Outcomes and Prognostic Factors for Patients With Brainstem Metastases Undergoing Stereotactic Radiosurgery

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 796-806 ◽  
Author(s):  
Mustafa Aziz Hatiboglu ◽  
Eric L Chang ◽  
Dima Suki ◽  
Raymond Sawaya ◽  
David M Wildrick ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Confidence Interval ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Lesion Volume ◽  
Local Tumor ◽  
Local Progression

Abstract BACKGROUND: Treatment of tumors metastatic to the brainstem with stereotactic radiosurgery (SRS) has not been widely studied. OBJECTIVE: To identify the effects of SRS on patients with brainstem metastases by assessing duration of local progression-free survival (LPFS) and overall survival. METHODS: We retrospectively reviewed clinical data collected from 60 patients undergoing linear accelerator-based SRS for tumors metastatic to the brainstem between August 1994 and December 2007. The LPFS and overall survival were calculated with the Kaplan-Meier method. Prognostic factors were evaluated with the log-rank test and Cox proportional hazards model. RESULTS: The median age of patients was 61 years (range, 39-85 years); the median treated lesion volume was 1.0 mL (range, 0.1-8.7 mL); and the median SRS dose was 15 Gy (range, 8-18 Gy). The median overall survival interval after SRS was 4 months (95% confidence interval, 3.4-4.9 months); crude local tumor control was 76%; and median LPFS was 5.7 months (95% confidence interval, 3.0-8.4 months). Shorter overall survival was associated with a pretreatment tumor volume ≥4 mL (P < .001) and male sex (P = .03). Shorter LPFS was associated with a pretreatment tumor volume ≥4 mL (P = .008), a melanoma primary tumor (P = .002), and the presence of necrosis in pre-SRS magnetic resonance imaging (P = .04). A Basic Score for Brain Metastases of 2 to 3 vs 1 (P = .007) and a Score Index for Radiosurgery >5 (P = .003) were significantly associated with longer survival. Twelve patients (20%) developed SRS-related complications. CONCLUSION: Stereotactic radiosurgery provides noninvasive treatment and favorable local tumor control for patients with brainstem metastases.

Stereotactic radiosurgery for intracranial hemangiopericytomas: a multicenter study

2017 ◽  
Vol 126 (3) ◽  
pp. 744-754 ◽  
Author(s):  
Or Cohen-Inbar ◽  
Cheng-Chia Lee ◽  
Seyed H. Mousavi ◽  
Hideyuki Kano ◽  
David Mathieu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stereotactic Radiosurgery ◽  
Multicenter Study ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Who Grade ◽  
Local Progression ◽  
Extracranial Metastases

OBJECTIVE Hemangiopericytomas (HPCs) are rare tumors widely recognized for their aggressive clinical behavior, high recurrence rates, and distant and extracranial metastases even after a gross-total resection. The authors report a large multicenter study, through the International Gamma Knife Research Foundation (IGKRF), reviewing management and outcome following stereotactic radiosurgery (SRS) for recurrent or newly discovered HPCs. METHODS Eight centers participating in the IGKRF participated in this study. A total of 90 patients harboring 133 tumors were identified. Patients were included if they had a histologically diagnosed HPC managed with SRS during the period 1988–2014 and had a minimum of 6 months' clinical and radiological follow-up. A de-identified database was created. The patients' median age was 48.5 years (range 13–80 years). Prior treatments included embolization (n = 8), chemotherapy (n = 2), and fractionated radiotherapy (n = 34). The median tumor volume at the time of SRS was 4.9 cm3 (range 0.2–42.4 cm3). WHO Grade II (typical) HPCs formed 78.9% of the cohort (n = 71). The median margin and maximum doses delivered were 15 Gy (range 2.8–24 Gy) and 32 Gy (range 8–51 Gy), respectively. The median clinical and radiographic follow-up periods were 59 months (range 6–190 months) and 59 months (range 6–183 months), respectively. Prognostic variables associated with local tumor control and post-SRS survival were evaluated using Cox univariate and multivariate analysis. Actuarial survival after SRS was analyzed using the Kaplan-Meier method. RESULTS Imaging studies performed at last follow-up demonstrated local tumor control in 55% of tumors and 62.2% of patients. New remote intracranial tumors were found in 27.8% of patients, and 24.4% of patients developed extracranial metastases. Adverse radiation effects were noted in 6.7% of patients. During the study period, 32.2% of the patients (n = 29) died. The actuarial overall survival was 91.5%, 82.1%, 73.9%, 56.7%, and 53.7% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. Local progression–free survival (PFS) was 81.7%, 66.3%, 54.5%, 37.2%, and 25.5% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. In our cohort, 32 patients underwent 48 repeat SRS procedures for 76 lesions. Review of these 76 treated tumors showed that 17 presented as an in-field recurrence and 59 were defined as an out-of-field recurrence. Margin dose greater than 16 Gy (p = 0.037) and tumor grade (p = 0.006) were shown to influence PFS. The development of extracranial metastases was shown to influence overall survival (p = 0.029) in terms of PFS; repeat (multiple) SRS showed additional benefit. CONCLUSIONS SRS provides a reasonable rate of local tumor control and a low risk of adverse effects. It also leads to neurological stability or improvement in the majority of patients. Long-term close clinical and imaging follow-up is necessary due to the high probability of local recurrence and distant metastases. Repeat SRS is often effective for treating new or recurrent HPCs.

Radiosurgery for chordomas and chondrosarcomas of the skull base

2007 ◽  
Vol 107 (4) ◽  
pp. 758-764 ◽  
Author(s):  
Juan J. Martin ◽  
Ajay Niranjan ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
Karl A. Lozanne ◽  
...  
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Local Tumor Control ◽  
Adjunctive Treatment ◽  
Tumor Control ◽  
Local Tumor ◽  
High Tendency ◽  
Local Progression ◽  
Multimodal Management

Object Chordomas and chondrosarcomas of the skull base are aggressive and locally destructive tumors with a high tendency for local progression despite treatment. The authors evaluated the effect of stereotactic radiosurgery (SRS) on local tumor control and survival. Methods Twenty-eight patients with histologically confirmed chordomas (18) or chondrosarcomas (10) underwent Gamma Knife SRS either as primary or adjuvant treatment. Their ages ranged from 17 to 72 years (median 44 years). The most common presenting symptom was diplopia (26 patients, 93%). In two patients, SRS was the sole treatment. Twenty-six patients underwent between one and five additional surgical procedures. Two underwent an initial trans-sphenoidal biopsy. The average tumor volume was 9.8 cm3. The median dose to the tumor margin was 16 Gy. Results No patient was lost to follow-up. Transient symptomatic adverse radiation effects developed in only one patient. The actuarial local tumor control for chondrosarcomas at 5 years was 80 ± 10.1%. For chordomas both the actuarial tumor control and survival was 62.9 ± 10.4%. Conclusions Stereotactic radiosurgery is an important option for skull base chordomas and chondrosarcomas either as primary or adjunctive treatment. Multimodal management appears crucial to improve tumor control in most patients.

scholarly journals PC3 - 138 Stereotactic Radiosurgery for Intracranial Hemangiopericytomas – A Multicenter Study

2016 ◽  
Vol 43 (S4) ◽  
pp. S21-S21
Author(s):  
O. Cohen-Inbar
Keyword(s):  
Stereotactic Radiosurgery ◽  
Multicenter Study ◽  
Radiation Effects ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Who Grade ◽  
Fractionated Radiotherapy ◽  
Local Progression

Hemangiopericytomas (HPC) are widely recognized for their aggressive clinical behavior. We report a large multicenter study, through the International Gamma Knife Research Foundation reviewing management and outcome following stereotactic radiosurgery (SRS) for recurrent or newly-discovered HPC’s. Methods: Eight centers participated, reviewing a total of 90 patients harboring 133 tumors. Prior treatments included embolization (n = 8), chemotherapy (n=2), and fractionated radiotherapy (n=34). The median tumor volume at the time of SRS was 4.9 ml (range 0.2-42.4 ml). WHO-grade II (typical) HPC’s formed 78.9% (n=71) of the cohort. The median margin and maximal doses delivered were 15 Gy (2.8-24) and 32 Gy (8-51), respectively. The median clinical and radiographic follow-up period was 59 months (6-190) and 59 months (6-183), respectively. Results: At last follow-up, 55% of tumors and 62.2% of patients demonstrated local tumor control. New remote intracranial tumors were found in 27.8%. 24.4% of patients developed extra-cranial metastases. Adverse radiation effects were noted in 6.7%. The overall survival was 91.5%, 82.1%, 73.9%, 56.7%, and 53.7% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. Local progression free survival was 81.7%, 66.3%, 54.5%, 37.2%, and 25.5% at 2, 4, 6, 8, and 10 years, respectively, after initial SRS. In our cohort, 32 patients underwent 48 repeat SRS procedures for 76 lesions. Margin dose greater than 16 Gy (p=0.037) and tumor histology (p=0.006) were shown to influence PFS. Conclusions: SRS provides a reasonable rate of local tumor control and a low risk of adverse effects

scholarly journals RADI-09. DEFINING PROGRESSION IN PATIENTS TREATED WITH TEN OR MORE BRAIN METASTASES FOLLOWING STEREOTACTIC RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i23-i23
Author(s):  
Sirisha Devi Viswanatha ◽  
Zaker Rana ◽  
Matthew Ehrlich ◽  
Michael Schulder ◽  
Anuj Goenka
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Tumor Control ◽  
Initial Increase ◽  
Lesion Volume ◽  
Brain Volumes ◽  
Mri Scans

Abstract BACKGROUND: An increasing trend has been to elect for Stereotactic Radiosurgery (SRS) for the treatment of brain metastases. Progression following treatment is typically defined as a 20% increase in the initial lesion volume treated. Challenges in defining progression can arise as the reported incidence of pseudoprogression or radiation necrosis following treatment ranges from 5%-30%. The purpose of this study was to assess patterns of failure in patients treated with 10 or more brain metastases. METHODS: From March 2014 to April 2018, fifty-five patients with 10 or more total brain metastases were retrospectively reviewed following frame-based radiosurgery to a dose of 12–20 Gy. Post-treatment MRI scans were used to assess tumor response in 3 month intervals. Tumor control was defined as tumor volume ≤ 1.2 times the baseline tumor volume at each measured interval. RESULTS: Fifty-five patients received 75 total radiosurgery treatments to 692 tumors. Forty patients received synchronous treatment, while 15 received metachronous treatment. 20 patients (36%) and 72 tumors (10%) experienced progression following treatment. 46 tumors were larger after first MRI in 15 patients (28%). Of these 15 patients, eight had complete resolution in 15 tumors on subsequent scan. Of the eight patients who had resolution, six patients received immunotherapy during and after treatment and all but one patient saw an initial increase >100% of their initial tumor volume. Median overall survival was 11 months. Univariate analysis revealed an association between larger brain volumes irradiated with 12 Gy and decreased overall survival (p < 0.05). CONCLUSION: It is important to consider tumor growth velocity and concurrent therapy when assessing true progression after SRS treatment of brain metastases.

Radiosurgery for Treatment of Recurrent Intracranial Hemangiopericytomas

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 905-911 ◽  
Author(s):  
Jason Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Survival Rates ◽  
Gamma Knife Radiosurgery ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
University Of Pittsburgh ◽  
Kaplan Meier

Abstract OBJECTIVE Hemangiopericytomas are highly aggressive meningeal tumors with tendencies for recurrence and metastasis. The purpose of this retrospective, single-institution review was to evaluate the efficacy and role of stereotactic radiosurgery in the management of recurrent hemangiopericytomas. METHODS We reviewed data for patients who underwent stereotactic radiosurgery at the University of Pittsburgh between 1987 and 2001. Fourteen patients underwent radiosurgery for 15 discrete tumors. Prior treatments included transsphenoidal resection (n = 1), craniotomy and resection (n = 27), embolization (n = 1), and conventional radiotherapy (n = 7). Clinical and radiological responses were evaluated. Follow-up periods varied from 5 to 76 months (mean, 31.3 mo; median, 21 mo). The mean radiation dose to the tumor margin was 15 Gy. RESULTS Seventy-nine percent of patients (11 of 14 patients) with recurrent hemangiopericytomas demonstrated local tumor control after radiosurgery. Twelve of 15 tumors (i.e., 80%) dramatically decreased in size on follow-up imaging scans. Regional intracranial recurrences were retreated with radiosurgery for two patients (i.e., 15%); neither of those two patients experienced long-term tumor control. Local recurrences occurred 12 to 75 months (median, 21 mo) after radiosurgery. Local tumor control and survival rates at 5 years after radiosurgery were 76 and 100%, respectively (Kaplan-Meier method). We could not correlate prior irradiation or tumor size with tumor control. Twenty-nine percent of the patients (4 of 14 patients) developed remote metastases. Radiosurgery did not seem to offer protection against the development of intra- or extracranial metastases. CONCLUSION Gamma knife radiosurgery provided local tumor control for 80% of recurrent hemangiopericytomas. When residual tumor is identified after resection or radiotherapy, early radiosurgery should be considered as a feasible treatment modality. Despite local tumor control, patients are still at risk for distant metastasis. Diligent clinical and radiological follow-up monitoring is necessary.

scholarly journals Single-session and multisession CyberKnife radiosurgery for spine metastases—University of Pittsburgh and Georgetown University experience

2012 ◽  
Vol 17 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Dwight E. Heron ◽  
Malolan S. Rajagopalan ◽  
Brandon Stone ◽  
Steven Burton ◽  
Peter C. Gerszten ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neurological Deficit ◽  
Pain Control ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Single Session ◽  
Local Tumor ◽  
University Of Pittsburgh ◽  
Cyberknife Radiosurgery

Object The authors compared the effectiveness of single-session (SS) and multisession (MS) stereotactic radiosurgery (SRS) for the treatment of spinal metastases. Methods The authors conducted a retrospective review of the clinical outcomes of 348 lesions in 228 patients treated with the CyberKnife radiosurgery at the University of Pittsburgh Cancer Institute and Georgetown University Medical Center. One hundred ninety-five lesions were treated using an SS treatment regimen (mean 16.3 Gy), whereas 153 lesions were treated using an MS approach (mean 20.6 Gy in 3 fractions, 23.8 Gy in 4 fractions, and 24.5 Gy in 5 fractions). The primary end point was pain control. Secondary end points included neurological deficit improvement, toxicity, local tumor control, need for retreatment, and overall survival. Results Pain control was significantly improved in the SS group (SSG) for all measured time points up to 1 year posttreatment (100% vs 88%, p = 0.003). Rates of toxicity and neurological deficit improvement were not statistically different. Local tumor control was significantly better in the MS group (MSG) up to 2 years posttreatment (96% vs 70%, p = 0.001). Similarly, the need for retreatment was significantly lower in the MSG (1% vs 13%, p < 0.001). One-year overall survival was significantly greater in the MSG than the SSG (63% vs 46%, p = 0.002). Conclusions Single-session and MS SRS regimens are both effective in the treatment of spinal metastases. While an SS approach provides greater early pain control and equivalent toxicity, an MS approach achieves greater tumor control and less need for retreatment in long-term survivors.

scholarly journals Local disease control for spinal metastases following “separation surgery” and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients

2013 ◽  
Vol 18 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Ilya Laufer ◽  
J. Bryan Iorgulescu ◽  
Talia Chapman ◽  
Eric Lis ◽  
Weiji Shi ◽  
...  
Keyword(s):  
Low Dose ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Surgical Decompression ◽  
Tumor Control ◽  
High Dose ◽  
Local Tumor ◽  
Single Fraction ◽  
Tumor Histology ◽  
Local Progression

Object Decompression surgery followed by adjuvant radiotherapy is an effective therapy for preservation or recovery of neurological function and achieving durable local disease control in patients suffering from metastatic epidural spinal cord compression (ESCC). The authors examine the outcomes of postoperative image-guided intensity-modulated radiation therapy delivered as single-fraction or hypofractionated stereotactic radiosurgery (SRS) for achieving long-term local tumor control. Methods A retrospective chart review identified 186 patients with ESCC from spinal metastases who were treated with surgical decompression, instrumentation, and postoperative radiation delivered as either single-fraction SRS (24 Gy) in 40 patients (21.5%), high-dose hypofractionated SRS (24–30 Gy in 3 fractions) in 37 patients (19.9%), or low-dose hypofractionated SRS (18–36 Gy in 5 or 6 fractions) in 109 patients (58.6%). The relationships between postoperative adjuvant SRS dosing and fractionation, patient characteristics, tumor histology–specific radiosensitivity, grade of ESCC, extent of surgical decompression, response to preoperative radiotherapy, and local tumor control were evaluated by competing risks analysis. Results The total cumulative incidence of local progression was 16.4% 1 year after SRS. Multivariate Gray competing risks analysis revealed a significant improvement in local control with high-dose hypofractionated SRS (4.1% cumulative incidence of local progression at 1 year, HR 0.12, p = 0.04) as compared with low-dose hypofractionated SRS (22.6% local progression at 1 year, HR 1). Although univariate analysis demonstrated a trend toward greater risk of local progression for patients in whom preoperative conventional external beam radiation therapy failed (22.2% local progression at 1 year, HR 1.96, p = 0.07) compared with patients who did not receive any preoperative radiotherapy (11.2% local progression at 1 year, HR 1), this association was not confirmed with multivariate analysis. No other variable significantly correlated with progression-free survival, including radiation sensitivity of tumor histology, grade of ESCC, extent of surgical decompression, or patient sex. Conclusions Postoperative adjuvant SRS following epidural spinal cord decompression and instrumentation is a safe and effective strategy for establishing durable local tumor control regardless of tumor histology–specific radiosensitivity. Patients who received high-dose hypofractionated SRS demonstrated 1-year local progression rates of less than 5% (95% CI 0%–12.2%), which were superior to the results of low-dose hypofractionated SRS. The local progression rate after single-fraction SRS was less than 10% (95% CI 0%–19.0%).

Stereotactic radiosurgery for cerebral metastatic melanoma

1993 ◽  
Vol 79 (5) ◽  
pp. 661-666 ◽  
Author(s):  
Salvador Somaza ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
John M. Kirkwood ◽  
John C. Flickinger
Keyword(s):  
Stereotactic Radiosurgery ◽  
Systemic Disease ◽  
Tumor Resection ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Local Tumor ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Content Type ◽  
Fine Print

✓ To determine local tumor control rates and survival of patients with melanoma metastases to the brain, the authors reviewed the results of 23 consecutive patients with a total of 32 tumors (19 patients had a solitary tumor and four had multiple tumors) who underwent adjuvant stereotactic radiosurgery. Tumor locations included the cerebral hemisphere (24 cases), brain stem (four cases), basal ganglia (two cases), and cerebellum (two cases). Fifteen patients had associated cranial symptomatology and eight had incidental metastases. All patients had tumors of 3 cm or less in diameter (mean tumor volume 2.5 cu cm), and all received fractionated whole-brain radiation therapy (30 Gy) in addition to radiosurgery (mean tumor margin dose 16 Gy). Nineteen patients were managed with both modalities at the time of diagnosis; four underwent radiosurgery 3 to 12 months after fractionated whole-brain radiotherapy. The mean patient follow-up period was 12 months (range 3 to 38 months). After radiosurgery, eight patients improved, 13 remained stable, and two deteriorated. One patient subsequently required craniotomy because of intratumoral hemorrhage; this patient and three others are living 13 to 38 months after radiosurgery. Nineteen patients died, 18 from progression of their systemic disease and one from another hemorrhage into a new brain metastasis. The local tumor control rate was 97%. Only two patients subsequently developed new intracranial metastases. The median survival period after diagnosis was 9 months (range 3 to 38 months). The authors believe that stereotactic radiosurgery coupled with fractionated whole-brain irradiation is an effective management strategy for cerebral metastases from a melanoma. Multi-institutional trials are warranted to confirm that stereotactic radiosurgery results equal or surpass the outcome achieved with craniotomy and tumor resection.

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