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The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases

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Abstract

The aim of the present study was to evaluate the efficacy and limitations of repeat stereotactic radiosurgery (SRS) salvage for patients with recurrence of brain metastases (BM) after whole brain radiotherapy (WBRT). This is a retrospective, observational, single-center trial analyzing 77 consecutive patients with recurrent BM who were treated primarily with WBRT. All patients underwent SRS as salvage treatment. Median age was 62 years, and median Karnofsky performance status (KPS) was 80. The median interval between the starting date of WBRT and radiosurgery was 10.6 months. One, two and more than two SRS sessions were required in 42, 13 and 22 patients, respectively. The median total planning target volume (PTV) was 8.1 mL and the median dose prescribed was 20 Gy. The median follow-up was 7.7 months. 1- and 2-year neurological death-free survival (NS) rates were 87 and 78 %, respectively. Competing risk analysis demonstrated active extra-central nervous system (CNS) disease [Hazard ratio (HR) 0.236, P = 0.041] and total PTV on initial SRS (≥5 mL) (HR 4.22, P = 0.033) to be associated with the NS rate. 1- and 2-year overall survival (OS) rates were 41 and 11 %, respectively. The median OS time was 8.2 months. Active extra-CNS disease (HR 1.94, P = 0.034) and high KPS (≥90) (HR 0.409, P = 0.006) were associated with the OS rate. In total, 798 tumors (75 %) in 66 patients (86 %) with sufficient radiological follow-up data were evaluated. 1- and 2-year metastasis local control rates were 76.6 and 57.9 %, respectively. Prescribed dose (≥20 Gy) (HR 0.326, P < 0.001), tumor volume (≥2 mL) (HR 1.98, P = 0.007) and metastases from breast cancer (HR 0.435, P < 0.001) were independent predictive factors for local tumor control. Repeat salvage SRS for recurrent BM after WBRT appeared to be a safe and effective treatment. In the majority of patients, even those with numerous BM, neurological death could be delayed or even prevented.

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References

  1. Sadikov E, Bezjak A, Yi QL, Wells W, Dawson L, Millar BA, Laperriere N (2007) Value of whole brain re-irradiation for brain metastases—single centre experience. Clin Oncol (R Coll Radiol) 19:532–538

    Article  CAS  Google Scholar 

  2. Son CH, Jimenez R, Niemierko A, Loeffler JS, Oh KS, Shih HA (2012) Outcomes after whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys 82:e167–e172

    Article  PubMed  Google Scholar 

  3. Wong WW, Schild SE, Sawyer TE, Shaw EG (1996) Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys 34:585–590

    Article  PubMed  CAS  Google Scholar 

  4. Maranzano E, Trippa F, Casale M, Costantini S, Anselmo P, Carletti S, Principi M, Caserta C, Loreti F, Giorgi C (2012) Reirradiation of brain metastases with radiosurgery. Radiother Oncol 102:192–197

    Article  PubMed  Google Scholar 

  5. Noel G, Proudhom MA, Valery CA, Cornu P, Boisserie G, Hasboun D, Simon JM, Feuvret L, Duffau H, Tep B, Delattre JY, Marsault C, Philippon J, Fohanno D, Baillet F, Mazeron JJ (2001) Radiosurgery for re-irradiation of brain metastasis: results in 54 patients. Radiother Oncol 60:61–67

    Article  PubMed  CAS  Google Scholar 

  6. Caballero JA, Sneed PK, Lamborn KR, Ma L, Denduluri S, Nakamura JL, Barani IJ, McDermott MW (2012) Prognostic factors for survival in patients treated with stereotactic radiosurgery for recurrent brain metastases after prior whole brain radiotherapy. Int J Radiat Oncol Biol Phys 83:303–309

    Article  PubMed  Google Scholar 

  7. Chao ST, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Neyman G, Reuther AM, Suh JH (2008) Salvage stereotactic radiosurgery effectively treats recurrences from whole-brain radiation therapy. Cancer 113:2198–2204

    Article  PubMed  Google Scholar 

  8. Yomo S, Hayashi M, Nicholson C (2012) A prospective pilot study of two-session Gamma Knife surgery for large metastatic brain tumors. J Neurooncol 109:159–165

    Article  PubMed  Google Scholar 

  9. Kano H, Kondziolka D, Lobato-Polo J, Zorro O, Flickinger JC, Lunsford LD (2010) T1/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery 66:486–491; discussion 491–482

    Article  PubMed  Google Scholar 

  10. Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, Ohata K (2008) Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med 49:694–699

    Article  PubMed  Google Scholar 

  11. Gray RJ (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154

    Article  Google Scholar 

  12. Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  13. Papadatos-Pastos D, Banerji U (2011) Revisiting the role of molecular targeted therapies in patients with brain metastases. J Neurooncol 105:467–474

    Article  PubMed  CAS  Google Scholar 

  14. Caffo M, Barresi V, Caruso G, Cutugno M, La Fata G, Venza M, Alafaci C, Tomasello F (2013) Innovative therapeutic strategies in the treatment of brain metastases. Int J Mol Sci 14:2135–2174

    Article  PubMed  CAS  Google Scholar 

  15. Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, Asher AL, Loeffler JS, Robinson PD, Andrews DW, Gaspar LE, Kondziolka D, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Patchell RA, Kalkanis SN (2010) The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:85–96

    Article  PubMed  Google Scholar 

  16. Cooper JS, Steinfeld AD, Lerch IA (1990) Cerebral metastases: value of reirradiation in selected patients. Radiology 174:883–885

    PubMed  CAS  Google Scholar 

  17. Abdel-Wahab MM, Wolfson AH, Raub W, Landy H, Feun L, Sridhar K, Brandon AH, Mahmood S, Markoe AM (1997) The role of hyperfractionated re-irradiation in metastatic brain disease: a single institutional trial. Am J Clin Oncol 20:158–160

    Article  PubMed  CAS  Google Scholar 

  18. Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Mueller RP, Tridello G, Collette L, Bottomley A (2013) A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31:65–72

    Article  PubMed  Google Scholar 

  19. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044

    Article  PubMed  Google Scholar 

  20. Davey P, O’Brien PF, Schwartz ML, Cooper PW (1994) A phase I/II study of salvage radiosurgery in the treatment of recurrent brain metastases. Br J Neurosurg 8:717–723

    Article  PubMed  CAS  Google Scholar 

  21. Yang CC, Ting J, Wu X, Markoe A (1998) Dose volume histogram analysis of the gamma knife radiosurgery treating twenty-five metastatic intracranial tumors. Stereotact Funct Neurosurg 70(Suppl 1):41–49

    Article  PubMed  Google Scholar 

  22. Yamamoto M, Ide M, Nishio S, Urakawa Y (2002) Gamma Knife radiosurgery for numerous brain metastases: is this a safe treatment? Int J Radiat Oncol Biol Phys 53:1279–1283

    Article  PubMed  Google Scholar 

  23. Hazuka MB, Kinzie JJ (1988) Brain metastases: results and effects of re-irradiation. Int J Radiat Oncol Biol Phys 15:433–437

    Google Scholar 

  24. Kurup P, Reddy S, Hendrickson FR (1980) Results of re-irradiation for cerebral metastases. Cancer 46:2587–2589

    Google Scholar 

Download references

Acknowledgments

We are grateful to Bierta Barfod, M.D., M.P.H. for her help with the preparation of this manuscript.

Conflict of interest

The authors have no personal, financial or institutional interests in any of the materials or devices described in this article.

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Authors and Affiliations

  1. Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, 2-5-1, Honjo, Matsumoto, Nagano Prefecture, 390-0814, Japan

    Shoji Yomo

  2. Saitama Gamma Knife Center, San-ai Hospital, Saitama, Japan

    Motohiro Hayashi

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  1. Shoji Yomo
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  2. Motohiro Hayashi
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Correspondence to Shoji Yomo.

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Yomo, S., Hayashi, M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol 113, 459–465 (2013). https://doi.org/10.1007/s11060-013-1138-y

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  • DOI: https://doi.org/10.1007/s11060-013-1138-y

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