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Title: Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS

Abstract

Purpose: To report the outcomes of repeat stereotactic radiosurgery (SRS), deferring whole-brain radiation therapy (WBRT), for distant intracranial recurrences and identify factors associated with prolonged overall survival (OS). Patients and Methods: We retrospectively identified 652 metastases in 95 patients treated with 2 or more courses of SRS for brain metastases, deferring WBRT. Cox regression analyzed factors predictive for OS. Results: Patients had a median of 2 metastases (range, 1-14) treated per course, with a median of 2 courses (range, 2-14) of SRS per patient. With a median follow-up after first SRS of 15 months (range, 3-98 months), the median OS from the time of the first and second course of SRS was 18 (95% confidence interval [CI] 15-24) and 11 months (95% CI 6-17), respectively. On multivariate analysis, histology, graded prognostic assessment score, aggregate tumor volume (but not number of metastases), and performance status correlated with OS. The 1-year cumulative incidence, with death as a competing risk, of local failure was 5% (95% CI 4-8%). Eighteen (24%) of 75 deaths were from neurologic causes. Nineteen patients (20%) eventually received WBRT. Adverse radiation events developed in 2% of SRS sites. Conclusion: Multiple courses of SRS, deferring WBRT, for distant brain metastases after initial SRS, seemmore » to be a safe and effective approach. The graded prognostic assessment score, updated at each course, and aggregate tumor volume may help select patients in whom the deferral of WBRT might be most beneficial.« less

Authors:
; ; ; ;  [1];  [1];  [2]; ; ; ;  [3];  [1];  [1]
  1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)
  2. (United States)
  3. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (United States)
Publication Date:
OSTI Identifier:
22462394
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 92; Journal Issue: 5; Other Information: Copyright (c) 2015 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; HISTOLOGY; METASTASES; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIOTHERAPY; SURGERY

Citation Formats

Shultz, David B., Modlin, Leslie A., Jayachandran, Priya, Von Eyben, Rie, Gibbs, Iris C., Choi, Clara Y.H., Department of Radiation Oncology, Santa Clara Valley Medical Center, San Jose, California, Chang, Steven D., Harsh, Griffith R., Li, Gordon, Adler, John R., Hancock, Steven L., and Soltys, Scott G., E-mail: sgsoltys@stanford.edu. Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS. United States: N. p., 2015. Web. doi:10.1016/J.IJROBP.2015.04.036.
Shultz, David B., Modlin, Leslie A., Jayachandran, Priya, Von Eyben, Rie, Gibbs, Iris C., Choi, Clara Y.H., Department of Radiation Oncology, Santa Clara Valley Medical Center, San Jose, California, Chang, Steven D., Harsh, Griffith R., Li, Gordon, Adler, John R., Hancock, Steven L., & Soltys, Scott G., E-mail: sgsoltys@stanford.edu. Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS. United States. doi:10.1016/J.IJROBP.2015.04.036.
Shultz, David B., Modlin, Leslie A., Jayachandran, Priya, Von Eyben, Rie, Gibbs, Iris C., Choi, Clara Y.H., Department of Radiation Oncology, Santa Clara Valley Medical Center, San Jose, California, Chang, Steven D., Harsh, Griffith R., Li, Gordon, Adler, John R., Hancock, Steven L., and Soltys, Scott G., E-mail: sgsoltys@stanford.edu. Sat . "Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS". United States. doi:10.1016/J.IJROBP.2015.04.036.
@article{osti_22462394,
title = {Repeat Courses of Stereotactic Radiosurgery (SRS), Deferring Whole-Brain Irradiation, for New Brain Metastases After Initial SRS},
author = {Shultz, David B. and Modlin, Leslie A. and Jayachandran, Priya and Von Eyben, Rie and Gibbs, Iris C. and Choi, Clara Y.H. and Department of Radiation Oncology, Santa Clara Valley Medical Center, San Jose, California and Chang, Steven D. and Harsh, Griffith R. and Li, Gordon and Adler, John R. and Hancock, Steven L. and Soltys, Scott G., E-mail: sgsoltys@stanford.edu},
abstractNote = {Purpose: To report the outcomes of repeat stereotactic radiosurgery (SRS), deferring whole-brain radiation therapy (WBRT), for distant intracranial recurrences and identify factors associated with prolonged overall survival (OS). Patients and Methods: We retrospectively identified 652 metastases in 95 patients treated with 2 or more courses of SRS for brain metastases, deferring WBRT. Cox regression analyzed factors predictive for OS. Results: Patients had a median of 2 metastases (range, 1-14) treated per course, with a median of 2 courses (range, 2-14) of SRS per patient. With a median follow-up after first SRS of 15 months (range, 3-98 months), the median OS from the time of the first and second course of SRS was 18 (95% confidence interval [CI] 15-24) and 11 months (95% CI 6-17), respectively. On multivariate analysis, histology, graded prognostic assessment score, aggregate tumor volume (but not number of metastases), and performance status correlated with OS. The 1-year cumulative incidence, with death as a competing risk, of local failure was 5% (95% CI 4-8%). Eighteen (24%) of 75 deaths were from neurologic causes. Nineteen patients (20%) eventually received WBRT. Adverse radiation events developed in 2% of SRS sites. Conclusion: Multiple courses of SRS, deferring WBRT, for distant brain metastases after initial SRS, seem to be a safe and effective approach. The graded prognostic assessment score, updated at each course, and aggregate tumor volume may help select patients in whom the deferral of WBRT might be most beneficial.},
doi = {10.1016/J.IJROBP.2015.04.036},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 92,
place = {United States},
year = {2015},
month = {8}
}