Changes in the characteristics of patients treated for brain metastases with repeat stereotactic radiotherapy (SRT): a retrospective study of 184 patients.
Brain metastases
Oligorecurrence
Radiotherapy
Reirradiation
Repeated radiosurgery
Salvage radiation
Stereotactic radiosurgery
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
30 Jan 2023
30 Jan 2023
Historique:
received:
02
03
2022
accepted:
03
01
2023
entrez:
31
1
2023
pubmed:
1
2
2023
medline:
2
2
2023
Statut:
epublish
Résumé
Brain metastases (BMs) are the leading cause of intracranial malignant neoplasms in adults. WHO, Karnofsky performance status (KPS), age, number of BMs, extracerebral progression (ECP), recursive partitioning analysis (RPA), diagnosis-specific graded prognostic assessment (Ds-GPA) are validated prognostic tools to help clinicians decide on treatment. No consensus exists for repeat stereotactic radiotherapy (SRT) for BMs. The aim of this study was to review the changes in patient characteristics treated with repeated SRTs. The data of patients treated between 2010 and 2020 with at least two courses of SRT without previous whole brain radiotherapy (WBRT) were reviewed. Age, WHO, KPS, ECP, type of systemic treatment, number of BMs were recorded. RPA, Ds-GPA and brain metastasis velocity (BMV) were calculated. 184 patients were treated for 915 BMs and received two to six SRTs for local or distant brain recurrence. The median number of BMs treated per SRT was 1 (range: 1-6), for a median of 4 BMs treated during all sessions (range: 2-19). WHO, Ds-GPA and RPA were stable between each session of SRT, whereas KPS was significantly better in SRT1 than in the following SRT. The number of BMs was not significantly different between each SRT, but there was a tendency for more BM at SRT1 (p = 0.06). At SRT1, patients had largest BM and undergo more surgery than during the following SRT (p < 0.001). 6.5%, 37.5% and 56% of patients were classified as high, intermediate, and low BMV, respectively, at the last SRT session. There was almost perfect concordance between the BMV-grade calculated at the last SRT session and at SRT2 (r = 0.89; p < 0.001). Repeated SRT doesn't lead to a marked alteration in the general condition, KPS was maintained at over 70% for more than 95% of patients during all SRTs. Long survival can be expected, especially in low-grade BMV patients. WBRT shouldn't be aborted, especially for patients developing more than twelve BMs annually.
Identifiants
pubmed: 36717863
doi: 10.1186/s13014-023-02200-z
pii: 10.1186/s13014-023-02200-z
pmc: PMC9885681
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
21Informations de copyright
© 2023. The Author(s).
Références
Cancer Radiother. 2015 Feb;19(1):16-9
pubmed: 25649387
Cancer Radiother. 2016 Sep;20 Suppl:S80-7
pubmed: 27523410
AJNR Am J Neuroradiol. 2018 Jun;39(6):1025-1031
pubmed: 29724761
Cancer Radiother. 2016 Dec;20(8):837-845
pubmed: 28270324
Curr Oncol Rep. 2012 Feb;14(1):48-54
pubmed: 22012633
Front Oncol. 2018 Nov 22;8:551
pubmed: 30524969
Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388-95
pubmed: 17674975
Neurosurgery. 2010 Mar;66(3):486-91; discussion 491-2
pubmed: 20173543
Acta Neurochir (Wien). 2004 Sep;146(9):989-93; discussion 993
pubmed: 15340810
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):993-999
pubmed: 26194677
J Neurosurg. 2016 Dec;125(Suppl 1):2-10
pubmed: 27903177
Radiother Oncol. 2014 Aug;112(2):212-6
pubmed: 25082096
Cancer Manag Res. 2020 Jun 03;12:4139-4149
pubmed: 32581585
JAMA. 2016 Jul 26;316(4):401-409
pubmed: 27458945
Int J Radiat Oncol Biol Phys. 2017 May 1;98(1):131-141
pubmed: 28586952
J Neurosurg. 2012 Dec;117 Suppl:38-44
pubmed: 23205787
J Neurooncol. 2021 Apr;152(2):333-338
pubmed: 33512631
World Neurosurg. 2019 May;125:156-163
pubmed: 30738931
Neuro Oncol. 2014 Sep;16(9):1283-8
pubmed: 24558022
J Neurosurg. 2020 Jul 10;134(6):1791-1799
pubmed: 32650308
Eur Urol Focus. 2019 May;5(3):474-481
pubmed: 29311016
Crit Rev Oncol Hematol. 2020 Sep;153:103028
pubmed: 32622322
World Neurosurg. 2014 Dec;82(6):1242-9
pubmed: 25109592
Clin Colorectal Cancer. 2020 Dec;19(4):263-269
pubmed: 33012679
Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
pubmed: 9128946
Future Oncol. 2021 Feb;17(5):597-609
pubmed: 33401981
Lancet Oncol. 2017 Jul;18(7):863-873
pubmed: 28592387
Oncoscience. 2020 Apr 24;7(3-4):19-20
pubmed: 32426417
Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1001-6
pubmed: 10863071
World Neurosurg. 2018 May;113:e1-e9
pubmed: 29104152
Neuro Oncol. 2015 May;17(5):639-51
pubmed: 25846288
J Neurooncol. 2012 Aug;109(1):149-58
pubmed: 22638727
Curr Neurol Neurosci Rep. 2018 Aug 18;18(10):70
pubmed: 30121715
N Engl J Med. 2020 Feb 13;382(7):597-609
pubmed: 31825569
J Neurooncol. 2010 Jan;96(1):85-96
pubmed: 19957016
Int J Radiat Oncol Biol Phys. 2010 Jul 1;77(3):655-61
pubmed: 19942357
Neurosurgery. 2017 Jun 1;80(6):871-879
pubmed: 28327948
Cancer Radiother. 2021 Jun;25(4):390-399
pubmed: 33431294
N Engl J Med. 2018 Aug 23;379(8):722-730
pubmed: 30134131
Neuro Oncol. 2013 Dec;15(12):1732-8
pubmed: 24243914
Int J Radiat Oncol Biol Phys. 2019 Mar 1;103(3):631-637
pubmed: 30395905