scholarly journals Executive summary from American Radium Society’s appropriate use criteria on neurocognition after stereotactic radiosurgery for multiple brain metastases

2020 ◽  
Vol 22 (12) ◽  
pp. 1728-1741 ◽  
Author(s):  
Michael T Milano ◽  
Veronica L S Chiang ◽  
Scott G Soltys ◽  
Tony J C Wang ◽  
Simon S Lo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Poor Performance Status ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Good Performance Status ◽  
Multiple Brain Metastases ◽  
Hippocampal Sparing

Abstract Background The American Radium Society (ARS) Appropriate Use Criteria brain malignancies panel systematically reviewed (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]) published literature on neurocognitive outcomes after stereotactic radiosurgery (SRS) for patients with multiple brain metastases (BM) to generate consensus guidelines. Methods The panel developed 4 key questions (KQs) to guide systematic review. From 11 614 original articles, 12 were selected. The panel developed model cases addressing KQs and potentially controversial scenarios not addressed in the systematic review (which might inform future ARS projects). Based upon quality of evidence, the panel confidentially voted on treatment options using a 9-point scale of appropriateness. Results The panel agreed that SRS alone is usually appropriate for those with good performance status and 2–10 asymptomatic BM, and usually not appropriate for >20 BM. For 11–15 and 16–20 BM there was (between 2 case variants) agreement that SRS alone may be appropriate or disagreement on the appropriateness of SRS alone. There was no scenario (among 6 case variants) in which conventional whole-brain radiotherapy (WBRT) was considered usually appropriate by most panelists. There were several areas of disagreement, including: hippocampal sparing WBRT for 2–4 asymptomatic BM; WBRT for resected BM amenable to SRS; fractionated versus single-fraction SRS for resected BM, larger targets, and/or brainstem metastases; optimal treatment (WBRT, hippocampal sparing WBRT, SRS alone to all or select lesions) for patients with progressive extracranial disease, poor performance status, and no systemic options. Conclusions For patients with 2–10 BM, SRS alone is an appropriate treatment option for well-selected patients with good performance status. Future study is needed for those scenarios in which there was disagreement among panelists.

scholarly journals A Review of Stereotactic Radiosurgery in the Management of Brain Metastases

2003 ◽  
Vol 2 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Paul W. Sperduto
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Clinical Judgment ◽  
Randomized Trials ◽  
Performance Status ◽  
Poor Performance ◽  
Mass Effect ◽  
Poor Performance Status ◽  
Whole Brain Radiation ◽  
Brain Radiation

This review addresses the epidemiology, historical reports, current issues, data and controversies involved in the management of brain metastases. The literature regarding surgery, whole brain radiation therapy, stereotactic radiosurgery or some combination of those treatments is discussed as well as issues of cost-effectiveness. Ongoing prospective randomized trials will further elucidate the optimal management for patients with brain metastases. Until those data are available, clinicians are encouraged to apply the existing data reviewed here in conjunction with best clinical judgment. A brief clinical guide is as follows. Patients with a solitary metastasis in an operable location and symptomatic mass effect should undergo surgery. Patients with poor performance status (KPS < 70) or more than three brain metastases should receive WBRT alone. Patients with 1-3 brain metastases and KPS ≥ 70, should receive WBRT + SRS. If the patient refuses WBRT or needs salvage after WBRT, then SRS alone is appropriate. Clinicians should not be too dogmatic and should always apply the best clinical judgment.

Is stereotactic radiosurgery of brain metastases in patients with poor performance status worthwhile?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 192-192
Author(s):  
Federico Ampil ◽  
Donghyun Kim ◽  
Troy Richards ◽  
Moiz Vora ◽  
Glenn Morris Mills ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Survival Rates ◽  
Poor Performance ◽  
Tumor Control ◽  
Poor Performance Status ◽  
Survival Group ◽  
Prognostic Utility ◽  
The Mean

192 Background: Performance status is a consistent predictor of outcome in people with advanced disease. Variable prognosis has not led to the exclusion of patients with Karnofsky performance scores of < 70 from treatment of brain metastases (BRM) with stereotactic radiosurgery (SRS). The role of SRS for BRM in individuals with poor performance status (PPS) has not been elucidated to date. To better understand the prognostic utility of SRS in this particular patient cohort, we assessed the longevity periods of our treated PPS subjects with BRM. Methods: A retrospective review of patients with BRM treated by SRS during a 10-year period (2000-2009) identified 22 adult individuals with PPS; PPS was defined by the presence of severe hemiparesis or cerebellar ataxia. The primary endpoint of the analysis was survival because of some limitations in the obtained data. The mean follow-up was 26 months (range: < 1 to 144 months). Results: The mean age was 55.8 years, and the majority of the subjects were female. Most of the patients were younger and diagnosed with solitary brain metastasis. The synchronous primary malignant tumor was not yet under control in a third of the patients, and extracranial metastases were noted in 45% of the subjects. Thirteen people (59%) died within two months after therapy, and nine patients (41%) lived for two years or longer. The overall crude survival rates at 1 year and 5 years were 41% and 18%, respectively. Treatment response information was not available in the short-survival group because of early demise. Intracranial tumor control was achieved in the long-term survivors, considering that BRM progression requiring repeat SRS was not observed in any instance. Characterization of the two groups with different longevities was not possible. Conclusions: Early mortality was not predominant in this limited experience, and the observed prolonged survival suggests that SRS still represents a valuable treatment option for individuals with PPS and BRM.

scholarly journals Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

2021 ◽  
Author(s):  
Sergej Telentschak ◽  
Daniel Ruess ◽  
Stefan Grau ◽  
Roland Goldbrunner ◽  
Niklas von Spreckelsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Poor Prognosis ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Salvage Treatment ◽  
Treatment Modalities ◽  
Large Tumor ◽  
Fractionated Radiotherapy ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

scholarly journals Melanoma Brain Metastases in the Era of Targeted Therapy and Checkpoint Inhibitor Therapy

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1489
Author(s):  
John M. Rieth ◽  
Umang Swami ◽  
Sarah L. Mott ◽  
Mario Zanaty ◽  
Michael D. Henry ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Treatment Strategies ◽  
Poor Performance Status ◽  
Poor Overall Survival ◽  
Melanoma Brain Metastases

Brain metastases commonly develop in melanoma and are associated with poor overall survival of about five to nine months. Fortunately, new therapies, including immune checkpoint inhibitors and BRAF/MEK inhibitors, have been developed. The aim of this study was to identify outcomes of different treatment strategies in patients with melanoma brain metastases in the era of checkpoint inhibitors. Patients with brain metastases secondary to melanoma were identified at a single institution. Univariate and multivariable analyses were performed to identify baseline and treatment factors, which correlated with progression-free and overall survival. A total of 209 patients with melanoma brain metastases were identified. The median overall survival of the cohort was 5.3 months. On multivariable analysis, the presence of non-cranial metastatic disease, poor performance status (ECOG 2–4), whole-brain radiation therapy, and older age at diagnosis of brain metastasis were associated with poorer overall survival. Craniotomy (HR 0.66, 95% CI 0.45–0.97) and treatment with a CTLA-4 checkpoint inhibitor (HR 0.55, 95% CI 0.32–0.94) were the only interventions associated with improved overall survival. Further studies with novel agents are needed to extend lifespan in patients with brain metastases in melanoma.

Management of multiple brain metastases via dual-isocenter VMAT stereotactic radiosurgery

2021 ◽  
Author(s):  
Allison N Palmiero ◽  
Denise Fabian ◽  
William St Clair ◽  
Marcus Randall ◽  
Damodar Pokhrel
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Multiple Brain Metastases
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