The Role of Radio Surgery in Brain Metastases Treatment – Attaining Local Control

Abstract BACKGROUND: Optimal postoperative management paradigm for brain metastases remains controversial. OBJECTIVE: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases. METHODS: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate. RESULTS: Fourteen studies involving 629 patients were included. Median survival for all studies was 14 months. Local control was correlated with the median volume treated with radiosurgery (r = −0.766, P < .05) and with the rate of gross total resection (r = .728, P < .03). Mean crude local control was 83%; 1-year local control was 85%. Distant intracranial failure occurred in 49% of cases, and salvage whole-brain radiation therapy was required in 29% of cases. Use of a radiosurgical margin did not lead to increased local control or overall survival. CONCLUSION: Our systematic review supports the use of radiosurgery as a safe and effective strategy for adjuvant treatment of brain metastases, particularly when gross total resection has been achieved. With all limitations of comparisons between studies, no increase in local recurrence or decrease in overall survival compared with rates with adjuvant whole-brain radiation therapy was found.

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Role of Surgical Resection in Patients with Single Large Brain Metastases: Feasibility, Morbidity, and Local Control Evaluation

World Neurosurgery ◽

10.1016/j.wneu.2016.06.098 ◽

2016 ◽

Vol 94 ◽

pp. 6-12 ◽

Cited By ~ 14

Author(s):

Federico Pessina ◽

Pierina Navarria ◽

Luca Cozzi ◽

Anna Maria Ascolese ◽

Giulia Maggi ◽

...

Keyword(s):

Brain Metastases ◽

Surgical Resection ◽

Local Control ◽

Large Brain ◽

Control Evaluation

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The Role of Tumor Size in the Radiosurgical Management of Patients with Ambiguous Brain Metastases

Neurosurgery ◽

10.1227/01.neu.0000073546.61154.9a ◽

2003 ◽

Vol 53 (2) ◽

pp. 272-281 ◽

Cited By ~ 69

Author(s):

Eric L. Chang ◽

Samuel J. Hassenbusch ◽

Almon S. Shiu ◽

Frederick F. Lang ◽

Pamela K. Allen ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Local Control ◽

Medical Records ◽

Tumor Volume ◽

Unknown Primary ◽

Inclusion Criteria ◽

Peripheral Dose

Abstract OBJECTIVE To identify a size cutoff below which it is safe to observe obscure brain lesions suspected of being metastases so that treatment of nonmetastases can be avoided. METHODS Medical records from patients who underwent linear accelerator-based radiosurgery from August 1991 to October 2001 were reviewed. Inclusion criteria were defined as brain metastasis tumor volume less than 5 cm3 (diameter, ∼2.1 cm) treated with a dose of 20 Gy or more. One hundred thirty-five patients had 153 evaluable brain metastases with follow-up imaging that met inclusion criteria. Median age was 54 years (range, 18–79 yr). Lesion primaries were non-small-cell lung (n = 39), melanoma (n = 44), renal (n = 37), breast (n = 18), colon (n = 3), sarcoma (n = 5), other (n = 5), and unknown primary (n = 2). Median tumor volume was 0.67 cm3 (range, 0.06–4.58 cm3). The minimum peripheral dose was 20 Gy (n = 132) or 21 to 24 Gy (n = 21). At the time of analysis, the median follow-up for all patients was 10 months (range, 0.2–99 mo). RESULTS The 1- and 2-year actuarial local control rates for all of the lesions were 69 and 46%, respectively. For lesions of 1 cm (0.5 cm3) or less, the corresponding local control rates were 86 and 78%, respectively, which was significantly higher than the corresponding rates of 56 and 24%, respectively, for lesions larger than 1 cm (0.5 cm3) (P = 0.0016). CONCLUSION A convincing brain metastasis measuring less than 1 cm should be pursued aggressively. If the suspected brain metastasis is ambiguous, observation is proposed up to a diameter of 1 cm. This is the first study in the literature to identify a 1-cm cutoff for radiosurgical control of small brain metastases, and validation by additional studies is required.

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The Expanding Role of Radiosurgery for Brain Metastases

10.20944/preprints201807.0455.v1 ◽

2018 ◽

Author(s):

Mark O'Beirn ◽

Helen Benghiat ◽

Sara Meade ◽

Geoff Heyes ◽

Vijay Sawlani ◽

...

Keyword(s):

Brain Metastases ◽

Local Control ◽

Systemic Disease ◽

Whole Brain Radiotherapy ◽

Targeted Agents ◽

Brain Radiotherapy ◽

Multiple Metastases ◽

Rising Incidence ◽

Molecular Information

Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole brain radiotherapy (WBRT) improved local control rates versus WBRT alone. Concerns with WBRT associated neurocognitive toxicity have contributed to greater use of SRS alone, including for patients with multiple metastases and following surgical resection. Molecular information, targeted agents and immunotherapy have also altered the landscape for the management of brain metastases. This review summarises current and emerging data on the role of SRS in the management of brain metastases.

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The Expanding Role of Radiosurgery for Brain Metastases

Medicines ◽

10.3390/medicines5030090 ◽

2018 ◽

Vol 5 (3) ◽

pp. 90 ◽

Cited By ~ 9

Author(s):

Mark O’Beirn ◽

Helen Benghiat ◽

Sara Meade ◽

Geoff Heyes ◽

Vijay Sawlani ◽

...

Keyword(s):

Brain Metastases ◽

Local Control ◽

Systemic Disease ◽

Whole Brain Radiotherapy ◽

Targeted Agents ◽

Brain Radiotherapy ◽

Multiple Metastases ◽

Rising Incidence ◽

Molecular Information

Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole-brain radiotherapy (WBRT) improved local control rates compared with WBRT alone. Concerns with WBRT associated neurocognitive toxicity have contributed to a greater use of SRS alone, including for patients with multiple metastases and following surgical resection. Molecular information, targeted agents, and immunotherapy have also altered the landscape for the management of brain metastases. This review summarises current and emerging data on the role of SRS in the management of brain metastases.

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Long-term management of patients with multiple brain metastases after shaped beam radiosurgery

Journal of Neurosurgery ◽

10.3171/jns.2004.101.supplement_3.0406 ◽

2004 ◽

pp. 406-412

Author(s):

Paul Okunieff ◽

Michael C. Schell ◽

Russell Ruo ◽

E. Ronald Hale ◽

Walter G. O'Dell ◽

...

Keyword(s):

Brain Metastases ◽

Tumor Control ◽

Content Type ◽

Negative Results ◽

Multiple Metastases ◽

Extracranial Disease ◽

Successful Control ◽

The Brain

✓ The role of radiosurgery in the treatment of patients with advanced-stage metastatic disease is currently under debate. Previous randomized studies have not consistently supported the use of radiosurgery to treat patients with numbers of brain metastases. In negative-results studies, however, intracranial tumor control was high but extracranial disease progressed; thus, patient survival was not greatly affected, although neurocognitive function was generally maintained until death. Because the future promises improved systemic (extracranial) therapy, the successful control of brain disease is that much more crucial. Thus, for selected patients with multiple metastases to the brain who remain in good neurological condition, aggressive lesion-targeting radiosurgery should be very useful. Although a major limitation to success of this therapy is the lack of control of extracranial disease in most patients, it is clear that well-designed, aggressive treatment substantially decreases the progression of brain metastases and also improves neurocognitive survival. The authors present the management and a methodology for rational treatment of a patient with breast cancer who has harbored 24 brain metastases during a 3-year period.

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Erratum to: The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline

Journal of Neuro-Oncology ◽

10.1007/s11060-009-0099-7 ◽

2010 ◽

Vol 96 (1) ◽

pp. 69-70 ◽

Cited By ~ 4

Author(s):

Mark E. Linskey ◽

David W. Andrews ◽

Anthony L. Asher ◽

Stuart H. Burri ◽

Douglas Kondziolka ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Evidence Based ◽

Newly Diagnosed

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Extrapulmonary Small Cell Cancer: A New Insight into a Rare Disease

Oncology ◽

10.1159/000514520 ◽

2021 ◽

pp. 1-7

Author(s):

Leora Brazg Ferro ◽

Ido Wolf ◽

Shira Peleg Hasson ◽

Inbal Golomb ◽

Ester Osher ◽

...

Keyword(s):

Brain Metastases ◽

Response Rate ◽

Medical Center ◽

Cell Cancer ◽

Small Cell ◽

Ki 67 ◽

Small Cell Cancer ◽

Pathological Characteristics ◽

Results Of Treatment

Introduction: Extrapulmonary small-cell cancer (EPSCC) is a relatively rare malignancy. The management of EPSCC is usually extrapolated from small-cell lung cancer (SCLC). In spite of the morphological similarity of the 2 malignancies, there are many differences in clinical features, prognosis, and recommendations of treatment of these disorders. The data on the correlation of clinical-pathological characteristics of EPSCC and treatment results is scarce. Materials and Methods: This retrospective analysis of 41 consecutively treated patients diagnosed with EPSCC in 2015–2018 was performed in a tertiary medical center. The correlation between the clinical and pathological characteristics and the treatment outcome (response rate, disease-free interval, and overall medial survival) was done using the standard statistics, Kaplan-Meier method, and multivariate analyses. The stratification was done on the stage of the disease, Ki-67 proliferative index, the location of the tumor, and smoking. Results: Forty-one patients were included with a median age of 66.3 years. The most common primary site was the gastrointestinal tract (28, 68.3%) including the pancreas. The most common distant metastasis site was the liver (23, 56.1%). Only 2 patients (4.9%) had brain metastases. Unlike in SCLC, most patients did not have any history of smoking (23, 56.1%). Nineteen patients with metastatic disease received systemic treatment, mostly cisplatin-based chemotherapy, with a response rate of 57.9%. The results of treatment were significantly better in patients with disseminated EPSCC with Ki-67 <55%, while its role in limited disease was nonsignificant. Discussion: The results of our study show the unique entity of EPSCC. The rarity of brain metastases proves that prophylactic brain irradiation should not be recommended in practice. The provocative idea of prophylactic liver irradiation in limited-stage EPSCC of gastrointestinal origin can be evaluated in future studies. The predictive role of Ki-67 is important in metastatic EPSCC. There is probably no role of smoking in developing EPSCC.

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