scholarly journals Salvage Surgical Resection after Linac-Based Stereotactic Radiosurgery for Newly Diagnosed Brain Metastasis

2021 ◽  
Vol 28 (6) ◽  
pp. 5255-5265
Author(s):  
Ryosuke Matsuda ◽  
Takayuki Morimoto ◽  
Tetsuro Tamamoto ◽  
Nobuyoshi Inooka ◽  
Tomoko Ochi ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Survival Time ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Statistical Significance ◽  
Cyst Formation ◽  
Histopathological Diagnosis ◽  
Newly Diagnosed

Background: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for newly diagnosed brain metastasis. Methods: Between November 2009 and May 2020, 318 consecutive patients with 1114 brain metastases were treated with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During this study period, 21 of 318 patients (6.6%) and 21 of 1114 brain metastases (1.9%) went on to receive SSR after SRS/fSRT. Three patients underwent multiple surgical resections. Twenty-one consecutive patients underwent twenty-four SSRs. Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 17 months (range: 2–78 months). The range of tumor volume at initial SRS/fSRT was 0.12–21.46 cm3 (median: 1.02 cm3). Histopathological diagnosis after SSR was recurrence in 15 cases, and radiation necrosis (RN) or cyst formation in 6 cases. The time from SRS/fSRT to SSR was shorter in the recurrence than in the RNs and cyst formation, but these differences did not reach statistical significance (p = 0.067). The median survival time from SSR and from initial SRS/fSRT was 17 and 74 months, respectively. The cases with recurrence had a shorter survival time from initial SRS/fSRT than those without recurrence (p = 0.061). Conclusions: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.

Salvage Surgical Resection After Linac-based Stereotactic Radiosurgery and Radiotherapy for Newly Diagnosed Brain Metastasis

2021 ◽  
Author(s):  
Ryosuke Matsuda ◽  
Takayuki Morimoto ◽  
Tetsuro Tamamoto ◽  
Nobuyoshi Inooka ◽  
Tomoko Ochi ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Survival Time ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Cyst Formation ◽  
Histopathological Diagnosis ◽  
Newly Diagnosed ◽  
Long Term Follow Up

Abstract Purpose: This study aimed to assess the clinical outcomes of salvage surgical resection (SSR) after stereotactic radiosurgery and fractionated stereotactic radiotherapy (SRS/fSRT) for brain metastasis.Methods: Between November 2009 and December 2018, we treated 427 consecutive patients with 919 lesions with SRS/fSRT for newly diagnosed brain metastasis at our hospital. During the follow-up period, we treated 19 consecutive patients who underwent 21 SSRs for recurrence, radiation necrosis (RN), and cyst formation after SRS/fSRT for newly diagnosed brain metastasis. Two patients underwent multiple surgical resections. Brain metastasis originated from the lung (n=15, 78.9%), breast (n=3, 15.7%), and colon (n=1, 5.2%). Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 15 months (range: 2–76 months). The range of tumor volume at initial SRS/SRT was 0.121–21.459 cm3 (median: 2.188 cm3). Histopathological diagnosis after SSR was recurrence, RN and cyst formation in 13 and 6 cases, respectively. The median survival time from SSR and from initial SRS/SRT was 17 months and 74 months, respectively. The cases with recurrence had a significantly shorter survival time than those without recurrence (p=0.0453).Conclusion: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.

scholarly journals MET-5 Salvage surgical resection after linac-based stereotactic radiosurgery and radiotherapy for brain metastasis

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi25-vi25
Author(s):  
Ryosuke Matsuda ◽  
Takayuki Morimoto ◽  
Tetsuro Tamamoto ◽  
Masashi Kotsugi ◽  
Yasuhiro Takeshima ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Survival Time ◽  
Statistical Significance ◽  
Cyst Formation ◽  
Histopathological Diagnosis ◽  
Long Term Follow Up ◽  
To Receive

Abstract Methods: Between November 2009 and December 2018, 335 consecutive patients with 1085 brain metastases were treated with SRS/fSRT for newly diagnosed brain metastasis at our hospital. Nineteen of 335 patients (5.6%) and 19 of 1044 brain metastases (1.8%) went on to receive SSR after SRS/fSRT during this study period. Two patients underwent multiple surgical resections. Nineteen consecutive patients underwent 21 SSRs. Results: The median time from initial SRS/fSRT to SSR was 14 months (range: 2–96 months). The median follow-up after SSR was 15 months (range: 2–76 months). The range of tumor volume at initial SRS/fSRT was 0.12–21.46 cm3 (median: 2.19 cm3). Histopathological diagnosis after SSR was recurrence, radiation necrosis (RN) and cyst formation in 13 and 6 cases, respectively. The time from SRS/fSRT to SSR were shorter in the recurrence than in the RNs and cyst formation, but these differences did not reach statistical significance (p = 0.07). The median survival time from SSR and from initial SRS/fSRT was 17 months and 74 months, respectively. The cases with recurrence had a significantly shorter survival time from initial SRS/fSRT than those without recurrence (p=0.045).Conclusion: The patients treated with SRS/fSRT for brain metastasis need long-term follow-up. SSR is a safe and effective treatment for the recurrence, RN, and cyst formation after SRS/fSRT for brain metastasis.

scholarly journals TRLS-09. RTOG1119: PHASE II RANDOMIZED STUDY OF WHOLE BRAIN RADIOTHERAPY / STEREOTACTIC RADIOSURGERY IN COMBINATION WITH CONCURRENT LAPATINIB IN PATIENTS WITH BRAIN METASTASIS FROM HER2-POSITIVE BREAST CANCER

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i10-i10
Author(s):  
In Ah Kim ◽  
Kathryn Winter ◽  
David Peereboom ◽  
Paul Sperduto ◽  
Jennifer De Los Santos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Disease Control ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Response Rate ◽  
Her2 Positive ◽  
Positive Breast Cancer

Abstract The addition of trastuzumab to cytotoxic chemotherapy has improved outcomes for patients with HER2 positive breast cancer. Increased survival coupled with limited blood-brain barrier (BBB) penetration of trastuzumab may contribute to the increased incidence of brain metastasis in these patients. Half of these patients die of intracranial disease progression rather than extracranial disease. Therefore, strategies to improve survival must include increased CNS disease control in these patients. Lapatinib crosses the BBB and demonstrates modest activity against intracranial metastases. Based upon preclinical data and results of a phase I study, we hypothesized that lapatinib plus WBRT /SRS can improve the intracranial disease control compared to WBRT / SRS alone. A randomized phase II trial of WBRT (37.5 Gy/3 weeks) or SRS plus or minus concurrent lapatinib (daily 1000 mg for 6 weeks) was initiated. CNS penetrating HER2 targeted therapy is permitted throughout the study, but patients not on trastuzumab, pertuzumab or any other breast cancer therapy at study entry are not permitted to begin this therapy while on protocol treatment, but may begin it 24 hours after completion of protocol treatment. Eligibility includes HER2+ breast cancer with at least one measurable, unirradiated parenchymal brain metastasis. The two populations targeted for accrual include patients with 1) newly diagnosed, multiple brain metastases or 2) progressive brain metastases after stereotactic radiosurgery (SRS) or surgical resection of 1–3 metastases. Prior lapatinib is allowed. Patients are stratified by breast-specific graded prognostic assessment; use of non-CNS penetrating HER2 targeted therapy; and prior SRS or surgical resection. The primary endpoint is complete response rate in the brain 12 weeks after WBRT. Secondary endpoints include objective response rate, lesion-specific response rate, CNS progression-free survival, and overall survival. 140 of 143 target accrual have enrolled (4/22/2019).

Quality of Life following Stereotactic Radiosurgery for Single and Multiple Brain Metastases

Neurosurgery ◽  
2017 ◽  
Vol 81 (1) ◽  
pp. 147-155 ◽  
Author(s):  
Jacob A. Miller ◽  
Rupesh Kotecha ◽  
Gene H. Barnett ◽  
John H. Suh ◽  
Lilyana Angelov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Minimum Clinically Important Difference ◽  
Clinically Important Difference ◽  
Patient Health ◽  
Appropriate Therapy

Abstract BACKGROUND: Given the neurological morbidity and poor prognosis associated with brain metastases, it is critical to deliver appropriate therapy while remaining mindful of patient quality of life (QOL). For many patients, stereotactic radiosurgery (SRS) effectively controls intracranial disease, but QOL outcomes have not been characterized. OBJECTIVE: To determine the effect of number of brain metastases upon QOL preservation following SRS. METHODS: The EuroQol 5 Dimensions questionnaire (EQ-5D) and Patient Health Questionnaire 9 instruments were prospectively collected from a cohort of patients undergoing SRS for brain metastasis between 2008 and 2015. These instruments served as measures of overall QOL and depression. QOL deterioration exceeding the minimum clinically important difference was considered failure. Freedom from 12-month EQ-5D index failure was the primary outcome. RESULTS: One hundred and twenty-two SRS treatments (67 patients, 421 lesions) were eligible for inclusion. Intracranial failure (local or distant) occurred following 61% of treatments. Among 421 lesions, 8% progressed locally. Median follow-up was 12 months. All subscores of the EQ-5D instrument expectantly worsened at last follow-up; however, the magnitude of this difference (0.079) did not exceed the EQ-5D index minimum clinically important difference (mean 0.752 vs 0.673, P < .01). Twelve-month EQ-5D index QOL preservation was 79%. Patients with more than 3 brain metastases had a greater rate of EQ-5D index deterioration (hazard ratio 4.14, P < .01) than those with a single metastasis. CONCLUSIONS: Among patients with brain metastasis, QOL preservation must remain paramount as multimodality therapy continues to improve. In the present investigation, 12-month QOL preservation was 79%. However, patients with more than 3 brain metastases were at significantly greater risk for QOL decline.

scholarly journals Stereotactic Radiosurgery for Renal Cancer Brain Metastasis: Prognostic Factors and the Role of Whole-Brain Radiation and Surgical Resection

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Franziska M. Ippen ◽  
Anand Mahadevan ◽  
Eric T. Wong ◽  
Erik J. Uhlmann ◽  
Soma Sengupta ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Patient Treatment ◽  
Consecutive Series ◽  
Additional Surgery

Background. Renal cell carcinoma is a frequent source of brain metastasis. We present our consecutive series of patients treated with Stereotactic Radiosurgery (SRS) and analyse prognostic factors and the interplay of WBRT and surgical resection.Methods. This is a retrospective study of 66 patients with 207 lesions treated with the Cyberknife radiosurgery system in our institution. The patients were followed up with imaging and clinical examination 1 month and 2-3 months thereafter for the brain metastasis. Patient, treatment, and outcomes characteristics were analysed.Results. 51 male (77.3%) and 15 female (22.7%) patients, with a mean age of 58.9 years (range of 31–85 years) and a median Karnofsky Performance Status (KPS) of 90 (range of 60–100), were included in the study. The overall survival was 13.9 months, 21.9 months, and 5.9 months for the patients treated with SRS only, additional surgery, and WBRT, respectively. The actuarial 1-year Local Control rates were 84%, 94%, and 88% for SRS only, for surgery and SRS, and for WBRT and additional SRS, respectively.Conclusions. Stereotactic radiosurgery is a safe and effective treatment option in patients with brain metastases from RCC. In case of a limited number of brain metastases, surgery and SRS might be appropriate.

scholarly journals Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry

2019 ◽  
Vol 131 (6) ◽  
pp. 1848-1854 ◽  
Author(s):  
Jason P. Sheehan ◽  
Inga Grills ◽  
Veronica L. Chiang ◽  
Huamei Dong ◽  
Arthur Berg ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
National Registry ◽  
Karnofsky Performance Scale ◽  
Linear Regression Models ◽  
Anxiety Depression

OBJECTIVEStereotactic radiosurgery (SRS) is increasingly used for the treatment of brain metastasis. To date, most studies have focused on survival, radiological response, or surrogate quality endpoints such as Karnofsky Performance Scale status or neurocognitive indices. The current study prospectively evaluated pre-procedural factors impacting quality of life in brain metastasis patients undergoing SRS.METHODSUsing a national, cloud-based platform, patients undergoing SRS for brain metastasis were accrued to the registry. Quality of life prior to SRS was assessed using the 5-level EQ-5D (EQ5D-L) validated tool; additionally, patient and treatment attributes were collected. Patient quality of life was assessed as part of routine follow-up after SRS. Factors predicting a difference in the aggregate EQ5D-L score or the subscores were evaluated. Pre-SRS covariates impacting changes in EQ5D-L were statistically evaluated. Statistical analyses were conducted using multivariate linear regression models.RESULTSEQ5D-L results were available for 116 patients. EQ5D-L improvement (average of 0.387) was noted in patients treated with earlier SRS (p = 0.000175). Worsening overall EQ5D-L (average of 0.052 per lesion) was associated with an increased number of brain metastases at the time of initial presentation (p = 0.0399). Male sex predicted a risk of worsening (average of 0.347) of the pain and discomfort subscore at last follow-up (p = 0.004205). Baseline subscores of pain/discomfort were not correlated with pain/discomfort subscores at follow-up (p = 0.604), whereas baseline subscores of anxiety/depression were strongly positively correlated with the anxiety/depression follow-up subscores (p = 0.0039).CONCLUSIONSAfter SRS, quality of life was likely to improve in patients treated early with SRS and worsen in those with a greater number of brain metastases. Sex differences appear to exist regarding pain and discomfort worsening after SRS. Those with high levels of anxiety and depression at SRS may benefit from medical treatment as this particular quality of life factor generally remains unchanged after SRS.

A PILOT STUDY OF NEUROCOGNITIVE FUNCTION IN PATIENTS WITH ONE TO THREE NEW BRAIN METASTASES INITIALLY TREATED WITH STEREOTACTIC RADIOSURGERY ALONE

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Eric L. Chang ◽  
Jeffrey S. Wefel ◽  
Moshe H. Maor ◽  
Samuel J. Hassenbusch ◽  
Anita Mahajan ◽  
...  
Keyword(s):  
Executive Function ◽  
Pilot Study ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Neurocognitive Function ◽  
Newly Diagnosed ◽  
Whole Brain Radiation ◽  
Motor Dexterity ◽  
Improved Learning

Abstract OBJECTIVE Whether to administer or omit adjuvant whole-brain radiation therapy in conjunction with stereotactic radiosurgery (SRS) in the initial management of patients with one to three newly diagnosed brain metastases is the subject of debate. This report provides data from a pilot study in which neurocognitive function (NCF) was prospectively measured for patients with one to three newly diagnosed brain metastases treated with initial SRS alone. METHODS Fifteen patients were prospectively treated with initial SRS alone. Assessment of NCF and magnetic resonance imaging scans were performed. RESULTS At baseline, 67% of the patients had impairment on one or more tests of NCF. The domains most frequently impaired at baseline were executive function, motor dexterity, and learning/memory with an incidence of 50, 40, and 27% respectively. Brain metastasis volume (.3 cm3) measured at the time of initial SRS treatment was associated with worse performance on a measure of attention (P < 0.05). At 1 month, declines in the learning/memory and motor dexterity domains were most common. In a subgroup of five patients still alive 200 days after enrollment, four patients (80%) demonstrated stable or improved learning/memory, three (60%) demonstrated stable or improved executive function, and three (60%) demonstrated stable or improved motor dexterity relative to their baseline evaluation. CONCLUSION Although two-thirds of the brain metastasis patients had impaired NCF at baseline, the majority of five long-term survivors had stable or improved NCF performance across executive function, learning/memory, and motor dexterity.

196 Checkpoint blockade therapy for brain-metastatic non-small cell lung cancer: a comparative effectiveness analysis of national data

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A211-A211
Author(s):  
Nayan Lamba ◽  
Bryan Iorgulescu
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Advanced Nsclc ◽  
Small Cell ◽  
Second Line ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Survival Analyses ◽  
Stage 4 ◽  
Insured Patients

BackgroundManagement of advanced non-small cell lung carcinoma (NSCLC) has been transformed by PD-1/PD-L1 immune checkpoint inhibitors (ICI), with FDA approvals in 2015 (second-line) and 2016 (first-line). Despite ~40% of NSCLC patients developing brain metastases, these patients were disproportionately excluded from the pioneering ICI trials. Thus herein we evaluate the overall survival (OS) associated with ICI in NSCLC brain metastases nationally.MethodsPatients newly-diagnosed with stage 4 NSCLC, including brain metastases, from 2010–2016 were identified from the National Cancer Database (comprising >70% of all newly-diagnosed cancers in the U.S.) Landmark survival analysis was used to address immortal time bias. Post-approval, median time from diagnosis to ICI was 58 days, and this timepoint was selected for all landmark survival analyses (OS estimated by Kaplan-Meier technique, and compared by logrank test and multivariable Cox regression) and for multivariable logistic regression to identify predictors of ICI utilization.Results50,858 patients presented with advanced NSCLC that involved the brain: representing 27.6% of all newly-diagnosed stage 4 cases. Following initial FDA approvals in 2015, ICI use in brain metastasis patients rose from 7.2% in 2015 to 12.7% in 2016. OS for NSCLC brain metastasis patients diagnosed post-approval (i.e. 2015, median 6.3 months, 95% [confidence interval] CI: 6.0–6.6) was substantially better than those diagnosed pre-approval (median 5.5 months, 95%CI: 5.4–5.7, p<0.001) and, in fact, than those diagnosed in 2014 (median 5.9 months, 95%CI: 5.6–6.1, p=0.002). Among patients diagnosed post-approval (in 2015, n=7,431), ICI receipt demonstrated substantially improved OS in landmark survival analyses (median 13.8 months, 95%CI: 12.2–15.1; vs. 8.5 months, 95%CI: 8.3–8.9, p<0.001) – benefits which persisted in multivariable landmark survival analyses (hazard ratio [HR] 0.83, 95%CI: 0.71–0.96, p=0.02), independent of patient characteristics, other therapies, and extracranial disease. For patients diagnosed post-approval, who reached the landmark timepoint, ICI receipt was independent of patient demographics, socioeconomic status, and hospital type—with the exception of Medicaid-insured patients, who were less likely than privately insured patients to receive ICI (OR 0.77, 95%CI: 0.60–0.97, p=0.03).ConclusionsNationally, the use of ICI for NSCLC brain metastasis patients is increasing, generally without significant socioeconomic barriers. Brain metastasis patients diagnosed in the post-approval second-line ICI era (2015) demonstrated significantly better OS than patients diagnosed pre-approval and even than patients diagnosed only in 2014. ICI was associated with a >60% relative increase in median OS. Together our findings from a real-world population demonstrate that the dramatic OS benefits of ICIs for advanced NSCLC also extended to brain metastasis patients.

161: Surgical Resection(S) Plus Stereotactic Radiosurgery (SRS) Versus SRS Alone for Large Brain Metastases: A Comparative Study

2021 ◽  
Vol 163 ◽  
pp. S68
Author(s):  
Barbara-Ann Millar ◽  
Normand Laperriere ◽  
Tatiana Conrad ◽  
Aristotelis Kalyvas ◽  
Gelareh Zadeh ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Comparative Study ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Large Brain
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