Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

被引:4
作者
Carpenter, David J. [1 ]
Fairchild, Andrew T. [2 ]
Adamson, Justus D. [1 ]
Fecci, Peter E. [3 ]
Sampson, John H. [3 ]
Herndon II, James E. [4 ]
Torok, Jordan A. [5 ]
Mullikin, Trey C. [1 ]
Kim, Grace J. [1 ]
Reitman, Zachary J. [1 ]
Kirkpatrick, John P. [1 ,3 ]
Floyd, Scott R. [1 ]
机构
[1] Duke Univ, Dept Radiat Oncol, Med Ctr, Durham, NC 27710 USA
[2] Piedmont Radiat Oncol, Winston Salem, NC USA
[3] Duke Univ, Dept Neurosurg, Med Ctr, Durham, NC USA
[4] Duke Univ, Dept Biostat & Bioinformat, Med Ctr, Durham, NC USA
[5] St Clair Hosp, Dept Radiat Oncol, Canc Ctr, Pittsburgh, PA USA
关键词
SINGLE-FRACTION; RADIATION-THERAPY; TUMOR-CONTROL; LOCAL-CONTROL; RADIOTHERAPY; TOXICITY; SURVIVAL; DISEASE; CAVITY; VOLUME;
D O I
10.1016/j.adro.2022.101166
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Hypofractionated stereotactic radiosurgery (HF-SRS) with or without surgical resection is potentially a preferred treatment for larger or symptomatic brain metastases (BMs). Herein, we report clinical outcomes and predictive factors following HF-SRS. Methods and Materials: Patients undergoing HF-SRS for intact (iHF-SRS) or resected (rHF-SRS) BMs from 2008 to 2018 were retrospectively identified. Linear accelerator-based image-guided HF-SRS consisted of 5 fractions at 5, 5.5, or 6 Gy per fraction. Time to local progression (LP), time to distant brain progression (DBP), and overall survival (OS) were calculated. Cox models assessed effect of clinical factors on OS. Fine and Gray's cumulative incidence model for competing events examined effect of factors on LP and DBP. The occurrence of leptomeningeal disease (LMD) was determined. Logistic regression examined predictors of LMD. Results: Among 445 patients, median age was 63.5 years; 87% had Karnofsky performance status & GE;70. Fifty-three % of patients underwent surgical resection, and 75% received 5 Gy per fraction. Patients with resected BMs had higher Karnofsky performance status (90-100, 41 vs 30%), less extracranial disease (absent, 25 vs 13%), and fewer BMs (multiple, 32 vs 67%). Median diameter of the dominant BM was 3.0 cm (interquartile range, 1.8-3.6 cm) for intact BMs and 4.6 cm (interquartile range, 3.9-5.5 cm) for resected BMs. Median OS was 5.1 months (95% confidence interval [CI], 4.3-6.0) following iHF-SRS and 12.8 months (95% CI, 10.8-16.2) following rHF-SRS (P < .01). Cumulative LP incidence was 14.5% at 18 months (95% CI, 11.4-18.0%), significantly associated with greater total GTV (hazard ratio, 1.12; 95% CI, 1.05-1.20) following iFR-SRS, and with recurrent versus newly diagnosed BMs across all patients (hazard ratio, 2.28; 95% CI, 1.01-5.15). Cumulative DBP incidence was significantly greater following rHF-SRS than iHF-SRS (P = .01), with respective 24-month rates of 50.0 (95% CI, 43.3-56.3) and 35.7% (95% CI, 29.2-42.2). LMD (57 events total; 33% nodular, 67% diffuse) was observed in 17.1% of rHF-SRS and 8.1% of iHF-SRS cases (odds ratio, 2.46; 95% CI, 1.34-4.53). Any radionecrosis and grade 2+ radionecrosis events were observed in 14 and 8% of cases, respectively.
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页数:11
相关论文
共 37 条
[1]   IRRADIATED VOLUME AS A PREDICTOR OF BRAIN RADIONECROSIS AFTER LINEAR ACCELERATOR STEREOTACTIC RADIOSURGERY [J].
Blonigen, Brian J. ;
Steinmetz, Ryan D. ;
Levin, Linda ;
Lamba, Michael A. ;
Warnick, Ronald E. ;
Breneman, John C. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2010, 77 (04) :996-1001
[2]   Breast brain metastases are associated with increased risk of leptomeningeal disease after stereotactic radiosurgery: a systematic review and meta-analysis [J].
Brown, Desmond A. ;
Lu, Victor M. ;
Himes, Benjamin T. ;
Burns, Terry C. ;
Quinones-Hinojosa, Alfredo ;
Chaichana, Kaisorn L. ;
Parney, Ian F. .
CLINICAL & EXPERIMENTAL METASTASIS, 2020, 37 (02) :341-352
[3]   Stereotactic Radiosurgery of the Postoperative Resection Cavity for Brain Metastases: Prospective Evaluation of Target Margin on Tumor Control [J].
Choi, Clara Y. H. ;
Chang, Steven D. ;
Gibbs, Iris C. ;
Adler, John R. ;
Harsh, Griffith R. ;
Lieberson, Robert E. ;
Soltys, Scott G. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2012, 84 (02) :336-342
[4]  
Clinical Trials, SINGL FRACT STER RAD
[5]   Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases [J].
Eaton, Bree R. ;
La Riviere, Michael J. ;
Kim, Sungjin ;
Prabhu, Roshan S. ;
Patel, Kirtesh ;
Kandula, Shravan ;
Oyesiku, Nelson ;
Olson, Jeffrey ;
Curran, Walter ;
Shu, Hui-Kuo ;
Crocker, Ian .
JOURNAL OF NEURO-ONCOLOGY, 2015, 123 (01) :103-111
[6]   Stereotactic radiotherapy for large solitary brain metastases [J].
Feuvret, L. ;
Vinchon, S. ;
Martin, V. ;
Lamproglou, I. ;
Halley, A. ;
Calugaru, V. ;
Chea, M. ;
Valery, C. A. ;
Simon, J. -M. ;
Mazeron, J-J .
CANCER RADIOTHERAPIE, 2014, 18 (02) :97-106
[7]   Stereotactic radiosurgery and fractionated stereotactic radiotherapy: comparison of efficacy and toxicity in 260 patients with brain metastases [J].
Fokas, Emmanouil ;
Henzel, Martin ;
Surber, Gunnar ;
Kleinert, Gabriele ;
Hamm, Klaus ;
Engenhart-Cabillic, Rita .
JOURNAL OF NEURO-ONCOLOGY, 2012, 109 (01) :91-98
[8]   Fractionated Stereotactic Gamma Knife Radiosurgery for Large Brain Metastases: A Retrospective, Single Center Study [J].
Kim, Joo Whan ;
Park, Hye Ran ;
Lee, Jae Meen ;
Kim, Jin Wook ;
Chung, Hyun-Tai ;
Kim, Dong Gyu ;
Jung, Hee-Won ;
Paek, Sun Ha .
PLOS ONE, 2016, 11 (09)
[9]   SINGLE-DOSE VERSUS FRACTIONATED STEREOTACTIC RADIOTHERAPY FOR BRAIN METASTASES [J].
Kim, Yeon-Joo ;
Cho, Kwan Ho ;
Kim, Joo-Young ;
Lim, Young Kyung ;
Min, Hye Sook ;
Lee, Sang Hyun ;
Kim, Ho Jin ;
Gwak, Ho Shin ;
Yoo, Heon ;
Lee, Seung Hoon .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2011, 81 (02) :483-489
[10]   Classifying Leptomeningeal Disease: An Essential Element in Managing Advanced Metastatic Disease in the Central Nervous System [J].
Kirkpatrick, John P. .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2020, 106 (03) :587-588