A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis
Abstract Background Hypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes bet...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-05-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-020-01522-6 |
| _version_ | 1818777205954576384 |
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| author | Jill S. Remick Emily Kowalski Rahul Khairnar Kai Sun Emily Morse Hua-Ren R. Cherng Yannick Poirier Narottam Lamichhane Stewart J. Becker Shifeng Chen Akshar N. Patel Young Kwok Elizabeth Nichols Pranshu Mohindra Graeme F. Woodworth William F. Regine Mark V. Mishra |
| author_facet | Jill S. Remick Emily Kowalski Rahul Khairnar Kai Sun Emily Morse Hua-Ren R. Cherng Yannick Poirier Narottam Lamichhane Stewart J. Becker Shifeng Chen Akshar N. Patel Young Kwok Elizabeth Nichols Pranshu Mohindra Graeme F. Woodworth William F. Regine Mark V. Mishra |
| author_sort | Jill S. Remick |
| collection | DOAJ |
| description | Abstract Background Hypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes between SF-SRS versus HF-SRS across our multi-center academic network. Methods Patients treated with SF-SRS or HF-SRS for brain metastasis from 2013 to 2018 across 5 radiation oncology centers were retrospectively reviewed. SF-SRS dosing was standardized, whereas HF-SRS dosing regimens were variable. The co-primary endpoints of local control and radiation necrosis were estimated using the Kaplan Meier method. Multivariate analysis using Cox proportional hazards modeling was performed to evaluate the impact of select independent variables on the outcomes of interest. Propensity score adjustments were used to reduce the effects confounding variables. To assess dose response for HF-SRS, Biologic Effective Dose (BED) assuming an α/β of 10 (BED10) was used as a surrogate for total dose. Results One-hundred and fifty six patients with 335 brain metastasis treated with SF-SRS (n = 222 lesions) or HF-SRS (n = 113 lesions) were included. Prior whole brain radiation was given in 33% (n = 74) and 34% (n = 38) of lesions treated with SF-SRS and HF-SRS, respectively (p = 0.30). After a median follow up time of 12 months in each cohort, the adjusted 1-year rate of local control and incidence of radiation necrosis was 91% (95% CI 86–96%) and 85% (95% CI 75–95%) (p = 0.26) and 10% (95% CI 5–15%) and 7% (95% CI 0.1–14%) (p = 0.73) for SF-SRS and HF-SRS, respectively. For lesions > 2 cm, the adjusted 1 year local control was 97% (95% CI 84–100%) for SF-SRS and 64% (95% CI 43–85%) for HF-SRS (p = 0.06). On multivariate analysis, SRS fractionation was not associated with local control and only size ≤2 cm was associated with a decreased risk of developing radiation necrosis (HR 0.21; 95% CI 0.07–0.58, p < 0.01). For HF-SRS, 1 year local control was 100% for lesions treated with a BED10 ≥ 50 compared to 77% (95% CI 65–88%) for lesions that received a BED10 < 50 (p = 0.09). Conclusions In this comparison study of dose fractionation for the treatment of brain metastases, there was no difference in local control or radiation necrosis between HF-SRS and SF-SRS. For HF-SRS, a BED10 ≥ 50 may improve local control. |
| first_indexed | 2024-12-18T11:25:08Z |
| format | Article |
| id | doaj.art-0f9311206b724c889f185501923de5cb |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-18T11:25:08Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-0f9311206b724c889f185501923de5cb2022-12-21T21:09:43ZengBMCRadiation Oncology1748-717X2020-05-0115111110.1186/s13014-020-01522-6A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasisJill S. Remick0Emily Kowalski1Rahul Khairnar2Kai Sun3Emily Morse4Hua-Ren R. Cherng5Yannick Poirier6Narottam Lamichhane7Stewart J. Becker8Shifeng Chen9Akshar N. Patel10Young Kwok11Elizabeth Nichols12Pranshu Mohindra13Graeme F. Woodworth14William F. Regine15Mark V. Mishra16Department of Radiation Oncology, University of Maryland Medical CenterDepartment of Radiation Oncology, University of Maryland Medical CenterDepartment of Pharmaceutical Health Services Research, University of Maryland School of PharmacyDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineChesapeake Oncology Hematology AssociatesDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Neurosurgery, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland School of MedicineAbstract Background Hypofractionated-SRS (HF-SRS) may allow for improved local control and a reduced risk of radiation necrosis compared to single-fraction-SRS (SF-SRS). However, data comparing these two treatment approaches are limited. The purpose of this study was to compare clinical outcomes between SF-SRS versus HF-SRS across our multi-center academic network. Methods Patients treated with SF-SRS or HF-SRS for brain metastasis from 2013 to 2018 across 5 radiation oncology centers were retrospectively reviewed. SF-SRS dosing was standardized, whereas HF-SRS dosing regimens were variable. The co-primary endpoints of local control and radiation necrosis were estimated using the Kaplan Meier method. Multivariate analysis using Cox proportional hazards modeling was performed to evaluate the impact of select independent variables on the outcomes of interest. Propensity score adjustments were used to reduce the effects confounding variables. To assess dose response for HF-SRS, Biologic Effective Dose (BED) assuming an α/β of 10 (BED10) was used as a surrogate for total dose. Results One-hundred and fifty six patients with 335 brain metastasis treated with SF-SRS (n = 222 lesions) or HF-SRS (n = 113 lesions) were included. Prior whole brain radiation was given in 33% (n = 74) and 34% (n = 38) of lesions treated with SF-SRS and HF-SRS, respectively (p = 0.30). After a median follow up time of 12 months in each cohort, the adjusted 1-year rate of local control and incidence of radiation necrosis was 91% (95% CI 86–96%) and 85% (95% CI 75–95%) (p = 0.26) and 10% (95% CI 5–15%) and 7% (95% CI 0.1–14%) (p = 0.73) for SF-SRS and HF-SRS, respectively. For lesions > 2 cm, the adjusted 1 year local control was 97% (95% CI 84–100%) for SF-SRS and 64% (95% CI 43–85%) for HF-SRS (p = 0.06). On multivariate analysis, SRS fractionation was not associated with local control and only size ≤2 cm was associated with a decreased risk of developing radiation necrosis (HR 0.21; 95% CI 0.07–0.58, p < 0.01). For HF-SRS, 1 year local control was 100% for lesions treated with a BED10 ≥ 50 compared to 77% (95% CI 65–88%) for lesions that received a BED10 < 50 (p = 0.09). Conclusions In this comparison study of dose fractionation for the treatment of brain metastases, there was no difference in local control or radiation necrosis between HF-SRS and SF-SRS. For HF-SRS, a BED10 ≥ 50 may improve local control.http://link.springer.com/article/10.1186/s13014-020-01522-6Brain metastasisStereotactic radiosurgeryHypofractionated stereotactic radiosurgeryGammaKnifeNormal tissue injuryBiologic effective dose |
| spellingShingle | Jill S. Remick Emily Kowalski Rahul Khairnar Kai Sun Emily Morse Hua-Ren R. Cherng Yannick Poirier Narottam Lamichhane Stewart J. Becker Shifeng Chen Akshar N. Patel Young Kwok Elizabeth Nichols Pranshu Mohindra Graeme F. Woodworth William F. Regine Mark V. Mishra A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis Radiation Oncology Brain metastasis Stereotactic radiosurgery Hypofractionated stereotactic radiosurgery GammaKnife Normal tissue injury Biologic effective dose |
| title | A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| title_full | A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| title_fullStr | A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| title_full_unstemmed | A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| title_short | A multi-center analysis of single-fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| title_sort | multi center analysis of single fraction versus hypofractionated stereotactic radiosurgery for the treatment of brain metastasis |
| topic | Brain metastasis Stereotactic radiosurgery Hypofractionated stereotactic radiosurgery GammaKnife Normal tissue injury Biologic effective dose |
| url | http://link.springer.com/article/10.1186/s13014-020-01522-6 |
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