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Irradiated tumor volume as a predictor of local recurrence and radionecrosis in lung cancer with brain metastases treated with stereotactic radiosurgery.
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Koulouris A, Grundberg O, Skribek M, Kamali C, Hydbring P, Gubanski M, Ekman S, Tsakonas G
Аннотация
BACKGROUND: Stereotactic radiosurgery (SRS) is a standard treatment of brain metastases (BM), but it may lead to radionecrosis (RN) or local recurrence (LR). This study evaluates irradiated tumor volume as a predictor of LR and RN in SRS-treated lung cancer patients with BM.
METHODS: We retrospectively analyzed 431 lung cancer patients with BM who underwent SRS at Karolinska University Hospital (all-comers, 2009-2020). Associations among irradiated tumor volume and risks of RN, symptomatic RN, and LR at 6 and 12 months were assessed using Cox regression models. Furthermore, we evaluated the diagnostic performance of methionine positron emission tomography-computed tomography (PET-CT) in differentiating RN from LR.
RESULTS: Forty patients (9.3%) developed asymptomatic RN, 36 (8.4%) symptomatic RN, and 67 (15.5%) LR. Larger tumor volumes significantly increased RN and LR risks. At 6 months, a volume of 4.75 cm3 corresponded to an RN risk reaching up to 20%. By 12 months, substantially smaller volumes were correlated with the same risk levels. Symptomatic RN followed a similar trend, at 6 months and 12 months. A 20% risk of LR was observed with volumes of 5.66 cm3 and 3.28 cm3 at 6 months and 12 months, respectively. Methionine PET-CT had a sensitivity of 0.909 and specificity of 0.600 in detecting RN or LR, with no significant diagnostic advantage compared with magnetic resonance imaging (MRI).
CONCLUSION: Larger irradiated tumor volumes were correlated with increased RN or LR risk. Smaller volumes can lead to RN and LR, not evident at 6 months, but emerging by 12 months after SRS. Methionine PET-CT showed high sensitivity but modest specificity and offered no significant benefit over MRI in differentiating RN from LR.
METHODS: We retrospectively analyzed 431 lung cancer patients with BM who underwent SRS at Karolinska University Hospital (all-comers, 2009-2020). Associations among irradiated tumor volume and risks of RN, symptomatic RN, and LR at 6 and 12 months were assessed using Cox regression models. Furthermore, we evaluated the diagnostic performance of methionine positron emission tomography-computed tomography (PET-CT) in differentiating RN from LR.
RESULTS: Forty patients (9.3%) developed asymptomatic RN, 36 (8.4%) symptomatic RN, and 67 (15.5%) LR. Larger tumor volumes significantly increased RN and LR risks. At 6 months, a volume of 4.75 cm3 corresponded to an RN risk reaching up to 20%. By 12 months, substantially smaller volumes were correlated with the same risk levels. Symptomatic RN followed a similar trend, at 6 months and 12 months. A 20% risk of LR was observed with volumes of 5.66 cm3 and 3.28 cm3 at 6 months and 12 months, respectively. Methionine PET-CT had a sensitivity of 0.909 and specificity of 0.600 in detecting RN or LR, with no significant diagnostic advantage compared with magnetic resonance imaging (MRI).
CONCLUSION: Larger irradiated tumor volumes were correlated with increased RN or LR risk. Smaller volumes can lead to RN and LR, not evident at 6 months, but emerging by 12 months after SRS. Methionine PET-CT showed high sensitivity but modest specificity and offered no significant benefit over MRI in differentiating RN from LR.