Stereotactic radiosurgery of brain metastases: a retrospective study
Abstract Background Single-fraction stereotactic radiosurgery (SRS) is an established standard for radiation therapy of brain metastases although recent developments indicate that multi-fractionated stereotactic radiotherapy (FSRT) results in lower radiation necrosis especially for larger metastases...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Radiation Oncology |
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| Online Access: | https://doi.org/10.1186/s13014-023-02389-z |
| _version_ | 1797276400636395520 |
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| author | Isabella Gruber Karin Weidner Marius Treutwein Oliver Koelbl |
| author_facet | Isabella Gruber Karin Weidner Marius Treutwein Oliver Koelbl |
| author_sort | Isabella Gruber |
| collection | DOAJ |
| description | Abstract Background Single-fraction stereotactic radiosurgery (SRS) is an established standard for radiation therapy of brain metastases although recent developments indicate that multi-fractionated stereotactic radiotherapy (FSRT) results in lower radiation necrosis especially for larger metastases, and the same or even better local control in comparison to SRS. Methods Seventy-two patients with 111 brain metastases received SRS with a single dose of 18 Gy between September 2014 and December 2021. The dose prescription was either 18 Gy given to the enclosing 80% isodose with a normalization to Dmax = 100% of 22.5 Gy (part I) or 18 Gy = D98, while D0.03 cc of 21.6–22.5 Gy was accepted (part II). The study retrospectively evaluated local progression-free survival (LPFS), response on the first follow-up magnetic resonance imaging (MRI), and radiation necrosis. Results Melanoma brain metastases (n = 44) were the most frequent metastases. The median gross tumor volume (GTV) was 0.30 cm³ (IQR, 0.17–0.61). The median follow-up time of all patients was 50.8 months (IQR, 30.4–64.6). Median LPFS was 23.5 months (95%CI 17.2, 29.8). The overall LPFS rates at 12-, 18-, 24- and 30 months were 65.3%, 56.3%, 46.5%, and 38.8%. Brain metastases with radioresistant histology (melanoma, renal cell cancer, and sarcoma) showed a 12-month LPFS of 60.2%, whereas brain metastases with other histology had a 12-month LPFS of 70.1%. The response of brain metastases on first follow-up MRIs performed after a median time of 47 days (IQR, 40–63) was crucial for long-term local control and survival. Eight brain metastases (7.2%) developed radiation necrosis after a median time of 18.4 months (IQR, 9.4–26.5). In multivariate analyses, a GTV > 0.3 cm³ negatively affected LPFS (HR 2.229, 95%CI 1.172, 4.239). Melanoma, renal cell cancers, and sarcoma had a lower chance of LPFS in comparison to other cancer types (HR 2.330, 95%CI 1.155, 4.699). Conclusions Our results indicate a reasonable 1-year local control of brain metastases with radiosensitive histology. Radioresistant metastases show a comparatively poor local control. Treatment refinements merit exploration to improve local control of brain metastases. Trial registration This study is retrospectively registered (ethics approval number 23-3451-104). |
| first_indexed | 2024-03-07T15:27:46Z |
| format | Article |
| id | doaj.art-6aa7aea792f845538357b752cdf2a049 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-07T15:27:46Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-6aa7aea792f845538357b752cdf2a0492024-03-05T16:37:17ZengBMCRadiation Oncology1748-717X2023-12-0118111310.1186/s13014-023-02389-zStereotactic radiosurgery of brain metastases: a retrospective studyIsabella Gruber0Karin Weidner1Marius Treutwein2Oliver Koelbl3Department of Radiation Oncology, University Hospital RegensburgDepartment of Radiation Oncology, University Hospital RegensburgDepartment of Radiation Oncology, University Hospital RegensburgDepartment of Radiation Oncology, University Hospital RegensburgAbstract Background Single-fraction stereotactic radiosurgery (SRS) is an established standard for radiation therapy of brain metastases although recent developments indicate that multi-fractionated stereotactic radiotherapy (FSRT) results in lower radiation necrosis especially for larger metastases, and the same or even better local control in comparison to SRS. Methods Seventy-two patients with 111 brain metastases received SRS with a single dose of 18 Gy between September 2014 and December 2021. The dose prescription was either 18 Gy given to the enclosing 80% isodose with a normalization to Dmax = 100% of 22.5 Gy (part I) or 18 Gy = D98, while D0.03 cc of 21.6–22.5 Gy was accepted (part II). The study retrospectively evaluated local progression-free survival (LPFS), response on the first follow-up magnetic resonance imaging (MRI), and radiation necrosis. Results Melanoma brain metastases (n = 44) were the most frequent metastases. The median gross tumor volume (GTV) was 0.30 cm³ (IQR, 0.17–0.61). The median follow-up time of all patients was 50.8 months (IQR, 30.4–64.6). Median LPFS was 23.5 months (95%CI 17.2, 29.8). The overall LPFS rates at 12-, 18-, 24- and 30 months were 65.3%, 56.3%, 46.5%, and 38.8%. Brain metastases with radioresistant histology (melanoma, renal cell cancer, and sarcoma) showed a 12-month LPFS of 60.2%, whereas brain metastases with other histology had a 12-month LPFS of 70.1%. The response of brain metastases on first follow-up MRIs performed after a median time of 47 days (IQR, 40–63) was crucial for long-term local control and survival. Eight brain metastases (7.2%) developed radiation necrosis after a median time of 18.4 months (IQR, 9.4–26.5). In multivariate analyses, a GTV > 0.3 cm³ negatively affected LPFS (HR 2.229, 95%CI 1.172, 4.239). Melanoma, renal cell cancers, and sarcoma had a lower chance of LPFS in comparison to other cancer types (HR 2.330, 95%CI 1.155, 4.699). Conclusions Our results indicate a reasonable 1-year local control of brain metastases with radiosensitive histology. Radioresistant metastases show a comparatively poor local control. Treatment refinements merit exploration to improve local control of brain metastases. Trial registration This study is retrospectively registered (ethics approval number 23-3451-104).https://doi.org/10.1186/s13014-023-02389-zStereotactic radiosurgeryFractionated stereotactic radiotherapyBrain metastasesBrain radiation necrosis |
| spellingShingle | Isabella Gruber Karin Weidner Marius Treutwein Oliver Koelbl Stereotactic radiosurgery of brain metastases: a retrospective study Radiation Oncology Stereotactic radiosurgery Fractionated stereotactic radiotherapy Brain metastases Brain radiation necrosis |
| title | Stereotactic radiosurgery of brain metastases: a retrospective study |
| title_full | Stereotactic radiosurgery of brain metastases: a retrospective study |
| title_fullStr | Stereotactic radiosurgery of brain metastases: a retrospective study |
| title_full_unstemmed | Stereotactic radiosurgery of brain metastases: a retrospective study |
| title_short | Stereotactic radiosurgery of brain metastases: a retrospective study |
| title_sort | stereotactic radiosurgery of brain metastases a retrospective study |
| topic | Stereotactic radiosurgery Fractionated stereotactic radiotherapy Brain metastases Brain radiation necrosis |
| url | https://doi.org/10.1186/s13014-023-02389-z |
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