Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study
Abstract Background Brainstem metastases (BSM) are associated with a poor prognosis and their management represents a therapeutic challenge. BSM are often inoperable and, in absence of randomized trials, the optimal radiation treatment of BSM remains to be defined. We evaluated the efficacy and toxi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-022-02111-5 |
| _version_ | 1818084344452874240 |
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| author | Luca Nicosia Piera Navarria Valentina Pinzi Martina Giraffa Ivana Russo Paolo Tini Niccolò Giaj-Levra Filippo Alongi Giuseppe Minniti |
| author_facet | Luca Nicosia Piera Navarria Valentina Pinzi Martina Giraffa Ivana Russo Paolo Tini Niccolò Giaj-Levra Filippo Alongi Giuseppe Minniti |
| author_sort | Luca Nicosia |
| collection | DOAJ |
| description | Abstract Background Brainstem metastases (BSM) are associated with a poor prognosis and their management represents a therapeutic challenge. BSM are often inoperable and, in absence of randomized trials, the optimal radiation treatment of BSM remains to be defined. We evaluated the efficacy and toxicity of linear accelerator (linac)-based stereotactic radiosurgery (SRS) and hypofractionated steretotactic radiotherapy (HSRT) in the treatment of BSM in a series of patients treated in different clinical centers. Methods We conducted a multicentric retrospective study of patients affected by 1–2 BSM from different histologies who underwent SRS/HSRT. Freedom from local progression (FLP), cancer-specific survival (CSS), overall survival (OS), and treatment-related toxicity were evaluated. In addition, predictors of treatment response and survivals were evaluated. Results Between 2008 and 2021, 105 consecutive patients with 111 BMS who received SRS or HSRT for 1–2 BSM were evaluated. Median follow-up time was 10 months (range 3–130). One-year FLP rate was 90.4%. At the univariate analysis, tumor volume ≤ 0.4 cc, and concurrent targeted therapy were associated with longer FLP, with combined treatment that remained a significant independent predictor [0.058, HR 0.139 (95% CI 0.0182–1.064]. Median OS and CSS were 11 months and 14.6 months, respectively. At multivariate analysis, concurrent targeted therapy administration was significantly associated with longer OS [HR 0.514 (95%CI 0.302–0.875); p = 0.01]. Neurological death occurred in 30.4% of patients, although this was due to local progression in only 3 (2.8%) patients. Conclusion Linac-based SRS/HSRT offers excellent local control to patients with BSM, with low treatment-related toxicity and no apparent detrimental effects on OS. When treated with ablative intent, BSM are an uncommon cause of neurological death. The present results indicates that patients with BSM should not be excluded a priori from clinical trials. |
| first_indexed | 2024-12-10T19:52:24Z |
| format | Article |
| id | doaj.art-f69ab36f7c4c46cebeeb3252c8a7bc61 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-10T19:52:24Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-f69ab36f7c4c46cebeeb3252c8a7bc612022-12-22T01:35:45ZengBMCRadiation Oncology1748-717X2022-08-011711810.1186/s13014-022-02111-5Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective studyLuca Nicosia0Piera Navarria1Valentina Pinzi2Martina Giraffa3Ivana Russo4Paolo Tini5Niccolò Giaj-Levra6Filippo Alongi7Giuseppe Minniti8Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria HospitalRadiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCSDepartment of Neurosurgery, Fondazione IRCCS Istituto Neurologico C BestaUPMC Hillman Cancer Center, San Pietro Hospital FBFUPMC Hillman Cancer CenterDepartment of Medicine, Surgery and Neurosciences, University of SienaAdvanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria HospitalAdvanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria HospitalDepartment of Medicine, Surgery and Neurosciences, University of SienaAbstract Background Brainstem metastases (BSM) are associated with a poor prognosis and their management represents a therapeutic challenge. BSM are often inoperable and, in absence of randomized trials, the optimal radiation treatment of BSM remains to be defined. We evaluated the efficacy and toxicity of linear accelerator (linac)-based stereotactic radiosurgery (SRS) and hypofractionated steretotactic radiotherapy (HSRT) in the treatment of BSM in a series of patients treated in different clinical centers. Methods We conducted a multicentric retrospective study of patients affected by 1–2 BSM from different histologies who underwent SRS/HSRT. Freedom from local progression (FLP), cancer-specific survival (CSS), overall survival (OS), and treatment-related toxicity were evaluated. In addition, predictors of treatment response and survivals were evaluated. Results Between 2008 and 2021, 105 consecutive patients with 111 BMS who received SRS or HSRT for 1–2 BSM were evaluated. Median follow-up time was 10 months (range 3–130). One-year FLP rate was 90.4%. At the univariate analysis, tumor volume ≤ 0.4 cc, and concurrent targeted therapy were associated with longer FLP, with combined treatment that remained a significant independent predictor [0.058, HR 0.139 (95% CI 0.0182–1.064]. Median OS and CSS were 11 months and 14.6 months, respectively. At multivariate analysis, concurrent targeted therapy administration was significantly associated with longer OS [HR 0.514 (95%CI 0.302–0.875); p = 0.01]. Neurological death occurred in 30.4% of patients, although this was due to local progression in only 3 (2.8%) patients. Conclusion Linac-based SRS/HSRT offers excellent local control to patients with BSM, with low treatment-related toxicity and no apparent detrimental effects on OS. When treated with ablative intent, BSM are an uncommon cause of neurological death. The present results indicates that patients with BSM should not be excluded a priori from clinical trials.https://doi.org/10.1186/s13014-022-02111-5Brainstem metastasesSRS, stereotactic radiosurgerySRT, stereotactic radiotherapyBrain metastasesLinac |
| spellingShingle | Luca Nicosia Piera Navarria Valentina Pinzi Martina Giraffa Ivana Russo Paolo Tini Niccolò Giaj-Levra Filippo Alongi Giuseppe Minniti Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study Radiation Oncology Brainstem metastases SRS, stereotactic radiosurgery SRT, stereotactic radiotherapy Brain metastases Linac |
| title | Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study |
| title_full | Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study |
| title_fullStr | Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study |
| title_full_unstemmed | Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study |
| title_short | Stereotactic radiosurgery for the treatment of brainstem metastases: a multicenter retrospective study |
| title_sort | stereotactic radiosurgery for the treatment of brainstem metastases a multicenter retrospective study |
| topic | Brainstem metastases SRS, stereotactic radiosurgery SRT, stereotactic radiotherapy Brain metastases Linac |
| url | https://doi.org/10.1186/s13014-022-02111-5 |
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