Stereotactic radiosurgery for single or oligometastatic brain lesions: A single institutional experience

Abstract INTRODUCTION Despite increasing use of stereotactic radiosurgery (SRS) for management of brain metastases (BM), published Australian data is scarce. We aim to report on the outcomes following SRS for limited BM in a single Australian institution. METHODS This is a retrospective cohort of patients with limited BM treated with SRS between August 2015 and March 2019. A dose of 24Gy/3# were prescribed to intact lesion, and 21Gy/3# to surgical cavity post-surgical resection. All patients were followed with 3-monthly surveillance MRI brain. Primary outcomes were: local failure (LF: increased in size of SRS-treated BM lesion/ recurrence in surgical cavity), distant failure (DF: intracranial progression outside of the SRS-treated lesion/ cavity), and overall survival (OS). LF, DF and OS were estimated using the Kaplan-Meier method. Multivariate Cox regressions were used to evaluate factors associated with outcomes of interest, with death as competing-risk events for LF and DF. RESULTS 76 courses of SRS were delivered in 65 patients (54 unresected BM lesions, and 22 surgical cavities). 43 (66%) patients were ECOG 0–1. 35 (54%) patients had solitary BM. 41 (63%) had symptomatic BM. Half of the patients had primary lung cancer. Median follow-up was 4.8 months (range:0.1–39 months). 10 LF were observed at a median of 3.5 month post-SRS, with 6- and 12-month LF cumulative incidence of 14% and 24% respectively. 30 DF were observed at a median of 3.3 months, with 6- and 12-month DF cumulative incidence of 38% and 63% respectively. The 12- and 24-month OS were 39% and 26% respectively. In multivariate analyses, better ECOG status, solitary BM lesion, resection of BM pre-SRS, and use of subsequent systemic therapy were independently associated with improved OS. CONCLUSION This is one of the few Australian series reporting on outcomes following SRS for limited BM, with comparable outcomes to published international series.

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RTHP-04. PEDIATRIC STEREOTACTIC RADIOSURGERY FOR BENIGN NEUROLOGIC DISEASE: A 25-YEAR INSTITUTIONAL EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noz175.877 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi210-vi210

Author(s):

Alexander Sherry ◽

Brian Bingham ◽

Ellen Kim ◽

Benjin Facer ◽

Valentine Chukwuma ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Venous Malformation ◽

Disease Free Survival ◽

Neurologic Disease ◽

Institutional Review ◽

Median Total Dose ◽

Institutional Experience ◽

One Year

Abstract Long-term outcomes and sequalae of pediatric stereotactic radiosurgery (SRS) for benign neurologic disease are poorly understood. We sought to explore the efficacy and late effects of SRS in pediatric patients treated our institution. After institutional review board approval, we performed a retrospective analysis of patients age 21 or younger treated between 1990 and 2016. Covariates were summarized with descriptive statistics. 56 consecutive patients were enrolled. Patients were primarily Caucasian (n=51, 93%) males (n=30, 54%). Diagnoses included arterio-venous malformation (n=41, 73%) and functional pituitary adenoma (n=9, 16%) as well as vestibular schwannoma, craniopharyngioma, meningioma, papilloma, and ganglioglioma. Average age was 14 years (95% CI 13–16 years). SRS was often the first intervention (n=22, 44%); treatments prior to SRS included embolization (n=18, 36%) and surgery (n=10, 20%). SRS was typically single fraction (n=45, 94%) with a median total dose of 16 Gy (IQR 15–18 Gy). Most patients had no acute side effects of SRS (n=40, 87%). Median follow-up time after SRS was 12 years (IQR 6–18 years, max 26 years). 91% of patients had no late sequelae of SRS. One patient was diagnosed with radionecrosis one year after repeat SRS for residual malformation. Two patients had malformation hemorrhage. One patient with brainstem malformation developed focal weakness after ischemia from treatment effect; another patient with malformation developed seizures related to SRS edema. Over 673 patient-years following SRS, no patient developed radiation-induced malignancy or malignant transformation. Median disease-free survival after SRS was 6 years (IQR 3–13) with 66% overall local control; 84% of local failures occurred within 5 years of SRS. At last follow-up, 95% of patients remained without evidence of disease with 100% overall survival. These data support the long-term safety and efficacy of pediatric SRS.

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SU-E-T-669: Dose Interplay Effects in Stereotactic Radiosurgery (SRS) of Multiple Brain Lesions

Medical Physics ◽

10.1118/1.4815096 ◽

2013 ◽

Vol 40 (6Part21) ◽

pp. 360-360

Author(s):

L Ma ◽

A Sahgal ◽

B Wang ◽

S Hossain ◽

S Ahmad ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Brain Lesions

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Stereotactic Radiosurgery for Brain Lesions

Journal of Neuroscience Nursing ◽

10.1097/01376517-200406000-00004 ◽

2004 ◽

Vol 36 (3) ◽

pp. 136-138 ◽

Cited By ~ 1

Author(s):

Angela Gnanadurai ◽

Lalitha Purushothamam ◽

V. Rajshekhar ◽

Ruben Choudhury ◽

Paul Ravindran

Keyword(s):

Stereotactic Radiosurgery ◽

Brain Lesions

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Stereotactic Radiosurgery for Brain Lesions: An Observation and Follow-up

Journal of Neuroscience Nursing ◽

10.1097/01376517-200408000-00010 ◽

2004 ◽

Vol 36 (4) ◽

pp. 225-227 ◽

Cited By ~ 4

Author(s):

Angela Gnanadurai ◽

Lalitha Purushothamam ◽

V. Rajshekhar ◽

Ruben Choudhury ◽

Paul Ravindran

Keyword(s):

Stereotactic Radiosurgery ◽

Brain Lesions

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Reconsidering an important subclass of high-risk dural arteriovenous fistulas for stereotactic radiosurgery

Journal of Neurosurgery ◽

10.3171/2017.10.jns171802 ◽

2019 ◽

Vol 130 (3) ◽

pp. 972-976 ◽

Cited By ~ 2

Author(s):

Daniel A. Tonetti ◽

Bradley A. Gross ◽

Brian T. Jankowitz ◽

Hideyuki Kano ◽

Edward A. Monaco ◽

...

Keyword(s):

High Risk ◽

Stereotactic Radiosurgery ◽

Significant Risk ◽

Venous Drainage ◽

Significant Risk Factor ◽

Low Risk ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Institutional Experience ◽

Cortical Venous Drainage

OBJECTIVEAggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated.METHODSThe authors evaluated their institutional experience with SRS for dAVFs with CVD for the period from 1991 to 2016, assessing angiographic outcomes and posttreatment hemorrhage rates. They subsequently pooled their results with those published in the literature and stratified the results based on the mode of clinical presentation.RESULTSIn an institutional cohort of 42 dAVFs with CVD treated using SRS, there were no complications or hemorrhages after treatment in 19 patients with nonaggressive dAVFs, but there was 1 radiation-induced complication and 1 hemorrhage among the 23 patients with aggressive dAVFs. In pooling these cases with 155 additional cases from the literature, the authors found that the hemorrhage rate after SRS was significantly lower among the patients with nonaggressive dAVFs (0% vs 6.8%, p = 0.003). Similarly, the number of radiation-related complications was 0/124 in nonaggressive dAVF cases versus 6/73 in aggressive dAVF cases (p = 0.001). The annual rate of hemorrhage after SRS for aggressive fistulas was 3.0% over 164.5 patient-years, whereas none of the nonaggressive fistulas bled after radiosurgery over 279.4 patient-years of follow-up despite the presence of CVD.CONCLUSIONSCortical venous drainage is thought to be a significant risk factor in all dAVFs. In the institutional experience described here, SRS proved to be a low-risk strategy associated with a very low risk of subsequent hemorrhage or radiation-related complications in nonaggressive dAVFs with CVD.

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