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Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis.

Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, Romano A, Enrici RM - Radiat Oncol (2011)

Bottom Line: On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit.Neurological complications were recorded in 27 (13%) patients.SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy. gminniti@ospedalesantandrea.it

ABSTRACT

Purpose: to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis.

Patients and methods: Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications.

Results: Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm3 and V12 Gy >10.9 cm3 the risk of radionecrosis was 47%.

Conclusions: SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm3 carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.

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Kaplan-Meier analysis of overall survival, brain control, and local control
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Figure 1: Kaplan-Meier analysis of overall survival, brain control, and local control

Mentions: At a median clinical follow-up of 9.4 months (range 2-42 months) median survival and brain control were 14.1 months and 10 months, respectively (Figure 1). The 1-year and 2-year survival rates were 58% and 24%, and respective brain control rates were 43% and 22%. Seventy-nine percent of patients succumbed to their extracranial disease and 21% of patients died of progressive intracranial disease. Intracranial tumor progression at either distant or local sites in the brain was observed in 74 patients. Sixty-three patients had new brain metastases at distant sites. The 6-month and 12-month actuarial rates of developing new brain metastases were 26% and 50%, respectively. Sixteen patients recurred locally after SRS. The 1-year and 2-year local control rates were 92% and 84%, respectively. Salvage WBRT was applied in 47 patients and salvage SRS in 21 patients. Ninety-two (30%) metastases had a complete response, 106 (34%) had a partial response, and 112 (36%) remained stable. A clinical neurological improvement of pre-RT existing symptoms was recorded in 26 out of 77 patients (34%) during the follow-up.


Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis.

Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, Romano A, Enrici RM - Radiat Oncol (2011)

Kaplan-Meier analysis of overall survival, brain control, and local control
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108308&req=5

Figure 1: Kaplan-Meier analysis of overall survival, brain control, and local control
Mentions: At a median clinical follow-up of 9.4 months (range 2-42 months) median survival and brain control were 14.1 months and 10 months, respectively (Figure 1). The 1-year and 2-year survival rates were 58% and 24%, and respective brain control rates were 43% and 22%. Seventy-nine percent of patients succumbed to their extracranial disease and 21% of patients died of progressive intracranial disease. Intracranial tumor progression at either distant or local sites in the brain was observed in 74 patients. Sixty-three patients had new brain metastases at distant sites. The 6-month and 12-month actuarial rates of developing new brain metastases were 26% and 50%, respectively. Sixteen patients recurred locally after SRS. The 1-year and 2-year local control rates were 92% and 84%, respectively. Salvage WBRT was applied in 47 patients and salvage SRS in 21 patients. Ninety-two (30%) metastases had a complete response, 106 (34%) had a partial response, and 112 (36%) remained stable. A clinical neurological improvement of pre-RT existing symptoms was recorded in 26 out of 77 patients (34%) during the follow-up.

Bottom Line: On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit.Neurological complications were recorded in 27 (13%) patients.SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy. gminniti@ospedalesantandrea.it

ABSTRACT

Purpose: to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis.

Patients and methods: Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications.

Results: Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm3 and V12 Gy >10.9 cm3 the risk of radionecrosis was 47%.

Conclusions: SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm3 carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.

Show MeSH
Related in: MedlinePlus