RADT-02. FACTORS ASSOCIATED WITH NEW-ONSET SEIZURES AFTER STEREOTACTIC RADIOSURGERY FOR NEWLY DIAGNOSED BRAIN METASTASES

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi41-vi41
Author(s):  
Ethan Srinivasan ◽  
Emily Lerner ◽  
Ryan Edwards ◽  
Aden Haskell-Mendoza ◽  
David Huie ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Target Volume ◽  
Newly Diagnosed ◽  
Single Institution ◽  
Primary Tumor Site ◽  
Significant Difference ◽  
Total Treatment ◽  
Treatment Volume ◽  
New Onset

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is a highly effective therapy for newly diagnosed brain metastases. Risk factors for new-onset seizures after SRS have not been well established. In this study, we aimed to characterize the variables predictive of seizure risk. METHODS Patients treated with SRS for newly diagnosed brain metastases were retrospectively reviewed at a single institution. Data on baseline demographics, radiation parameters, and clinical courses were collected. RESULTS 120 patients without previous seizure history were identified. Median age was 65 years (56-70.8) and baseline KPS 90 (80-90). 16 (13%) patients developed new-onset seizures within 3 months of SRS. In analyses comparing patients with and without new-onset seizures, there was no association between new-onset seizures and baseline KPS(90:80, p=0.48), prior resection (31%:28%, p=0.76), prior WBRT (6%:10%, p=1), immunotherapy or chemotherapy within 1 month (31%:21%, p=0.52 and 56%:57%, p=1), primary tumor site (p=0.07), number of lesions (2.2:3, p=0.21), cerebellar (25%:37%, p=0.41) or brainstem involvement (19%:14%, p=0.71), irradiated maximum target diameter (2.8:2.0cm p=0.191), maximum target volume (7.6:2.9 cm3 p=0.133), total dose of radiation (25:20Gy, p = 0.12), or use of fractionation (56%:35%, p=0.11). However, there was a significant difference in the total irradiated target volume (11.6 vs. 3.8 cm3, p=0.019) and a trend toward increased post-treatment seizures among patients with a total irradiated volume greater than 10cm3 (20%:9%, p=0.11, OR 2.4 [0.85-6.4]). Patients with seizures were also more likely to have received steroids (69%:34%, p=0.012) and AEDs (28%:15%, p=0.021) prior to SRS. CONCLUSIONS Our data suggest that total treatment volume is associated with new-onset seizures within 3 months of SRS. The association between seizures and exposure to steroids or AEDs prior to SRS may be a surrogate for neurologic symptoms at presentation. Patients undergoing SRS to larger volumes and necessitating prophylactic steroids or AEDs may benefit from counseling or intensification of anti-seizure therapy.

scholarly journals Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes

2014 ◽  
Vol 14 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Matthew B. Potts ◽  
Sunil A. Sheth ◽  
Jonathan Louie ◽  
Matthew D. Smyth ◽  
Penny K. Sneed ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Target Volume ◽  
Neurological Deficits ◽  
Single Institution ◽  
Risks And Benefits ◽  
Scale Scores ◽  
Time Of Presentation

Object Stereotactic radiosurgery (SRS) is an established treatment modality for brain arteriovenous malformations (AVMs) in children, but the optimal treatment parameters and associated treatment-related complications are not fully understood. The authors present their single-institution experience of using SRS, at a relatively low marginal dose, to treat AVMs in children for nearly 20 years; they report angiographic outcomes, posttreatment hemorrhage rates, adverse treatment-related events, and functional outcomes. Methods The authors conducted a retrospective review of 2 cohorts of children (18 years of age or younger) with AVMs treated from 1991 to 1998 and from 2000 to 2010. Results A total of 80 patients with follow-up data after SRS were identified. Mean age at SRS was 12.7 years, and 56% of patients had hemorrhage at the time of presentation. Median target volume was 3.1 cm3 (range 0.09–62.3 cm3), and median prescription marginal dose used was 17.5 Gy (range 12–20 Gy). Angiograms acquired 3 years after treatment were available for 47% of patients; AVM obliteration was achieved in 52% of patients who received a dose of 18–20 Gy and in 16% who received less than 18 Gy. At 5 years after SRS, the cumulative incidence of hemorrhage was 25% (95% CI 16%–37%). No permanent neurological deficits occurred in patients who did not experience posttreatment hemorrhage. Overall, good functional outcomes (modified Rankin Scale Scores 0–2) were observed for 78% of patients; for 66% of patients, functional status improved or remained the same as before treatment. Conclusions A low marginal dose minimizes SRS-related neurological deficits but leads to low rates of obliteration and high rates of hemorrhage. To maximize AVM obliteration and minimize posttreatment hemorrhage, the authors recommend a prescription marginal dose of 18 Gy or more. In addition, SRS-related symptoms such as headache and seizures should be considered when discussing risks and benefits of SRS for treating AVMs in children.

Bony-based and prostate-based image guidance for lo-calized prostate cancer radiotherapy

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Saulo Santos Fortes ◽  
Luiz Antonio Ribeiro Da Rosa
Keyword(s):  
Prostate Cancer ◽  
Normal Tissue ◽  
Bone Structure ◽  
Absorbed Dose ◽  
Target Volume ◽  
Image Guided Radiotherapy ◽  
Beam Modulation ◽  
Significant Difference ◽  
Treatment Volume ◽  
Treatment Plans

An important modality for the treatment of prostate cancer is teletherapy. The use of image-guided radiotherapy (IGRT) is a valuable tool in this treatment. This study retrospectively compared how repositioning the patient based on bone structure (B-ISO) and the prostate itself (P-ISO) affected the volumetric dose in the rectum, bladder, and clinical treatment volume (CTV). Additionally, the probability of normal tissue complication (NTCP) for the rectum was computed. We evaluated 155 cone-beam computed tomography (CBCT) from 8 patients. The treatment plans used beam modulation techniques. The planning target volume (PTV) margin adopted in both scenarios was 1 cm. The organs of interest were outlined over each CBCT and then treatment plans were applied so that the absorbed dose could be computed. NTCP values were calculated for the rectum. Analyzing dose-volume metrics published by the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC), there was no significant difference between the two repositioning strategies for the rectum and bladder. There was a slight degradation in CTV coverage for the B-ISO strategy, but still with adequate coverage. Analysis of the uniform equivalent dose (EUD) and NTCP for the rectum showed little sensitivity to the strategy used. The present study showed that the use of CBCT in radiotherapy for prostate cancer treatment did not significantly improve volumetric doses for the rectum, bladder, and CTV, as well as NTCP for the rectum.

Stereotactic radiosurgery for newly diagnosed brain metastases

2014 ◽  
Vol 190 (9) ◽  
pp. 786-791 ◽  
Author(s):  
Dirk Rades ◽  
Dagmar Hornung ◽  
Oliver Blanck ◽  
Kristina Martens ◽  
Mai Trong Khoa ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Newly Diagnosed

Use of 3.0-T MRI for Stereotactic Radiosurgery Planning for Treatment of Brain Metastases: A Single-Institution Retrospective Review

2010 ◽  
Vol 78 (4) ◽  
pp. 1142-1146 ◽  
Author(s):  
Paul A. Saconn ◽  
Edward G. Shaw ◽  
Michael D. Chan ◽  
Sarah E. Squire ◽  
Annette J. Johnson ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Retrospective Review ◽  
Single Institution ◽  
3.0 T ◽  
3.0 T Mri

Stereotactic radiosurgery for the treatment of brain metastases; results from a single institution experience

2013 ◽  
Vol 182 (3) ◽  
pp. 481-485 ◽  
Author(s):  
D. Burke ◽  
C. Mascott ◽  
L. Rock ◽  
S. Callinan ◽  
A. Mihai ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Single Institution

scholarly journals Factors influencing the outcome of stereotactic radiosurgery in patients with five or more brain metastases

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
E. Hamel-Perreault ◽  
D. Mathieu ◽  
L. Masson-Cote
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Karnofsky Performance Status ◽  
Systemic Disease ◽  
Performance Status ◽  
Recursive Partitioning ◽  
Nonsmall Cell Lung Cancer ◽  
Factors Influencing ◽  
Treatment Volume ◽  
Extracranial Disease

Background Stereotactic radiosurgery (srs) for patients with 5 or more brain metastases (bmets) is a matter of debate. We report our results with that approach and the factors influencing outcome.Methods In the 103 patients who underwent srs for the treatment of 5 or more bmets, primary histology was nonsmall- cell lung cancer (57% of patients). All patients were grouped by Karnofsky performance status and recursive partitioning analysis (rpa) classification. In our cohort, 72% of patients had uncontrolled extracranial disease, and 28% had stable or responding systemic disease. Previous irradiation for 1–4 bmets had been given to 56 patients (54%). The mean number of treated bmets was 7 (range: 5–19), and the median cumulative bmets volume was 2 cm3 (range: 0.06–28 cm3).Results Multivariate analyses showed that stable extracranial disease (p < 0.001) and rpa (p = 0.022) were independent prognostic factors for overall survival (os). Moreover, a cumulative treated bmets volume of less than 6 cm3 (adjusted hazard ratio: 2.54; p = 0.006; 95% confidence interval: 1.30 to 4.99) was associated with better os. The total number of bmets had no effect on survival (p = 0.206). No variable was found to be predictive of local control. The rpa was significant (p = 0.027) in terms of distant recurrence.Conclusions Our study suggests that srs is a reasonable option for the management of patients with 5 or more bmets, especially with a cumulative treatment volume of less than 6 cm3.

scholarly journals RTHP-42. OUTCOMES AFTER FRACTIONATED STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi218-vi218
Author(s):  
Rebecca Anderson ◽  
Liberty Bonestroo ◽  
Christopher Spencer
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Whole Brain Radiotherapy ◽  
Symptomatic Patient ◽  
Target Volume ◽  
Time To Death ◽  
Brain Radiotherapy ◽  
Fractionated Stereotactic Radiosurgery

Abstract PURPOSE To examine outcomes in patients undergoing linear accelerator (LINAC) based fractionated stereotactic radiosurgery (fSRS) to 30 Gy in 5 fractions. METHODS We completed a retrospective review of patients with brain metastases treated with 5-fraction LINAC fSRS at Phelps Health. All patients with CNS metastatic disease treated with fSRS were included in the study. Incidence of symptomatic radionecrosis (sRN), local brain failure (LBF), time to death, target volume and dose, prior whole brain radiotherapy (WBRT), prior surgical resection, and concurrent immunotherapy were assessed. sRN was defined as grade 2 or higher per CTCAE v4.0. RESULTS From 2016–2019, 28 patients and 60 lesions were treated. The most common metastasis histology was non-small cell lung cancer (n = 22), renal cell carcinoma (n = 12), and melanoma (n = 11). Median follow-up time was 6.49 months (range 0.33 – 23.96). Of 60 lesions, three lesions developed sRN and one asymptomatic patient developed radiographic evidence of radiation necrosis. Mean GTV was 1.03cm3 in patients with sRN. Of 57 lesions without sRN, median GTV was 1.45cm3 (range 0.11 - 20.1). Mean time to sRN was 3.17 months. Two symptomatic patients received prior WBRT. One symptomatic patient received concurrent immunotherapy. No symptomatic patients had surgical resection prior to fSRS. Among 24 lesions without prior radiation, 1 (4.2%) developed sRN. 10 lesions underwent surgical resection prior to fSRS with none developing sRN. 34 lesions were treated with concurrent immunotherapy and one developed sRN (2.9%). Local failure occurred in 9 lesions (15%). Median time to death for all patients was 4.50 months (range 1.02 - 19.40). CONCLUSIONS fSRS to 30 Gy in 5 fractions has promising efficacy with low incidence of sRN in treatment of CNS metastatic disease. Further investigation is required to determine predictors in patient outcome.

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