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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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Risk of brain radionecrosis after stereotactic radiosurgery for brain metastases in relation to brain volumes receiving 12 Gy (V12 Gy) stratified for quartiles (Q1-Q4). The risk increased significantly through Q1-Q4, corresponding to V12 Gy < 3.3 cm3, 3.3-5.9 cm3, 6.0-10.9 cm3, and >10.9 cm3, respectively. The actuarial risk at 1 year was 0% for Q1, 16% for Q2, 24% for Q3, and 51% for Q4
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Figure 2: Risk of brain radionecrosis after stereotactic radiosurgery for brain metastases in relation to brain volumes receiving 12 Gy (V12 Gy) stratified for quartiles (Q1-Q4). The risk increased significantly through Q1-Q4, corresponding to V12 Gy < 3.3 cm3, 3.3-5.9 cm3, 6.0-10.9 cm3, and >10.9 cm3, respectively. The actuarial risk at 1 year was 0% for Q1, 16% for Q2, 24% for Q3, and 51% for Q4

Mentions: Univariate analysis showed that KPS, tumor volume, parietal location, and V10 through V16 Gy were significant variables for either symptomatic or asymptomatic brain necrosis (Table 4). The results of the Cox regression analysis showed that V10 Gy and V12 Gy were the most predictive independent risk factors for radionecrosis (p = 0.0001). The correlation was more significant for symptomatic than asymptomatic brain necrosis. In a subsequent analysis we have evaluated the incidence of events according to the V10 and V12 Gy quarpercentiles distribution. At a median follow-up of 9.4 months V10 Gy radionecrosis rates were 2.6% for volumes <4.5 cm3 (1st quartile, Q1), 11% for volumes of 4.5-7.7 cm3 (2nd quartile, Q2), 24% for volumes of 7.8-12.6 cm3 (3rd quartile, Q3), and 47% for volumes >12.6 cm3 (4th quartile, Q4). The V12 Gy radionecrosis rates were the same for volumes < 3.3 cm3 (Q1), 3.3-5.9 cm3 (Q2), 6.0-10.9 cm3 (Q3), and >10.9 cm3 (Q4). For V10 Gy > 19.1 cm3 and V12 Gy > 15.4 cm3 corresponding to the 90th percentile the risk of radionecrosis was 62%. The actuarial risk at 1 year for the development of brain radionecrosis was 0% in Q1, 16% in Q2, 24% in Q3, and 51% for V12 Gy (Figure 2).


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)

Risk of brain radionecrosis after stereotactic radiosurgery for brain metastases in relation to brain volumes receiving 12 Gy (V12 Gy) stratified for quartiles (Q1-Q4). The risk increased significantly through Q1-Q4, corresponding to V12 Gy < 3.3 cm3, 3.3-5.9 cm3, 6.0-10.9 cm3, and >10.9 cm3, respectively. The actuarial risk at 1 year was 0% for Q1, 16% for Q2, 24% for Q3, and 51% for Q4
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Risk of brain radionecrosis after stereotactic radiosurgery for brain metastases in relation to brain volumes receiving 12 Gy (V12 Gy) stratified for quartiles (Q1-Q4). The risk increased significantly through Q1-Q4, corresponding to V12 Gy < 3.3 cm3, 3.3-5.9 cm3, 6.0-10.9 cm3, and >10.9 cm3, respectively. The actuarial risk at 1 year was 0% for Q1, 16% for Q2, 24% for Q3, and 51% for Q4
Mentions: Univariate analysis showed that KPS, tumor volume, parietal location, and V10 through V16 Gy were significant variables for either symptomatic or asymptomatic brain necrosis (Table 4). The results of the Cox regression analysis showed that V10 Gy and V12 Gy were the most predictive independent risk factors for radionecrosis (p = 0.0001). The correlation was more significant for symptomatic than asymptomatic brain necrosis. In a subsequent analysis we have evaluated the incidence of events according to the V10 and V12 Gy quarpercentiles distribution. At a median follow-up of 9.4 months V10 Gy radionecrosis rates were 2.6% for volumes <4.5 cm3 (1st quartile, Q1), 11% for volumes of 4.5-7.7 cm3 (2nd quartile, Q2), 24% for volumes of 7.8-12.6 cm3 (3rd quartile, Q3), and 47% for volumes >12.6 cm3 (4th quartile, Q4). The V12 Gy radionecrosis rates were the same for volumes < 3.3 cm3 (Q1), 3.3-5.9 cm3 (Q2), 6.0-10.9 cm3 (Q3), and >10.9 cm3 (Q4). For V10 Gy > 19.1 cm3 and V12 Gy > 15.4 cm3 corresponding to the 90th percentile the risk of radionecrosis was 62%. The actuarial risk at 1 year for the development of brain radionecrosis was 0% in Q1, 16% in Q2, 24% in Q3, and 51% for V12 Gy (Figure 2).

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