Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity

Journal Article · Sat Oct 01 04:00:00 EDT 2016 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2016.06.009· OSTI ID:22645642

Lee, Cheng-Chia ^[1]; Kano, Hideyuki; Cohen, Jonathan ^[2]; Janopaul-Naylor, James; Alonso-Basanta, Michelle; Lee, John Y.K. ^[3]; Simonova, Gabriela; Liscak, Roman ^[4]; Wolf, Amparo; Kvint, Svetlana ^[5]; Grills, Inga S.; Johnson, Matthew ^[6]; Liu, Kang-Du; Lin, Chung-Jung ^[1]; Mathieu, David; Héroux, France ^[7]; Silva, Danilo; Sharma, Mayur ^[8]; Cifarelli, Christopher P. ^[9]; others, and

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1. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan (China)
2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)
3. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)
4. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague (Czech Republic)
5. Department of Neurosurgery, New York University Lagone Medical Center, New York, New York (United States)
6. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States)
7. Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec (Canada)
8. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States)
9. Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, West Virginia (United States)

Purpose: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). Methods and Materials: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. Results: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. Conclusions: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.

• OSTI ID: 22645642
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 96; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DOSIMETRY
MULTIVARIATE ANALYSIS
NEOPLASMS
PATIENTS
RADIATION DOSES
RADIATION HAZARDS
RADIOTHERAPY
SURGERY
TOXICITY