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16.03.2022 | Original Article

Local recurrence and cerebral progression-free survival after multiple sessions of stereotactic radiotherapy of brain metastases: a retrospective study of 184 patients

Statistical analysis

verfasst von: Laure Kuntz, Clara Le Fèvre, MD, MSc, Delphine Jarnet, PhD, Audrey Keller, MD, Philippe Meyer, PhD, Caroline Bund, MD, PhD, Isabelle Chambrelant, Delphine Antoni, MD, PhD, Georges Noel, MD, PhD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 6/2022

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Abstract

Purpose

Forty to sixty percent of patients treated with focal therapy for brain metastasis (BM) will have distant brain recurrence (C-LR), while 10–25% of patients will have local recurrence (LR) within 1 year after stereotactic radiotherapy (SRT). The purpose of this study was to analyze cerebral progression-free survival (C-PFS) and LR of BM among patients treated with repeated courses of radiotherapy in stereotactic conditions.

Methods and materials

We retrospectively reviewed data from 184 patients treated for 915 BMs with at least two courses of SRT without previous WBRT. Initial patient characteristics, patient characteristics at each SRT, brain metastasis velocity (BMV), delay between SRT, MRI response, LR and C‑LR were analyzed.

Results

In all, 123 (66.9%), 39 (21.2%), and 22 (12%) patients received 2, 3, or 4 or more SRT sessions, respectively. Ninety percent of BMs were irradiated without prior surgery, and 10% were irradiated after neurosurgery. The MRI response at 3, 6, 12 and 24 months after SRT was stable regardless of the SRT session. At 6, 12 and 24 months, the rates of local control were 96.3, 90.1, and 85.8%, respectively. In multivariate analysis, P‑LR was statistically associated with kidney (HR = 0.08) and lung cancer (HR = 0.3), ECOG 1 (HR = 0.5), and high BMV grade (HR = 5.6). The median C‑PFS after SRT1, SRT2, SRT3 and SRT4 and more were 6.6, 5.1, 6.7, and 7.7 months, respectively. C‑PFS after SRT2 was significantly longer among patients in good general condition (HR = 0.39), patients with high KPS (HR = 0.91), patients with no extracerebral progression (HR = 1.8), and patients with a low BMV grade (low vs. high: HR = 3.8).

Conclusion

Objective MRI response rate after repeated SRT is stable from session to session. Patients who survive longer, such as patients with breast cancer or with low BMV grade, are at risk of local reirradiation. C‑PFS after SRT2 is better in patients in good general condition, without extracerebral progression and with low BMV grade.

Nur mit Berechtigung zugänglich

Antoni D, Noël G, Mornex F (2013) The role of whole brain radiation therapy for brain metastases. Bull Cancer 100:15–22. https://doi.org/10.1684/bdc.2012.1675CrossRefPubMed

Kuntz L, Matthis R, Wegner N, Lutz S (2020) Dosimetric comparison of mono-isocentric and multi-isocentric plans for oligobrain metastases: a single institutional experience. Cancer Radiother 24:53–59. https://doi.org/10.1016/j.canrad.2019.10.003CrossRefPubMed

Mori Y, Kaneda N, Hagiwara M, Ishiguchi T (2016) Dosimetric study of automatic brain metastases planning in comparison with conventional multi-Isocenter dynamic conformal arc therapy and gamma knife radiosurgery for multiple brain metastases. Cureus. https://doi.org/10.7759/cureus.882CrossRefPubMedPubMedCentral

Noel G, Keller A, Antoni D (2019) Stereotactic radiotherapy of brain metastases in complex situations. Cancer Radiother 23:708–715. https://doi.org/10.1016/j.canrad.2019.07.146CrossRefPubMed

Nguyen M‑N, Noel G, Antoni D (2019) Reirradiation of brain metastasis: review of the last five years. Cancer Radiother 23:531–540. https://doi.org/10.1016/j.canrad.2019.07.144CrossRefPubMed

Chidambaram S, Pannullo SC, Schwartz TH, Wernicke AG (2019) Reirradiation of recurrent brain metastases: where do we stand? World Neurosurg 125:156–163. https://doi.org/10.1016/j.wneu.2019.01.182CrossRefPubMed

Khan M, Lin J, Liao G et al (2017) Comparison of WBRT alone, SRS alone, and their combination in the treatment of one or more brain metastases: review and meta-analysis. Tumour Biol 39:1010428317702903. https://doi.org/10.1177/1010428317702903CrossRefPubMed

Rades D, Kueter J‑D, Hornung D et al (2008) Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT+SRS) for one to three brain metastases. Strahlenther Onkol 184:655–662. https://doi.org/10.1007/s00066-008-1946-8CrossRefPubMed

Aoyama H, Tago M, Kato N et al (2007) Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 68:1388–1395. https://doi.org/10.1016/j.ijrobp.2007.03.048CrossRefPubMed

10.

Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316:401–409. https://doi.org/10.1001/jama.2016.9839CrossRefPubMedPubMedCentral

11.

Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044. https://doi.org/10.1016/S1470-2045(09)70263-3CrossRefPubMed

12.

Delphine A (2018) Neurocognition: impact of radiotherapy. Bull Cancer 105:126–131. https://doi.org/10.1016/j.bulcan.2017.11.003CrossRefPubMed

13.

Nayak L, Lee EQ, Wen PY (2012) Epidemiology of brain metastases. Curr Oncol Rep 14:48–54. https://doi.org/10.1007/s11912-011-0203-yCrossRefPubMed

14.

Ostrom QT, Wright CH, Barnholtz-Sloan JS (2018) Brain metastases: epidemiology. Handb Clin Neurol 149:27–42. https://doi.org/10.1016/B978-0-12-811161-1.00002-5CrossRefPubMed

15.

Amin S, Baine MJ, Meza JL, Lin C (2020) Association of immunotherapy with survival among patients with brain metastases whose cancer was managed with definitive surgery of the primary tumor. JAMA Netw Open 3:e2015444. https://doi.org/10.1001/jamanetworkopen.2020.15444CrossRefPubMedPubMedCentral

16.

Latorzeff I, Antoni D, Gaudaire-Josset S et al (2016) Radiothérapie des métastases cérébrales. Cancer Radiother 20:S80–S87. https://doi.org/10.1016/j.canrad.2016.07.041CrossRefPubMed

17.

Keller A, Lefebvre F, Ricard D et al (2020) Outcomes of adjuvant whole-brain radiotherapy versus hypofractionated stereotactic radiotherapy after surgical resection of brain metastases: a propensity score-matched analysis. Chin Clin Oncol 9:55. https://doi.org/10.21037/cco-19-269CrossRefPubMed

18.

Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751. https://doi.org/10.1016/s0360-3016(96)00619-0CrossRefPubMed

19.

Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77:655–661. https://doi.org/10.1016/j.ijrobp.2009.08.025CrossRefPubMed

20.

Farris M, McTyre ER, Cramer CK et al (2017) Brain metastasis velocity: a novel prognostic metric predictive of overall survival and freedom from whole-brain radiation therapy after distant brain failure following upfront radiosurgery alone. Int J Radiat Oncol 98:131–141. https://doi.org/10.1016/j.ijrobp.2017.01.201CrossRef

21.

Chen W, Silverman DHS, Delaloye S et al (2006) 18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy. J Nucl Med 47:904–911PubMed

22.

Cicone F, Carideo L, Scaringi C et al (2021) Long-term metabolic evolution of brain metastases with suspected radiation necrosis following stereotactic radiosurgery: longitudinal assessment by F‑DOPA PET. Neuro Oncol 23:1024–1034. https://doi.org/10.1093/neuonc/noaa239CrossRefPubMed

23.

Cicone F, Minniti G, Romano A et al (2015) Accuracy of F‑DOPA PET and perfusion-MRI for differentiating radionecrotic from progressive brain metastases after radiosurgery. Eur J Nucl Med Mol Imaging 42:103–111. https://doi.org/10.1007/s00259-014-2886-4CrossRefPubMed

24.

Hernández Pinzón J, Mena D, Aguilar M et al (2016) Radionecrosis versus disease progression in brain metastasis. Value of (18)F-DOPA PET/CT/MRI. Rev Esp Med Nucl Imagen Mol 35:332–335. https://doi.org/10.1016/j.remn.2016.03.002CrossRefPubMed

25.

Wang B, Zhang Y, Zhao B et al (2018) Postcontrast T1 mapping for differential diagnosis of recurrence and radionecrosis after gamma knife radiosurgery for brain metastasis. AJNR Am J Neuroradiol 39:1025–1031. https://doi.org/10.3174/ajnr.A5643CrossRefPubMedPubMedCentral

26.

Delmaire C, Savatovsky J, Boulanger T et al (2015) Brain metastases imaging. Cancer Radiother 19:16–19. https://doi.org/10.1016/j.canrad.2014.11.008CrossRefPubMed

27.

Menoux I, Armspach J‑P, Noël G, Antoni D (2016) Imaging methods used in the differential diagnosis between brain tumour relapse and radiation necrosis after stereotactic radiosurgery of brain metastases: literature review. Cancer Radiother 20:837–845. https://doi.org/10.1016/j.canrad.2016.07.098CrossRefPubMed

28.

Kano H, Kondziolka D, Lobato-Polo J et al (2010) T1/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery 66:486–491. https://doi.org/10.1227/01.NEU.0000360391.35749.A5 (discussion 491–492)CrossRefPubMed

29.

Leeman JE, Clump DA, Flickinger JC et al (2013) Extent of perilesional edema differentiates radionecrosis from tumor recurrence following stereotactic radiosurgery for brain metastases. Neuro Oncol 15:1732–1738. https://doi.org/10.1093/neuonc/not130CrossRefPubMedPubMedCentral

30.

Stockham AL, Tievsky AL, Koyfman SA et al (2012) Conventional MRI does not reliably distinguish radiation necrosis from tumor recurrence after stereotactic radiosurgery. J Neurooncol 109:149–158. https://doi.org/10.1007/s11060-012-0881-9CrossRefPubMed

31.

Matuszak J, Waissi W, Clavier J‑B et al (2016) Métastases cérébrales : apport de l’acquisition tardive en TEP/TDM au 18F-FDG pour le diagnostic différentiel entre récurrence tumorale et radionécrose. Méd Nucl 40:129–141. https://doi.org/10.1016/j.mednuc.2016.02.001CrossRef

32.

Yamamoto M, Aiyama H, Koiso T et al (2019) Validity of a recently proposed prognostic grading index, brain metastasis velocity, for patients with brain metastasis undergoing multiple radiosurgical procedures. Int J Radiat Oncol Biol Phys 103:631–637. https://doi.org/10.1016/j.ijrobp.2018.10.036CrossRefPubMed

33.

LeCompte MC, Hughes RT, Farris M et al (2020) Impact of brain metastasis velocity on neurologic death for brain metastasis patients experiencing distant brain failure after initial stereotactic radiosurgery. J Neurooncol 146:285–292. https://doi.org/10.1007/s11060-019-03368-9CrossRefPubMed

34.

van der Steen-Banasik E, Hermans J, Tjho-Heslinga R et al (1992) The objective response of brain metastases on radiotherapy. A prospective study using computer tomography. Acta Oncol 31:777–780. https://doi.org/10.3109/02841869209083870CrossRefPubMed

35.

Lin NU, Lee EQ, Aoyama H et al (2015) Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol 16:e270–278. https://doi.org/10.1016/S1470-2045(15)70057-4CrossRefPubMed

36.

Aoyama H, Tago M, Shirato H, Japanese Radiation Oncology Study Group 99‑1 (JROSG 99-1) Investigators (2015) Stereotactic radiosurgery with or without whole-brain radiotherapy for brain metastases: secondary analysis of the JROSG 99‑1 randomized clinical trial. JAMA Oncol 1:457–464. https://doi.org/10.1001/jamaoncol.2015.1145CrossRefPubMed

37.

Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29:134–141. https://doi.org/10.1200/JCO.2010.30.1655CrossRefPubMed

38.

Koiso T, Yamamoto M, Kawabe T et al (2016) Follow-up results of brain metastasis patients undergoing repeat Gamma Knife radiosurgery. J Neurosurg 125:2–10. https://doi.org/10.3171/2016.6.GKS161404CrossRefPubMed

39.

Fritz C, Borsky K, Stark LS et al (2018) Repeated courses of radiosurgery for new brain metastases to defer whole brain radiotherapy: feasibility and outcome with validation of the new prognostic metric brain metastasis velocity. Front Oncol 8:551. https://doi.org/10.3389/fonc.2018.00551CrossRefPubMedPubMedCentral

40.

Rana N, Pendyala P, Cleary RK et al (2017) Long-term outcomes after salvage Stereotactic Radiosurgery (SRS) following in-field failure of initial SRS for brain metastases. Front Oncol 7:279. https://doi.org/10.3389/fonc.2017.00279CrossRefPubMedPubMedCentral

41.

Vigneau E, Jacquemin J, Benadon B et al (2021) Efficacy and safety of hypofractionated stereotactic radiotherapy for brain metastases using three fractions: a single-centre retrospective study. Cancer Radiother. https://doi.org/10.1016/j.canrad.2021.05.003CrossRefPubMed

42.

Loi M, Caini S, Scoccianti S et al (2020) Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: systematic review and meta-analysis. Crit Rev Oncol Hematol 153:103043. https://doi.org/10.1016/j.critrevonc.2020.103043CrossRefPubMed

43.

Iorio-Morin C, Mercure-Cyr R, Figueiredo G et al (2019) Repeat stereotactic radiosurgery for the management of locally recurrent brain metastases. J Neurooncol 145:551–559. https://doi.org/10.1007/s11060-019-03323-8CrossRefPubMed

44.

Holt DE, Gill BS, Clump DA et al (2015) Tumor bed radiosurgery following resection and prior stereotactic radiosurgery for locally persistent brain metastasis. Front Oncol. https://doi.org/10.3389/fonc.2015.00084CrossRefPubMedPubMedCentral

45.

Dincoglan F, Sager O, Demiral S et al (2019) Fractionated stereotactic radiosurgery for locally recurrent brain metastases after failed stereotactic radiosurgery. Indian J Cancer 56:151–156. https://doi.org/10.4103/ijc.IJC_786_18CrossRefPubMed

46.

Balermpas P, Stera S, von der Müller Grün J et al (2018) Repeated in-field radiosurgery for locally recurrent brain metastases: feasibility, results and survival in a heavily treated patient cohort. PLoS ONE 13:e198692. https://doi.org/10.1371/journal.pone.0198692CrossRefPubMedPubMedCentral

47.

Terakedis BE, Jensen RL, Boucher K, Shrieve DC (2014) Tumor control and incidence of radiation necrosis after reirradiation with stereotactic radiosurgery for brain metastases. J Radiosurg SBRT 3:21–28PubMedPubMedCentral

48.

Tsao MN, Xu W, Wong RK et al (2018) Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 1:CD3869. https://doi.org/10.1002/14651858.CD003869.pub4CrossRefPubMed

49.

Minniti G, Scaringi C, Paolini S et al (2016) Repeated stereotactic radiosurgery for patients with progressive brain metastases. J Neurooncol 126:91–97. https://doi.org/10.1007/s11060-015-1937-4CrossRefPubMed

50.

Guedes de Castro D, Braun AC, Calsavara VF et al (2021) Prospective assessment of the association between circulating tumor cells and control of brain disease after focal radiation therapy of breast cancer brain metastases. Adv Radiat Oncol 6:100673. https://doi.org/10.1016/j.adro.2021.100673CrossRefPubMedPubMedCentral

51.

Press RH, Prabhu RS, Nickleach DC et al (2015) Novel risk stratification score for predicting early distant brain failure and salvage whole-brain radiotherapy after stereotactic radiosurgery for brain metastases. Cancer 121:3836–3843. https://doi.org/10.1002/cncr.29590CrossRefPubMed

52.

McTyre ER, Soike MH, Farris M et al (2020) Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol 142:168–174. https://doi.org/10.1016/j.radonc.2019.08.011CrossRefPubMed

Titel: Local recurrence and cerebral progression-free survival after multiple sessions of stereotactic radiotherapy of brain metastases: a retrospective study of 184 patients
Statistical analysis
verfasst von: Laure Kuntz
Clara Le Fèvre, MD, MSc
Delphine Jarnet, PhD
Audrey Keller, MD
Philippe Meyer, PhD
Caroline Bund, MD, PhD
Isabelle Chambrelant
Delphine Antoni, MD, PhD
Georges Noel, MD, PhD
Publikationsdatum: 16.03.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 6/2022
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01913-6

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Local recurrence and cerebral progression-free survival after multiple sessions of stereotactic radiotherapy of brain metastases: a retrospective study of 184 patients

Statistical analysis