Health Sciences University, Basaksehir Cam and Sakura City Hospital, Department of Radiation Oncology, Turkeye , hskiziltan@gmail.com
Abstract: (925 Views)
Background:In this study, prognostic features of radiation were investigated in cancer patients with 1-10 brain metastases (BM) who have not under surgery and survived longer than 6 months. Materials and Methods:This retrospective study included 136 patients have lung, breast, colon cancer and malign melanoma (MM) with 1-10 BM. All patients and data of BM patients who lived longer than 6 months radiotherapy (RT) related factors affecting their survival rates were examined. Patients were given only WBRT (Whole brain Radiotherapy) in 8-20 fractions with a 160-300 cGy / day fraction, or WBRT with local boost RT with an additional daily 300-350 cGy fraction. Results:When the results were evaluated analysis showed that the having CT, breast cancer, a KPS of 60% or more, daily fraction dose of RT affected survival significantly in all patients. Then subgroub analysis were obtained according to survival rates, number of metastases more than 5 affects life negatively (r=-0.435 and p=0.03) for survival longer than 6 months (SL6m) and survival shorter or equal than 6 months SS6m. The WBRT doses of 3000 cGy with 300 cGy daily fraction size negatively affected life compared to 2500 cGy with 250 cGy (r=-0.280 and p=0.01). Conclusion: It was determined that KPS > 60 and limiting WBRT doses up to 250 / 2500 cGy daily and total in patients with BM between 1-10 was the important best prognostic factor due to RT for SL6m, which increased patient performance and survival rates.
1. 1. Rahmathulla G, Toms SA, Weil RJ (2012) The molecular biology of brain metastasis. J Oncol, 723541. [DOI:10.1155/2012/723541] [PMID] []
2. Gupta T (2005) Stereotactic radiosurgery for brain oligometastases: Good for some, better for all? Ann Oncol, 16: 1749-54. [DOI:10.1093/annonc/mdi392] [PMID]
3. Ellis TL, Neal MT, Chan MD (2002) The role of surgery, radiosurgery and whole brain radiation therapy in the management of patients with metastatic brain tumors. Int J Surg Oncol, 952345.
5. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 77: 655-661. [DOI:10.1016/j.ijrobp.2009.08.025] [PMID]
6. Knoll MA, Oermann EK, Yang AI, Paydar I, Steinberger J, et al. (2018) Survival of Patients With Multiple Intracranial Metastases Treated With Stereotactic Radiosurgery: Does the Number of Tumors Matter? Am J Clin Oncol, 41(5): 425-431. [DOI:10.1097/COC.0000000000000299] [PMID]
7. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC (1999) Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys, 45(2): 427-34. [DOI:10.1016/S0360-3016(99)00198-4]
9. Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, et al. (2015) Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys, 91:710-717. [DOI:10.1016/j.ijrobp.2014.10.024] [PMID]
10. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo et al. (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA, 295: 2483-2491. [DOI:10.1001/jama.295.21.2483] [PMID]
11. de Azevedo Santos TR, Tundisi CF, Ramos H, Maia MA, Pellizzon AC, et al. (2015) Local control after radiosurgery for brain metastases: predictive factors and implications for clinical decision. Radiat Oncol, 10: 63. [DOI:10.1186/s13014-015-0367-y] [PMID] []
12. Noel G, Medioni J, Valery CA, Boisserie G, Simon JM, Cornu P, et al. (2003) Three irradiation treatment options including radiosurgery for brain metastases from primary. Lung Cancer, 41: pp.333-343. [DOI:10.1016/S0169-5002(03)00236-8] [PMID]
13. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, et al. (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. [DOI:10.1016/S1470-2045(09)70263-3] [PMID]
14. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, et al. (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (ncctg n107c/cec·3): A multicentre, randomised, controlled, phase 3 trial. Lancet Oncol, 18: 1049-1060 [DOI:10.1016/S1470-2045(17)30441-2] [PMID]
15. Andrews DW, Scott CB, Sperduto PW, Flanders AE, et al. (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. Lancet, 363: 1665-72. [DOI:10.1016/S0140-6736(04)16250-8] [PMID]
16. Hall EJ and Brenner DJ (1993) The radiobiology of radiosurgery: Rationale for different treatment regimes for AVMs and malignancies. Int J Radiat Oncol Biol Phys, 25: 381-385. [DOI:10.1016/0360-3016(93)90367-5] [PMID]
17. Chen JC, Petrovich Z, O'Day S, Morton D, Essner R, et al. (2000) Stereotactic radiosurgery in the treatment of metastatic disease to the brain. Neurosurgery , 47: 268-279. [DOI:10.1097/00006123-200008000-00003] [PMID]
18. Murrell DH, Zarghami N, Jensen MD, Chambers AF, Wong E, Foster PJ (2016) Evaluating Changes to Blood-Brain Barrier Integrity in Brain Metastasis over Time and after Radiation Treatment. Transl Oncol, 9(3): 219-27 [DOI:10.1016/j.tranon.2016.04.006] [PMID] []
19. Tomita N, Kodaira T, Tachibana H, Nakamura T, Nakahara R, Inokuchi H, Shibamoto Y (2008) Helical tomotherapy for brain metastases: Dosimetric evaluation of treatment plans and early clinical results. Technol. Cancer Res. Treat, 7: 417-424. [DOI:10.1177/153303460800700602] [PMID]
20. Kirova YM, Chargari C, Zefkili S, Campana F (2010) Could helical tomotherapy do whole brain radiotherapy and radiosurgery? World J. Radiol, 2: 148-150. [DOI:10.4329/wjr.v2.i4.148] [PMID] []
21. Vanderspek L, Bauman G, Wang JZ, Yartsev S, Ménard C, Cho YB, et al. (2009) Dosimetric comparison of intensity-modulated radiosurgery and helical tomotherapy for the treatment of multiple intracranial metastases. Technol Cancer Res Treat, 8: 361-367. [DOI:10.1177/153303460900800506] [PMID]
22. Levegrün S, Pöttgen C, Wittig A, Lübcke W, Abu Jawad J, Stuschke M (2013) Helical tomotherapy for whole-brain irradiation with integrated boost to multiple brain metastases: Evaluation of dose distribution characteristics and comparison with alternative techniques. Int J Radiat Oncol Biol Phys, 86: 734-742. [DOI:10.1016/j.ijrobp.2013.03.031] [PMID]
23. Kyung HK, Byoung CC, Chang GL, Hye RK, Yang GS, et al. (2015) Hippocampus-sparing whole-brain radiotherapy and simultaneous integrated boost for multiple brain metastases from lung adenocarcinoma: Early response and dosimetric evaluation. Technol in Cancer Res Treat, DOI: 10.1177/1533034614566993 [DOI:10.1177/1533034614566993] [PMID]
24. Paolo B, Sara P, Luigi S, Rossella A, Mauro U, et al. (2016) Whole brain radiotherapy with adjuvant or concomitant boost in brain metastasis: dosimetric comparison between helical and volumetric IMRT technique. Radiat Oncol, 11: 59. [DOI:10.1186/s13014-016-0634-6] [PMID] []
25. Peñagarícano JA, Yan Y, Shi C, Linskey ME, Ratanatharathorn V (2006) Dosimetric comparison of helical tomotherapy and gamma knife stereotactic radiosurgery for single brain metastasis. Radiat Oncol,1: 26-31. [DOI:10.1186/1748-717X-1-26] [PMID] []
26. Shiby P, Nitin O, Christian V, Patrik B, Dinesh M, Wolfgang T, et al. (2021) The effect of low-dose radiation spillage during stereotactic radiosurgery for brain metastases on the development of de novo metastases. Clin Transl Radiat Oncol, 28: 79-84. [DOI:10.1016/j.ctro.2021.03.003] [PMID] []
27. Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, Bovi JA, Robinson C, Konski A, et al. (2020) Hippocampal avoidance during whole-brain radiotherapy plus memantine for patients with brain metastases: Phase iii trial nrg oncology cc001. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38: 1019-1029. [DOI:10.1200/JCO.19.02767] [PMID] []
28. Levegrün S, Pöttgen C, Wittig A, Lübcke W, Abu Jawad J, Stuschke M (2013) Helical tomotherapy for whole-brain irradiation with integrated boost to multiple brain metastases: evaluation of dose distribution characteristics and comparison with alternative techniques. Int J Radiat Oncol Biol Phys, 86(4):734-42. [DOI:10.1016/j.ijrobp.2013.03.031] [PMID]
29. Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg, 93(3): 219e222 [DOI:10.3171/jns.2000.93.supplement_3.0219]
31. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, et al.(2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA, 295(21): 2483-91. [DOI:10.1001/jama.295.21.2483] [PMID]
32. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, et al. (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol, 29(2): 134-41. [DOI:10.1200/JCO.2010.30.1655] [PMID] []
33. Sneed PK, Suh JH, Goetsch SJ, Sanghavi SN, Chappell R, Buatti JM, et al. (2002) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys, 53(3): 519-26. [DOI:10.1016/S0360-3016(02)02770-0] [PMID]
34. Park SH, Hwang SK, Kang DH, Lee SH, Park J, Hwang JH, Hamm IS, Park YM (2009) Gamma Knife Radiosurgery for Multiple Brain Metastases From Lung Cancer. J Clin Neurosci, 16(5): 626-9. [DOI:10.1016/j.jocn.2008.08.003] [PMID]
35. Suzuki S, Omagari J, Nishio S, Nishiye E, Fukui M (2000) Gamma Knife Radiosurgery for Simultaneous Multiple Metastatic Brain Tumors. J Neurosurg, 93(3): 30-1. [DOI:10.3171/jns.2000.93.supplement_3.0030]
36. Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M, Shaw P, Beyene J, Chang EL (2015) Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys, 91(4): 710-7. [DOI:10.1016/j.ijrobp.2014.10.024] [PMID]
37. Thomas EM, Popple RA, Wu X, Clark GM, Markert JM, Guthrie BL, et al. (2014) Comparison of plan quality and delivery time between volumetric arc therapy (RapidArc) and Gamma Knife radiosurgery for multiple cranial metastases. Neurosurgery, 75(4): 409-17. [DOI:10.1227/NEU.0000000000000448] [PMID] []
38. Alexander 3rd , Moriarty TM, Davis RB, Wen PY, Fine HA, Black PM, Kooy HM, Loeffler JS (1995) Stereotactic Radiosurgery for the Definitive, Noninvasive Treatment of Brain Metastases. J Natl Cancer Inst, 87(1): 34-40. [DOI:10.1093/jnci/87.1.34] [PMID]
39. Bhatnagar AK, Flickinger JC, Kondziolka D, Lunsford LD (2006) Stereotactic radiosurgery for four or more intracranial metastases. Int J Radiat Oncol Biol Phys, 64(3): 898-903. [DOI:10.1016/j.ijrobp.2005.08.035] [PMID]
40. Yamamoto M, Serizawa T, Higuchi Y, Sato Y, Kawagishi J, Yamanaka K, et al. (2017) A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores. Int J Radiat Oncol Biol Phys, 99(1): 31-40. [DOI:10.1016/j.ijrobp.2017.04.037] [PMID]
41. Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, et al. (2012) Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol, 2(3): 210-225. [DOI:10.1016/j.prro.2011.12.004] [PMID] []
42. Casanova N, Mazouni Z, Bieri S, Combescure C, Pica A, Weber DC (2010) Whole brain radiotherapy with a conformational external beam radiation boost for lung cancer patients with 1-3 brain metastasis: A multi institutional study. Radiat Oncol, 5: 13. [DOI:10.1186/1748-717X-5-13] [PMID] []
43. Vivek T, Subodh CP, Kamal V, and Sandeep G (2015) Simultaneous integrated boost with intensity modulated radiation therapy in brain oligometastases: A feasible technique for developing countries. South Asian J Cancer, 4(1): 11-14.
44. Ferro M, Chiesa S, Macchia G, Cilla S, Bertini F, Frezza G et al. (2017) Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Patients With Brain Oligometastases: A Phase 1 Study (ISIDE-BM-1). Int J Radiat Oncol Biol Phys, 97(1): 82-90. [DOI:10.1016/j.ijrobp.2016.09.020] [PMID]
45. Vargo JA, Plants BA, Mihailidis DN, Mallah J, Plants M, Welch CA, et al. (2011) Early clinical outcomes for 3 radiation techniques for brain metastases: focal versus whole-brain. Pract Radiat Oncol, 1(4): 261-70. [DOI:10.1016/j.prro.2011.03.005] [PMID]
47. Nabors LB, Portnow J, Ammirati M, Brem H, Brown P, Butowski N, et al. (2014) Central nervous system cancers, version 2.2014. Featured updates to the NCCN Guidelines. J Natl Compr Canc Netw, 12: 1517-23.
48. Paolo B, Sara P, Luigi S, Rossella A, Mauro U, Federica F, et al. (2016) Whole brain radiotherapy with adjuvant or concomitant boost in brain metastasis: dosimetric comparison between helical and volumetric IMRT technique. Radiat Oncol, 11: 59. [DOI:10.1186/s13014-016-0634-6] [PMID] []
49. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys, 37: 745-51. [DOI:10.1016/S0360-3016(96)00619-0] [PMID]
50. Pokhrel D, Sood S, McClinton C, Shen X, Lominska C, Saleh H, et al. (2016) Treatment planning strategy for whole-brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastases using intensity-modulated arc therapy. Med Dosim, 41(4): 315-322. [DOI:10.1016/j.meddos.2016.08.001] [PMID]
Kızıltan H, Coban G, Altınok P, Tekce E, Mayadagli A. Radiotherapy related prognostic factors in brain metastasis patients who have undergone whole brain radiotherapy or with local boost and survived more than 6 months. Int J Radiat Res 2023; 21 (1) :37-44 URL: http://ijrr.com/article-1-4567-en.html