title: The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases.
abstract: The aim of the present study was to evaluate the efficacy and limitations of repeat stereotactic radiosurgery (SRS) salvage for patients with recurrence of brain metastases (BM) after whole brain radiotherapy (WBRT). This is a retrospective, observational, single-center trial analyzing 77 consecutive patients with recurrent BM who were treated primarily with WBRT. All patients underwent SRS as salvage treatment. Median age was 62 years, and median Karnofsky performance status (KPS) was 80. The median interval between the starting date of WBRT and radiosurgery was 10.6 months. One, two and more than two SRS sessions were required in 42, 13 and 22 patients, respectively. The median total planning target volume (PTV) was 8.1 mL and the median dose prescribed was 20 Gy. The median follow-up was 7.7 months. 1- and 2-year neurological death-free survival (NS) rates were 87 and 78 %, respectively. Competing risk analysis demonstrated active extra-central nervous system (CNS) disease [Hazard ratio (HR) 0.236, P = 0.041] and total PTV on initial SRS (≥ 5 mL) (HR 4.22, P = 0.033) to be associated with the NS rate. 1- and 2-year overall survival (OS) rates were 41 and 11 %, respectively. The median OS time was 8.2 months. Active extra-CNS disease (HR 1.94, P = 0.034) and high KPS (≥ 90) (HR 0.409, P = 0.006) were associated with the OS rate. In total, 798 tumors (75 %) in 66 patients (86 %) with sufficient radiological follow-up data were evaluated. 1- and 2-year metastasis local control rates were 76.6 and 57.9 %, respectively. Prescribed dose (≥ 20 Gy) (HR 0.326, P < 0.001), tumor volume (≥ 2 mL) (HR 1.98, P = 0.007) and metastases from breast cancer (HR 0.435, P < 0.001) were independent predictive factors for local tumor control. Repeat salvage SRS for recurrent BM after WBRT appeared to be a safe and effective treatment. In the majority of patients, even those with numerous BM, neurological death could be delayed or even prevented.
authors: Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano Prefecture 390-0814, Japan. yomoshoji@gmail.com
authors: Shoji
authors: S
authors: Yomo
authors: Motohiro
authors: M
authors: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011836:Radiation Tolerance; D016634:Radiosurgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D047368:Tumor Burden
references: J Neurooncol. 2012 Aug;109(1):159-65
references: 22544651
references: J Neurooncol. 2011 Dec;105(3):467-74
references: 21785914
references: Radiother Oncol. 2012 Feb;102(2):192-7
references: 21880387
references: Radiother Oncol. 2001 Jul;60(1):61-7
references: 11410305
references: Cancer. 2008 Oct 15;113(8):2198-204
references: 18780319
references: Clin Oncol (R Coll Radiol). 2007 Sep;19(7):532-8
references: 17662582
references: Br J Neurosurg. 1994;8(6):717-23
references: 7718169
references: J Nucl Med. 2008 May;49(5):694-9
references: 18413375
references: Int J Radiat Oncol Biol Phys. 1988 Aug;15(2):433-7
references: 2841266
references: Am J Clin Oncol. 1997 Apr;20(2):158-60
references: 9124191
references: J Neurooncol. 2010 Jan;96(1):85-96
references: 19957016
references: Int J Radiat Oncol Biol Phys. 2002 Aug 1;53(5):1279-83
references: 12128130
references: Cancer. 1980 Dec 15;46(12):2587-9
references: 7448697
references: Int J Radiat Oncol Biol Phys. 1996 Feb 1;34(3):585-90
references: 8621282
references: Radiology. 1990 Mar;174(3 Pt 1):883-5
references: 2305074
references: Lancet Oncol. 2009 Nov;10(11):1037-44
references: 19801201
references: Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e167-72
references: 21620583
references: Stereotact Funct Neurosurg. 1998 Oct;70 Suppl 1:41-9
references: 9782234
references: Neurosurgery. 2010 Mar;66(3):486-91; discussion 491-2
references: 20173543
references: J Clin Oncol. 2013 Jan 1;31(1):65-72
references: 23213105
references: Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):303-9
references: 22079723
references: Int J Mol Sci. 2013 Jan 22;14(1):2135-74
references: 23340652