Radiation Oncology Journal

  • 제33권3호
  • /
  • Pages.207-216
  • /
  • 2015
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지
DOI QR코드

DOI QR Code

Stereotactic radiosurgery for brain metastasis in non-small cell lung cancer

  • Won, Yong Kyun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Ja Young (Department of Radiation Oncology, Pusan National University Yangsan Hospital) ;
  • Kang, Young Nam (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jang, Ji Sun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kang, Jin-Hyoung (Department of Medical Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jung, So-Lyoung (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Sung, Soo Yoon (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jo, In Young (Department of Radiation Oncology, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Hee Hyun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Dong-Soo (Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Chang, Ji Hyun (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Yun Hee (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Kim, Yeon-Sil (Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 투고 : 2015.07.07
  • 심사 : 2015.09.02
  • 발행 : 2015.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Stereotactic radiosurgery (SRS) has been introduced for small-sized single and oligo-metastases in the brain. The aim of this study is to assess treatment outcome, efficacy, and prognostic variables associated with survival and intracranial recurrence. Materials and Methods: This study retrospectively reviewed 123 targets in 64 patients with non-small cell lung cancer (NSCLC) treated with SRS between January 2006 and December 2012. Treatment responses were evaluated using magnetic resonance imaging. Overall survival (OS) and intracranial progression-free survival (IPFS) were determined. Results: The median follow-up was 13.9 months. The median OS and IPFS were 14.1 and 8.9 months, respectively. Fifty-seven patients died during the follow-up period. The 5-year local control rate was achieved in 85% of 108 evaluated targets. The 1- and 2-year OS rates were 55% and 28%, respectively. On univariate analysis, primary disease control (p < 0.001), the Eastern Cooperative Oncology Group (ECOG) performance status (0-1 vs. 2; p = 0.002), recursive partitioning analysis class (1 vs. 2; p = 0.001), and age (<65 vs. ${\geq}65$ years; p = 0.036) were significant predictive factors for OS. Primary disease control (p = 0.041) and ECOG status (p = 0.017) were the significant prognostic factors for IPFS. Four patients experienced radiation necrosis. Conclusion: SRS is a safe and effective local treatment for brain metastases in patients with NSCLC. Uncontrolled primary lung disease and ECOG status were significant predictors of OS and intracranial failure. SRS might be a tailored treatment option along with careful follow-up of the intracranial and primary lung disease status.

키워드

참고문헌

  1. Peacock KH, Lesser GJ. Current therapeutic approaches in patients with brain metastases. Curr Treat Options Oncol 2006;7:479-89. https://doi.org/10.1007/s11864-006-0023-8
  2. Cairncross JG, Kim JH, Posner JB. Radiation therapy for brain metastases. Ann Neurol 1980;7:529-41. https://doi.org/10.1002/ana.410070606
  3. Diener-West M, Dobbins TW, Phillips TL, Nelson DF. Identification of an optimal subgroup for treatment evaluation of patients with brain metastases using RTOG study 7916. Int J Radiat Oncol Biol Phys 1989;16:669-73. https://doi.org/10.1016/0360-3016(89)90483-5
  4. Kazda T, Jancalek R, Pospisil P, et al. Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy. Radiat Oncol 2014;9:139. https://doi.org/10.1186/1748-717X-9-139
  5. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990;322:494-500. https://doi.org/10.1056/NEJM199002223220802
  6. Noordijk EM, Vecht CJ, Haaxma-Reiche H, et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 1994;29:711-7. https://doi.org/10.1016/0360-3016(94)90558-4
  7. Mehta MP, Tsao MN, Whelan TJ, et al. The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2005;63:37-46. https://doi.org/10.1016/j.ijrobp.2005.05.023
  8. Lester-Coll NH, Dosoretz AP, Yu JB. Decision analysis of stereotactic radiation surgery versus stereotactic radiation surgery and whole-brain radiation therapy for 1 to 3 brain metastases. Int J Radiat Oncol Biol Phys 2014;89:563-8. https://doi.org/10.1016/j.ijrobp.2014.03.001
  9. Li J, Bentzen SM, Renschler M, Mehta MP. Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol 2007;25:1260-6. https://doi.org/10.1200/JCO.2006.09.2536
  10. Wegner RE, Olson AC, Kondziolka D, Niranjan A, Lundsford LD, Flickinger JC. Stereotactic radiosurgery for patients with brain metastases from small cell lung cancer. Int J Radiat Oncol Biol Phys 2011;81:e21-7. https://doi.org/10.1016/j.ijrobp.2011.01.001
  11. Serizawa T, Ono J, Iichi T, et al. Gamma knife radiosurgery for metastatic brain tumors from lung cancer: a comparison between small cell and non-small cell carcinoma. J Neurosurg 2002;97:484-8.
  12. Chang EL, Wefel JS, Maor MH, et al. A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone. Neurosurgery 2007;60:277-83. https://doi.org/10.1227/01.NEU.0000249272.64439.B1
  13. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004;363:1665-72. https://doi.org/10.1016/S0140-6736(04)16250-8
  14. Soffietti R, Kocher M, Abacioglu UM, et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 2013;31:65-72. https://doi.org/10.1200/JCO.2011.41.0639
  15. Caballero JA, Sneed PK, Lamborn KR, et al. Prognostic factors for survival in patients treated with stereotactic radiosurgery for recurrent brain metastases after prior whole brain radiotherapy. Int J Radiat Oncol Biol Phys 2012;83:303-9. https://doi.org/10.1016/j.ijrobp.2011.06.1987
  16. Yomo S, Hayashi M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol 2013;113:459-65. https://doi.org/10.1007/s11060-013-1138-y
  17. Tsao M, Xu W, Sahgal A. A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 2012;118:2486-93. https://doi.org/10.1002/cncr.26515
  18. Shehata MK, Young B, Reid B, et al. Stereotatic radiosurgery of 468 brain metastases < or =2 cm: implications for SRS dose and whole brain radiation therapy. Int J Radiat Oncol Biol Phys 2004;59:87-93. https://doi.org/10.1016/j.ijrobp.2003.10.009
  19. Kress MA, Oermann E, Ewend MG, Hoffman RB, Chaudhry H, Collins B. Stereotactic radiosurgery for single brain metastases from non-small cell lung cancer: progression of extracranial disease correlates with distant intracranial failure. Radiat Oncol 2013;8:64. https://doi.org/10.1186/1748-717X-8-64
  20. Gaspar LE, Scott C, Murray K, Curran W. Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 2000;47:1001-6. https://doi.org/10.1016/S0360-3016(00)00547-2
  21. Kepka L, Cieslak E, Bujko K, Fijuth J, Wierzchowski M. Results of the whole-brain radiotherapy for patients with brain metastases from lung cancer: the RTOG RPA intra-classes analysis. Acta Oncol 2005;44:389-98. https://doi.org/10.1080/02841860510029699
  22. Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745-51. https://doi.org/10.1016/S0360-3016(96)00619-0
  23. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 1999;45:427-34.
  24. Sperduto PW, Shanley R, Luo X, et al. Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA). Int J Radiat Oncol Biol Phys 2014;90:526-31. https://doi.org/10.1016/j.ijrobp.2014.07.002
  25. Aoyama H, Shirato H, Onimaru R, et al. Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull. Int J Radiat Oncol Biol Phys 2003;56:793-800. https://doi.org/10.1016/S0360-3016(03)00014-2
  26. Kocher M, Soffietti R, Abacioglu U, et al. 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 2011;29:134-41. https://doi.org/10.1200/JCO.2010.30.1655
  27. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 2009;10:1037-44. https://doi.org/10.1016/S1470-2045(09)70263-3
  28. Park SJ, Kim HT, Lee DH, et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutation. Lung Cancer 2012;77:556-60. https://doi.org/10.1016/j.lungcan.2012.05.092
  29. Kim YS, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for patients with nonsmall cell lung carcinoma metastatic to the brain. Cancer 1997;80:2075-83. https://doi.org/10.1002/(SICI)1097-0142(19971201)80:11<2075::AID-CNCR6>3.0.CO;2-W
  30. Sheehan JP, Sun MH, Kondziolka D, Flickinger J, Lunsford LD. Radiosurgery for non-small cell lung carcinoma metastatic to the brain: long-term outcomes and prognostic factors influencing patient survival time and local tumor control. J Neurosurg 2002;97:1276-81. https://doi.org/10.3171/jns.2002.97.6.1276
  31. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000;47:291-8. https://doi.org/10.1016/S0360-3016(99)00507-6
  32. Lee DS, Yu M, Jang HS, et al. Radiation-induced brain injury: retrospective analysis of twelve pathologically proven cases. Radiat Oncol J 2011;29:147-55. https://doi.org/10.3857/roj.2011.29.3.147

피인용 문헌

  1. Effect of miR-155 knockdown on the reversal of doxorubicin resistance in human lung cancer A549/dox cells vol.11, pp.2, 2015, https://doi.org/10.3892/ol.2015.3995
  2. EGFR and KRAS Mutations Predict the Incidence and Outcome of Brain Metastases in Non-Small Cell Lung Cancer vol.17, pp.12, 2015, https://doi.org/10.3390/ijms17122132
  3. Brain metastases from hepatocellular carcinoma: recent advances and future avenues vol.8, pp.15, 2017, https://doi.org/10.18632/oncotarget.15730
  4. Perihippocampal metastasis following hippocampus-avoiding prophylactic cranial irradiation for small cell lung cancer: a case report vol.10, pp.None, 2015, https://doi.org/10.2147/ott.s143719
  5. Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery vol.127, pp.1, 2017, https://doi.org/10.3171/2016.5.jns153051
  6. Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery vol.127, pp.1, 2017, https://doi.org/10.3171/2016.5.jns153051
  7. Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI vol.14, pp.1, 2017, https://doi.org/10.3892/ol.2017.6264
  8. Evaluations of the setup discrepancy between BrainLAB 6D ExacTrac and cone-beam computed tomography used with the imaging guidance system Novalis-Tx for intracranial stereotactic radiosurgery vol.12, pp.5, 2017, https://doi.org/10.1371/journal.pone.0177798
  9. First follow‐up radiographic response is one of the predictors of local tumor progression and radiation necrosis after stereotactic radiosurgery for brain metastases vol.6, pp.9, 2015, https://doi.org/10.1002/cam4.1149
  10. The miR-24-3p/p130Cas: a novel axis regulating the migration and invasion of cancer cells vol.7, pp.None, 2015, https://doi.org/10.1038/srep44847
  11. Intracranial control and survival outcome of tyrosine kinase inhibitor (TKI) alone versus TKI plus radiotherapy for brain metastasis of epidermal growth factor receptor-mutant non-small cell lung canc vol.139, pp.1, 2015, https://doi.org/10.1007/s11060-018-2861-1
  12. Brain Radiation Necrosis: Current Management With a Focus on Non-small Cell Lung Cancer Patients vol.8, pp.None, 2015, https://doi.org/10.3389/fonc.2018.00336
  13. Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR -mutated non-small-cell lung cancer with brain metastases: a ret vol.11, pp.None, 2015, https://doi.org/10.2147/cmar.s184922
  14. CIAPIN1 Targeted NHE1 and ERK1/2 to Suppress NSCLC Cells' Metastasis and Predicted Good Prognosis in NSCLC Patients Receiving Pulmonectomy vol.2019, pp.None, 2019, https://doi.org/10.1155/2019/1970818
  15. Complete and Durable Response to Combined Chemo/Radiation Therapy in EGFR Wild-Type Lung Adenocarcinoma with Diffuse Brain Metastases vol.9, pp.2, 2015, https://doi.org/10.3390/diagnostics9020042
  16. Predictive Factors of Intracranial Response of Immune Checkpoint Inhibitors in Patients with Brain Metastasis from Non-Small Cell Lung Cancer vol.10, pp.8, 2015, https://doi.org/10.4236/jct.2019.108057
  17. The role of EGFR mutation as a prognostic factor in survival after diagnosis of brain metastasis in non-small cell lung cancer: a systematic review and meta-analysis vol.19, pp.None, 2015, https://doi.org/10.1186/s12885-019-5331-z
  18. Intratumoural renal cell carcinoma haemorrhage following stereotactic radiotherapy: a case report vol.19, pp.1, 2015, https://doi.org/10.1186/s12885-019-5899-3
  19. Apatinib Monotherapy or Combination Therapy for Non-Small Cell Lung Cancer Patients With Brain Metastases vol.28, pp.2, 2015, https://doi.org/10.3727/096504019x15707896762251
  20. Non‑small cell lung cancer with multiple brain metastases remains relapse‑free for more than 13 years: A case report vol.16, pp.1, 2015, https://doi.org/10.3892/mco.2021.2448