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Title: What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach

Abstract

Purpose: Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity. Patients and Methods: We retrospectively evaluated 97 patients with brain metastases >2 cm in diameter treated with surgery and cavity SRS. Local and distant brain failure (DF) rates were analyzed with competing risk analysis, with death as a competing risk. The overall survival rate was calculated by the Kaplain-Meier product-limit method. Results: The median imaging follow-up duration for all patients was 10 months (range, 1-80 months). The 12-month cumulative incidence rates of LF, with death as a competing risk, were 9.3% (95% confidence interval [CI], 4.5%-16.1%), and the median time to LF was 6 months (range, 3-17 months). The 12-month cumulative incidence rate of DF, with death as a competing risk, was 53% (95% CI, 43%-63%). The median survival time for all patients was 15.6 months. The median survival times for recursive partitioning analysis classes 1, 2, and 3 were 33.8, 13.7, and 9.0 months, respectively (p =more » 0.022). On multivariate analysis, Karnofsky Performance Status ({>=}80 vs. <80; hazard ratio 0.54; 95% CI 0.31-0.94; p = 0.029) and maximum preoperative tumor diameter (hazard ratio 1.41; 95% CI 1.08-1.85; p = 0.013) were associated with survival. Five patients (5%) required intervention for Common Terminology Criteria for Adverse Events v4.02 grade 2 and 3 toxicity. Conclusion: Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.« less

Authors:
;  [1];  [2]; ;  [1];  [3];  [1];  [2]
  1. Department of Neurosurgery, Stanford University Medical Center, Stanford, California (United States)
  2. Department of Radiation Oncology, Stanford University Medical Center, Stanford, California (United States)
  3. Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul (Turkey)
Publication Date:
OSTI Identifier:
22149569
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; DEATH; HEALTH HAZARDS; IRRADIATION; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; PERFORMANCE; RADIOTHERAPY; RISK ASSESSMENT; SURGERY; SURVIVAL TIME; TOXICITY

Citation Formats

Choi, Clara Y.H., Chang, Steven D., Gibbs, Iris C., Adler, John R., Harsh, Griffith R., Atalar, Banu, Lieberson, Robert E., and Soltys, Scott G., E-mail: sgsoltys@stanford.edu. What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.028.
Choi, Clara Y.H., Chang, Steven D., Gibbs, Iris C., Adler, John R., Harsh, Griffith R., Atalar, Banu, Lieberson, Robert E., & Soltys, Scott G., E-mail: sgsoltys@stanford.edu. What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach. United States. doi:10.1016/J.IJROBP.2012.01.028.
Choi, Clara Y.H., Chang, Steven D., Gibbs, Iris C., Adler, John R., Harsh, Griffith R., Atalar, Banu, Lieberson, Robert E., and Soltys, Scott G., E-mail: sgsoltys@stanford.edu. Thu . "What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach". United States. doi:10.1016/J.IJROBP.2012.01.028.
@article{osti_22149569,
title = {What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach},
author = {Choi, Clara Y.H. and Chang, Steven D. and Gibbs, Iris C. and Adler, John R. and Harsh, Griffith R. and Atalar, Banu and Lieberson, Robert E. and Soltys, Scott G., E-mail: sgsoltys@stanford.edu},
abstractNote = {Purpose: Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity. Patients and Methods: We retrospectively evaluated 97 patients with brain metastases >2 cm in diameter treated with surgery and cavity SRS. Local and distant brain failure (DF) rates were analyzed with competing risk analysis, with death as a competing risk. The overall survival rate was calculated by the Kaplain-Meier product-limit method. Results: The median imaging follow-up duration for all patients was 10 months (range, 1-80 months). The 12-month cumulative incidence rates of LF, with death as a competing risk, were 9.3% (95% confidence interval [CI], 4.5%-16.1%), and the median time to LF was 6 months (range, 3-17 months). The 12-month cumulative incidence rate of DF, with death as a competing risk, was 53% (95% CI, 43%-63%). The median survival time for all patients was 15.6 months. The median survival times for recursive partitioning analysis classes 1, 2, and 3 were 33.8, 13.7, and 9.0 months, respectively (p = 0.022). On multivariate analysis, Karnofsky Performance Status ({>=}80 vs. <80; hazard ratio 0.54; 95% CI 0.31-0.94; p = 0.029) and maximum preoperative tumor diameter (hazard ratio 1.41; 95% CI 1.08-1.85; p = 0.013) were associated with survival. Five patients (5%) required intervention for Common Terminology Criteria for Adverse Events v4.02 grade 2 and 3 toxicity. Conclusion: Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.},
doi = {10.1016/J.IJROBP.2012.01.028},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}