International journal of radiation oncology, biology, physics · 2016
Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity.
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Trifiletti Daniel M, Lee Cheng-Chia, Kano Hideyuki, Cohen Jonathan, Janopaul-Naylor James, Alonso-Basanta Michelle, Lee John Y K, Simonova Gabriela, Liscak Roman, Wolf Amparo, Kvint Svetlana, Grills Inga S, Johnson Matthew, Liu Kang-Du, Lin Chung-Jung, Mathieu David, Héroux France, Silva Danilo, Sharma Mayur, Cifarelli Christopher P, Watson Christopher N, Hack Joshua D, Golfinos John G, Kondziolka Douglas, Barnett Gene, Lunsford L Dade, Sheehan Jason P
Аннотация
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.
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.
Предметные рубрики MeSH
AdultAge DistributionAgedAged, 80 and overBrain Stem NeoplasmsCausalityComorbidityCranial IrradiationDose-Response Relationship, RadiationFemaleHumansInternational CooperationMaleMiddle AgedRadiation InjuriesRadiosurgeryRadiotherapy DosageRetrospective StudiesRisk FactorsSex DistributionSurvival RateTreatment Outcome