of resected brain metastasis has shifted away from the historical use of whole-brain radiotherapy (WBRT) toward adjuvant radiosurgery (stereotactic radiosurgery [SRS]) based on a recent prospective clinical trial demonstrating less cognitive decline with the use of SRS alone and equivalent survival as compared with WBRT. Whereas all level 1 evidence to date concerns single-fraction SRS for postoperative brain metastasis, there is emerging evidence that fractionated stereotactic radiotherapy (FSRT) may improve local control at the resected tumor bed. The lack of direct comparative data for SRS vs FSRT results in a diversity in clinical practice. In this article, Greenspoon and Roberge defend the use of SRS as the standard of care for resected brain metastasis, whereas Palmer and Brown argue for FSRT.

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