Single- and Hypofractionated Stereotactic Radiosurgery for Large (> 2 cm) Brain Metastases: a Systematic Review

Overview

Journal J Neurooncol

Publisher Springer

Date 2021 Jul 16

PMID 34268640

Citations 11

Authors

Eun Jung Lee

Kyu-Sun Choi

Eun Suk Park

Young Hyun Cho

Affiliations

Soon will be listed here.

Abstract

Purpose: Since frameless stereotactic radiosurgery (SRS) techniques have been recently introduced, hypofractionated SRS (HF-SRS) for large brain metastases (BMs) is gradually increasing. To verify the efficacy and safety of HF-SRS for large BMs, we aimed to perform a systematic review and compared them with SF-SRS.

Methods: We systematically searched the studies regarding SF-SRS or HF-SRS for large (> 2 cm) BM from databases including PubMed, Embase, and the Cochrane Library on July 31, 2018. Biologically effective dose with the α/β ratio of 10 (BED), 1-year local control (LC), and radiation necrosis (RN) were compared between the two groups, with the studies being weighted by the sample size.

Results: The 15 studies with 1049 BMs that described 1-year LC and RN were included. HF-SRS tended to be performed in larger tumors; however, higher mean BED (50.1 Gy versus 40.4 Gy, p < 0.0001) was delivered in the HF-SRS group, which led to significantly improved 1-year LC (81.6 versus 69.0%, p < 0.0001) and 1-year overall survival (55.1 versus 47.2%, p < 0.0001) in the HF-SRS group compared to the SF-SRS group. In contrast, the incidence of radiation toxicity was significantly decreased in the HF-SRS group compared to the SF-SRS group (8.0 versus 15.6%, p < 0.0001).

Conclusion: HF-SRS results in better LC of large BMs while simultaneously reducing RN compared to SF-SRS. Thus, HF-SRS should be considered a priority for SF-SRS in patients with large BMs who are not suitable to undergo surgical resection.

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References

Jeong W, Park J, Lee E, Kim J, Kim C, Cho Y . Efficacy and Safety of Fractionated Stereotactic Radiosurgery for Large Brain Metastases. J Korean Neurosurg Soc. 2015; 58(3):217-24. PMC: 4630352. DOI: 10.3340/jkns.2015.58.3.217. View

Shiau C, Sneed P, Shu H, Lamborn K, McDermott M, Chang S . Radiosurgery for brain metastases: relationship of dose and pattern of enhancement to local control. Int J Radiat Oncol Biol Phys. 1997; 37(2):375-83. DOI: 10.1016/s0360-3016(96)00497-x. View

Matsuo T, Shibata S, Yasunaga A, Iwanaga M, Mori K, Shimizu T . Dose optimization and indication of Linac radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys. 1999; 45(4):931-9. DOI: 10.1016/s0360-3016(99)00271-0. View

Gerosa M, Nicolato A, Foroni R, Tomazzoli L, Bricolo A . Analysis of long-term outcomes and prognostic factors in patients with non-small cell lung cancer brain metastases treated by gamma knife radiosurgery. J Neurosurg. 2005; 102 Suppl:75-80. DOI: 10.3171/jns.2005.102.s_supplement.0075. View

Sheehan J, Kondziolka D, Flickinger J, Lunsford L . Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors. J Neurosurg. 2005; 102 Suppl:247-54. DOI: 10.3171/jns.2005.102.s_supplement.0247. View

Muacevic A, Kreth F, Tonn J, Wowra B . Stereotactic radiosurgery for multiple brain metastases from breast carcinoma. Cancer. 2004; 100(8):1705-11. DOI: 10.1002/cncr.20167. View

Selek U, Chang E, Hassenbusch 3rd S, Shiu A, Lang F, Allen P . Stereotactic radiosurgical treatment in 103 patients for 153 cerebral melanoma metastases. Int J Radiat Oncol Biol Phys. 2004; 59(4):1097-106. DOI: 10.1016/j.ijrobp.2003.12.037. View

Muacevic A, Siebels M, Tonn J, Wowra B . Treatment of brain metastases in renal cell carcinoma: radiotherapy, radiosurgery, or surgery?. World J Urol. 2005; 23(3):180-4. DOI: 10.1007/s00345-004-0471-3. View

Alexander 3rd E, Moriarty T, Davis R, Wen P, Fine H, Black P . Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases. J Natl Cancer Inst. 1995; 87(1):34-40. DOI: 10.1093/jnci/87.1.34. View

10.

Mori Y, Kondziolka D, Flickinger J, Kirkwood J, Agarwala S, Lunsford L . Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys. 1998; 42(3):581-9. DOI: 10.1016/s0360-3016(98)00272-7. View

11.

Noel G, Simon J, Valery C, Cornu P, Boisserie G, Hasboun D . Radiosurgery for brain metastasis: impact of CTV on local control. Radiother Oncol. 2003; 68(1):15-21. DOI: 10.1016/s0167-8140(03)00207-x. View

12.

Molenaar R, Wiggenraad R, Verbeek-de Kanter A, Walchenbach R, Vecht C . Relationship between volume, dose and local control in stereotactic radiosurgery of brain metastasis. Br J Neurosurg. 2009; 23(2):170-8. DOI: 10.1080/02688690902755613. View

13.

van Leeuwen C, Oei A, Crezee J, Bel A, Franken N, Stalpers L . The alfa and beta of tumours: a review of parameters of the linear-quadratic model, derived from clinical radiotherapy studies. Radiat Oncol. 2018; 13(1):96. PMC: 5956964. DOI: 10.1186/s13014-018-1040-z. View

14.

McClelland 3rd S, Ford B, Senatus P, Frucht S, Winfield L, Yu Q . Typical variations of subthalamic electrode location do not predict limb motor function improvement in Parkinson's disease. J Clin Neurosci. 2009; 16(6):771-8. DOI: 10.1016/j.jocn.2008.10.011. View

15.

Aoyama H, Shirato H, Onimaru R, Kagei K, Ikeda J, Ishii N . Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull. Int J Radiat Oncol Biol Phys. 2003; 56(3):793-800. DOI: 10.1016/s0360-3016(03)00014-2. View

16.

Ogura K, Mizowaki T, Ogura M, Sakanaka K, Arakawa Y, Miyamoto S . Outcomes of hypofractionated stereotactic radiotherapy for metastatic brain tumors with high risk factors. J Neurooncol. 2012; 109(2):425-32. DOI: 10.1007/s11060-012-0912-6. View

17.

Feuvret L, Vinchon S, Martin V, Lamproglou I, Halley A, Calugaru V . Stereotactic radiotherapy for large solitary brain metastases. Cancer Radiother. 2014; 18(2):97-106. DOI: 10.1016/j.canrad.2013.12.003. View

18.

Nagai A, Shibamoto Y, Yoshida M, Wakamatsu K, Kikuchi Y . Treatment of single or multiple brain metastases by hypofractionated stereotactic radiotherapy using helical tomotherapy. Int J Mol Sci. 2014; 15(4):6910-24. PMC: 4013669. DOI: 10.3390/ijms15046910. View

19.

Kim J, Park H, Lee J, Kim J, Chung H, Kim D . Fractionated Stereotactic Gamma Knife Radiosurgery for Large Brain Metastases: A Retrospective, Single Center Study. PLoS One. 2016; 11(9):e0163304. PMC: 5035085. DOI: 10.1371/journal.pone.0163304. View

20.

Minniti G, Scaringi C, Paolini S, Lanzetta G, Romano A, Cicone F . Single-Fraction Versus Multifraction (3 × 9 Gy) Stereotactic Radiosurgery for Large (>2 cm) Brain Metastases: A Comparative Analysis of Local Control and Risk of Radiation-Induced Brain Necrosis. Int J Radiat Oncol Biol Phys. 2016; 95(4):1142-8. DOI: 10.1016/j.ijrobp.2016.03.013. View