Whole-brain radiation practice pattern at a tertiary hospital with high-volume radiosurgery practice.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 113-113
Author(s):  
Lauren Boreta ◽  
Emily Yee ◽  
Susan Y. Wu ◽  
Steve E. Braunstein
Keyword(s):  
Median Survival ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Tertiary Hospital ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
Tertiary Cancer Center

113 Background: Whole brain radiation (WBRT) is standard therapy used for palliation of brain metastases (BM). SRS is also used as primary treatment in patients with multiple BM, with WBRT reserved for salvage. We sought to describe WBRT practice patterns at a tertiary cancer center with a high-volume radiosurgical practice, and hypothesized that patients treated with WBRT at our institution had limited survival. Methods: Retrospective chart review was performed for patients treated with WBRT for BM from January 2013-Jan 2019. Patients with complete records were included in the analysis. Mann-Whitney U and chi-squared tests were for comparison of clinical factors. Results: Data for 100 patients receiving WBRT were available for analysis. Patients had NSCLC (32%) breast cancer (30%) and melanoma (9%). Median age was 52 (IQR 23). 43% of patients had SRS prior to WBRT, and 41% had 2+ SRS treatments prior to WBRT. 44% of patients had WBRT only. Median survival from diagnosis of BM was 9.3 months (IQR 17.9) and median survival from WBRT was 2.7 months (IQR 11.3). 35% of patients died within 30 days of WBRT, and 3% of patients died on treatment. 77% of patients had uncontrolled extracranial metastases and 43% of patients had imaging evidence of leptomeningeal disease (LMD). Of those with documented cause of death, 65% of patients with LMD died of neurologic causes, compared with 22% of those without LMD (p < 0.001). Patients with KPS < 70 had median survival of 2 months after WBRT, compared with 3.7 months in those with KPS > 70. Patients treated with WBRT alone and those treated with salvage WBRT after SRS had median survival after WBRT of 2.1 months, however median survival from time of brain met diagnosis was 3.3 months in those treated with WBRT alone, versus 12.8 months in those treated with salvage WBRT (p < 0.0001). Conclusions: This study reveals the poor prognosis of patients requiring WBRT at a tertiary cancer center. 35% patients died within 30 days of WBRT, in contrast to a prior study demonstrating 10% 30-day mortality after SRS, owing to differences in patient selection. The potential for poor outcome should be discussed with patients during shared-decision making, balancing toxicity or futility with potential benefits of treatment.

Incidence, timing, and treatment of new brain metastases after Gamma Knife surgery for limited brain disease: the case for reducing the use of whole-brain radiation therapy

2011 ◽  
Vol 115 (1) ◽  
pp. 37-48 ◽  
Author(s):  
Stephen Rush ◽  
Robert E. Elliott ◽  
Amr Morsi ◽  
Nisha Mehta ◽  
Jeri Spriet ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Whole Brain Radiation Therapy ◽  
Leptomeningeal Disease ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

Object In this paper, the authors' goal was to analyze the incidence, timing, and treatment of new metastases following initial treatment with 20-Gy Gamma Knife surgery (GKS) alone in patients with limited brain metastases without whole-brain radiation therapy (WBRT). Methods A retrospective analysis of 114 consecutive adults (75 women and 34 men; median age 61 years) with KPS scores of 60 or higher who received GKS for 1–3 brain metastases ≤ 2 cm was performed (median lesion volume 0.35 cm3). Five patients lacking follow-up data were excluded from analysis. After treatment, patients underwent MR imaging at 6 weeks and every 3 months thereafter. New metastases were preferentially treated with additional GKS. Indications for WBRT included development of numerous metastases, leptomeningeal disease, or diffuse surgical-site recurrence. Results The median overall survival from GKS was 13.8 months. Excluding the 3 patients who died before follow-up imaging, 12 patients (11.3%) experienced local failure at a median of 7.4 months. Fifty-three patients (50%) developed new metastases at a median of 5 months. Six (7%) of 86 instances of new lesions were symptomatic. Most patients (67%) with distant failures were successfully treated using salvage GKS alone. Whole-brain radiotherapy was indicated in 20 patients (18.3%). Thirteen patients (11.9%) died of neurological disease. Conclusions For patients with limited brain metastases and functional independence, 20-Gy GKS provides excellent disease control and high-functioning survival with minimal morbidity. New metastases developed in almost 50% of patients, but additional GKS was extremely effective in controlling disease. Using our algorithm, fewer than 20% of patients required WBRT, and only 12% died of progressive intracranial disease.

BIOM-02. LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA: UPDATES ON THE VALIDITY OF THE VERIDEX CELLSEARCH SYSTEM

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi10-vi10
Author(s):  
yolanda Pina ◽  
Sepideh Mokhtari ◽  
Youngchul Kim ◽  
Brittany Evernden ◽  
Nam Tran ◽  
...  
Keyword(s):  
Median Survival ◽  
Gold Standard ◽  
Retrospective Chart Review ◽  
Standard Test ◽  
Diagnostic Tools ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
Csf Cytology ◽  
Cellsearch System ◽  
Additional Tool

Abstract BACKGROUND Leptomeningeal disease (LMD) is devastating with a median survival of 8-10 weeks without treatment. LMD affects approximately 5% to 25% of melanoma patients. Its pathophysiology remains unknown and effective treatments are virtually non-existent. The primary aim of this study was to evaluate the validity of Veridex CellSearch® System (VCS) compared to Gold Standard test (i.e., CSF cytology). MATERIALS AND METHODS A retrospective chart review was performed of subjects with suspected LMD from melanoma enrolled in the MCC 19332/19648 at Moffitt Cancer Center. Patients underwent standard of care with different treatments as deemed appropriate by treating physician. CSF samples were obtained from lumbar punctures, surgeries, and Ommaya reservoir. CSF was evaluated for quantification of CSF circulating tumor cells (CTCs) with the Veridex CellSearch® System (VCS). RESULTS Forty-eight patients were identified with melanoma as primary tumor, ages 29-80. Twenty-seven had LMD (median age 62) with median KPS 70. N=19 (70%) were diagnosed radiographically and n=5 (19%) with CSF cytology; n=14 (54%) had positive cytology on first LP. From 24 patients with LMD who underwent VCS, n=22 (92% patients had positive CSF CTCs. Number of CTCs/mL CSF was significantly higher in patients with LMD versus in patients without LMD (mean SD 227.6 vs. 0.07, p &lt; 0.001). VCS sensitivity and specificity was analyzed. AUC was 0.515, with TPR 0.250 and FPR 0.286. CSF analysis and treatments were described. The median survival of those with LMD was 2.7 months. CONCLUSION These results indicate the potential value of the VCS as an additional tool to the gold standard in the diagnosis of LMD in patients with high suspicion of the disease. Future directions involve doing prospective studies to further validate this method, and to better understand this patient population to enhance diagnostic tools and management of LMD.

Dry eye after whole brain radiation: Analysis from a prospective study.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 198-198
Author(s):  
Rachel Tobillo ◽  
Kevin A. Pearlstein ◽  
Zahra Mahbooba ◽  
Dominic Himchan Moon ◽  
Colette J. Shen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Median Survival ◽  
Dry Eye ◽  
Subjective Evaluation ◽  
Sign Test ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Imaging Results ◽  
Brain Radiation

198 Background: Lacrimal glands (LGs) receive incidental dose of unknown significance in patients undergoing whole brain radiation therapy (WBRT). Median survival following diagnosis of brain metastases is poor, so quality of life is of utmost importance for these patients. We enrolled patients on a prospective observational cohort study with an endpoint of dry eye syndrome, which is not thought to be a toxicity of WBRT. Methods: Patients receiving WBRT for any diagnosis to a total dose of 25 to 40 Gy in 10 to 20 fractions were eligible. Patients received 3D-conformal WBRT using opposed lateral fields covering the skull and C1 or C2 vertebrae. LGs were not prospectively contoured before treatment but were subsequently contoured for dosimetric analysis. Patients completed the single-question Subjective Evaluation of Symptom of Dryness (5-point Likert scale) at baseline, immediately after WBRT (EndRT), 1 month (1M), 3 months (3M), and 6 months (6M). The primary endpoint was change in proportion of patients at 1M experiencing moderate or worse dry eye (defined as symptoms that cause discomfort and interfere with activities). Orbital dose was analyzed as a surrogate for LG dose as LGs were difficult to contour on computed tomography (CT) imaging. Results: 73 enrolled patients were eligible for analysis. There were 69 evaluable patients at EndRT, 55 at 1M, 33 at 3M, and 28 at 6M. Most patients received 30 Gy in 10 fractions. Median bilateral orbit mean dose was 17 Gy. Median bilateral lacrimal mean dose was 25 Gy. Median survival was 8 months. At baseline, 4% of patients had moderate or worse dry eye versus 9% at EndRT, 11% at 1M (1-tailed sign test, p = 0.031), 9% at 3M, and 7% at 6M. No significant relationship was noted between presence of dry eye and CT-contoured lacrimal gland or orbit doses. Conclusions: WBRT appears to cause a small increase in dry eye symptoms. A correlation between dry eye and LG dose was not observed, perhaps due to the overall low rate of toxicity, uncertainty in CT-based contouring of the LGs, set-up variations between planned and delivered doses, and the possibility of non-radiation causes of dry eye. Nonetheless, physicians should be aware of the possible occurrence of dry eye after WBRT, given its potential effects on quality of life.

The Louisiana State University Experience in the Management of Single Small Cerebellar Metastasis

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1515-1522 ◽  
Author(s):  
Vijayakumar Javalkar ◽  
Raul Cardenas ◽  
Federico Ampil ◽  
Osama Ahmed ◽  
Runhua Shi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Gamma Knife ◽  
Median Survival ◽  
Gamma Knife Radiosurgery ◽  
Whole Brain Radiation Therapy ◽  
Treatment Modalities ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
Cerebellar Metastasis

Abstract BACKGROUND: Cerebellar metastasis is often believed to be a more immediately life-threatening complication than brain metastasis in other locations. It is considered a negative prognostic factor in patients with systemic cancers. Despite its clinical importance and technological advances, the survival outcomes of patients with single small cerebellar metastases are rarely studied. OBJECTIVE: To retrospectively evaluate our experience in the management of patients with single small cerebellar metastasis and compare the treatment modalities. MATERIAL AND METHODS: A total of 35 patients with single small cerebellar metastasis were included in this retrospective analysis. Of the 35 patients, 24 had surgery followed by whole-brain radiation therapy and 11 had Gamma Knife radiosurgery alone. RESULTS: The median survival for the whole cohort was 5.6 months after the intervention. No significant differences were noted in median survival between the surgery plus whole-brain radiation therapy and the Gamma Knife radiosurgery alone groups (6.3 months: 95% confidence interval [CI], 4.0-8.6; vs 5.0 months: 95% CI, 1.9-8.1; P = .9). There was no difference in the median time to local progression, distance progression, and overall progression between the 2 groups. Patients with hydrocephalus had a significantly lower survival rate (median, 3.3 months; 95% CI, 0.0-6.6) compared with those without hydrocephalus (median, 6.9 months; 95% CI, 4.4-9.8; P = .02). In the Cox regression model, the significant predictor of survival was hydrocephalus (P = .01; hazard ratio, 3.5; 95% CI, 1.3-9.1) after propensity score adjustment. CONCLUSION: Treatment with Gamma Knife radiosurgery alone and surgery plus whole-brain radiation therapy were both efficacious in patients with single small cerebellar metastasis. Overall survival was nearly identical in both treatment groups.

scholarly journals Long-term stabilization of leptomeningeal disease with whole-brain radiation therapy in a patient with metastatic melanoma treated with vemurafenib

2013 ◽  
Vol 23 (2) ◽  
pp. 175-178 ◽  
Author(s):  
Jee Min Lee ◽  
Urvi N. Mehta ◽  
Ly H. Dsouza ◽  
Beverly Ashleigh Guadagnolo ◽  
Deborah L. Sanders ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Metastatic Melanoma ◽  
Whole Brain Radiation Therapy ◽  
Leptomeningeal Disease ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

Results of surgical treatment of patients with multiple brain metastases

2016 ◽  
Vol 21 (3) ◽  
pp. 116-121
Author(s):  
Liudmila R. Kurilina ◽  
A. F Rekhalov ◽  
S. S Pavlov ◽  
V. A Kolesnikov ◽  
P. V Smirnov
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Multiple Brain Metastases ◽  
Whole Brain Radiation ◽  
Brain Radiation

Objective: to evaluate the results of surgical treatment ofpatients with multiple brain metastases and to determine prognostic factors. Material and methods. 57 patients with multiple brain metastases were operated, 146 metastatic foci were removed. All metastases were removed in 42 persons; only large clinically significant metastases were removed in 15 patients. Whole brain radiation therapy was applied in 37patients, alone or in combination with chemotherapy, 20 patients after surgery received only corticosteroid and symptomatic therapy. Results. Median survival time of the whole group was 7.3 months; for patients, who received adjuvant whole brain radiation therapy - 11.6 months. Two-year survival was 8.8 %. The number of patients with Karnofsky performance score ≥ 70 increased from 12 persons (21,1%) at admission to the hospital to 38 (66.7 %) at 9-1th day after surgery. Median survival time for patients with complete resection was 9,2 months, with partial resection - 3,7 months. Prognostic factors were Karnofsky performance score and RPA class, estimated before operation, but after the corticosteroid therapy: median survival time for patients with RPA-class I was 19.5 monthsversus 5.6 months for patients with RPA- class II and III. Conclusions. Surgery rapidly improves the condition of patients with multiple brain metastases and saves the time for postoperative adjuvant treatment. Median survival time for patients who received adjuvant whole brain radiation therapy reaches 11.6 months. Favorable prognostic factors for prolonged survival are total resection of all lesions, RPA-class I and adjuvant whole brain radiation therapy.

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