Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of response to stereotactic radiosurgery in patients with radioresistant brain metastases

  • Sayan, Mutlay (Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey) ;
  • Mustafayev, Teuta Zoto (Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University) ;
  • Sahin, Bilgehan (Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University) ;
  • Kefelioglu, Erva Seyma Sare (Institute of Health Sciences, Mehmet Ali Aydinlar Acibadem University) ;
  • Wang, Shang-Jui (Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey) ;
  • Kurup, Varsha (Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey) ;
  • Balmuk, Aykut (School of Medicine, Mehmet Ali Aydinlar Acibadem University) ;
  • Gungor, Gorkem (Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University) ;
  • Ohri, Nisha (Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey) ;
  • Weiner, Joseph (Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey) ;
  • Ozyar, Enis (Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University) ;
  • Atalar, Banu (Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University)
  • Received : 2019.07.20
  • Accepted : 2019.12.03
  • Published : 2019.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Renal cell carcinoma (RCC) and melanoma have been considered 'radioresistant' due to the fact that they do not respond to conventionally fractionated radiation therapy. Stereotactic radiosurgery (SRS) provides high-dose radiation to a defined target volume and a limited number of studies have suggested the potential effectiveness of SRS in radioresistant histologies. We sought to determine the effectiveness of SRS for the treatment of patients with radioresistant brain metastases. Materials and Methods: We performed a retrospective review of our institutional database to identify patients with RCC or melanoma brain metastases treated with SRS. Treatment response were determined in accordance with the Response Evaluation Criteria in Solid Tumors. Results: We identified 53 radioresistant brain metastases (28% RCC and 72% melanoma) treated in 18 patients. The mean target volume and coverage was 6.2 ± 9.5 mL and 95.5% ± 2.9%, respectively. The mean prescription dose was 20 ± 4.9 Gy. Forty lesions (75%) demonstrated a complete/partial response and 13 lesions (24%) with progressive/stable disease. Smaller target volume (p < 0.001), larger SRS dose (p < 0.001), and coverage (p = 0.008) were found to be positive predictors of complete response to SRS. Conclusion: SRS is an effective management option with up to 75% response rate for radioresistant brain metastases. Tumor volume and radiation dose are predictors of response and can be used to guide the decision-making for patients with radioresistant brain metastases.

Keywords

References

  1. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep 2012;14:48-54. https://doi.org/10.1007/s11912-011-0203-y
  2. Flanigan RC, Campbell SC, Clark JI, Picken MM. Metastatic renal cell carcinoma. Curr Treat Options Oncol 2003;4:385-90. https://doi.org/10.1007/s11864-003-0039-2
  3. Tas F. Metastatic behavior in melanoma: timing, pattern, survival, and influencing factors. J Oncol 2012;2012:647684. https://doi.org/10.1155/2012/647684
  4. Buchsbaum JC, Suh JH, Lee SY, Chidel MA, Greskovich JF, Barnett GH. Survival by radiation therapy oncology group recursive partitioning analysis class and treatment modality in patients with brain metastases from malignant melanoma: a retrospective study. Cancer 2002;94:2265-72. https://doi.org/10.1002/cncr.10426
  5. Halperin EC, Harisiadis L. The role of radiation therapy in the management of metastatic renal cell carcinoma. Cancer 1983;51:614-7. https://doi.org/10.1002/1097-0142(19830215)51:4<614::AID-CNCR2820510411>3.0.CO;2-J
  6. Maor MH, Frias AE, Oswald MJ. Palliative radiotherapy for brain metastases in renal carcinoma. Cancer 1988;62:1912-7. https://doi.org/10.1002/1097-0142(19881101)62:9<1912::AID-CNCR2820620908>3.0.CO;2-T
  7. Wronski M, Maor MH, Davis BJ, Sawaya R, Levin VA. External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 1997;37:753-9. https://doi.org/10.1016/S0360-3016(97)00006-0
  8. 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
  9. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 2006;295:2483-91. https://doi.org/10.1001/jama.295.21.2483
  10. 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
  11. Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 2017;18:1049-60. https://doi.org/10.1016/S1470-2045(17)30441-2
  12. Lwu S, Goetz P, Monsalves E, et al. Stereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases. Oncol Rep 2013;29:407-12. https://doi.org/10.3892/or.2012.2139
  13. Ahmed KA, Sarangkasiri S, Chinnaiyan P, et al. Outcomes following hypofractionated stereotactic radiotherapy in the management of brain metastases. Am J Clin Oncol 2016;39:379-83. https://doi.org/10.1097/COC.0000000000000076
  14. Rades D, Huttenlocher S, Gebauer N, et al. Impact of stereotactic radiosurgery dose on control of cerebral metastases from renal cell carcinoma. Anticancer Res 2015;35:3571-4.
  15. Yaeh A, Nanda T, Jani A, et al. Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery. J Neurooncol 2015;124:507-14. https://doi.org/10.1007/s11060-015-1871-5
  16. Lesueur P, Lequesne J, Barraux V, et al. Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer). Radiat Oncol 2018;13:138. https://doi.org/10.1186/s13014-018-1083-1
  17. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  18. Grob JJ, Regis J, Laurans R, et al. Radiosurgery without whole brain radiotherapy in melanoma brain metastases. Eur J Cancer 1998;34:1187-92. https://doi.org/10.1016/S0959-8049(98)00026-4
  19. Mori Y, Kondziolka D, Flickinger JC, Kirkwood JM, Agarwala S, Lunsford LD. Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys 1998;42:581-9. https://doi.org/10.1016/S0360-3016(98)00272-7
  20. Goyal LK, Suh JH, Reddy CA, Barnett GH. The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 2000;47:1007-12. https://doi.org/10.1016/S0360-3016(00)00536-8
  21. Selek U, Chang EL, Hassenbusch SJ 3rd, et al. Stereotactic radiosurgical treatment in 103 patients for 153 cerebral melanoma metastases. Int J Radiat Oncol Biol Phys 2004;59:1097-106. https://doi.org/10.1016/j.ijrobp.2003.12.037
  22. Shuto T, Inomori S, Fujino H, Nagano H. Gamma knife surgery for metastatic brain tumors from renal cell carcinoma. J Neurosurg 2006;105:555-60. https://doi.org/10.3171/jns.2006.105.4.555
  23. Mathieu D, Kondziolka D, Cooper PB, et al. Gamma knife radiosurgery for malignant melanoma brain metastases. Clin Neurosurg 2007;54:241-7.
  24. Bagshaw HP, Ly D, Suneja G, Jensen RL, Shrieve DC. Local control of melanoma brain metastases treated with stereotactic radiosurgery. J Radiosurg SBRT 2016;4:181-90.
  25. Lin HY, Watanabe Y, Cho LC, et al. Gamma knife stereotactic radiosurgery for renal cell carcinoma and melanoma brain metastases-comparison of dose response. J Radiosurg SBRT 2013;2:193-207.
  26. Lo SS, Chang EL, Suh JH. Stereotactic radiosurgery with and without whole-brain radiotherapy for newly diagnosed brain metastases. Expert Rev Neurother 2005;5:487-95. https://doi.org/10.1586/14737175.5.4.487
  27. Chang EL, Selek U, Hassenbusch SJ 3rd, et al. Outcome variation among "radioresistant" brain metastases treated with stereotactic radiosurgery. Neurosurgery 2005;56:936-45.
  28. Mingione V, Oliveira M, Prasad D, Steiner M, Steiner L. Gamma surgery for melanoma metastases in the brain. J Neurosurg 2002;96:544-51. https://doi.org/10.3171/jns.2002.96.3.0544
  29. Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multiinstitutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 2010;77:655-61. https://doi.org/10.1016/j.ijrobp.2009.08.025

Cited by

  1. Management of symptomatic radiation necrosis after stereotactic radiosurgery and clinical factors for treatment response vol.38, pp.3, 2019, https://doi.org/10.3857/roj.2020.00171
  2. Efficacy and Safety of a Second Course of Stereotactic Radiation Therapy for Locally Recurrent Brain Metastases: A Systematic Review vol.13, pp.19, 2021, https://doi.org/10.3390/cancers13194929
  3. Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms vol.5, pp.4, 2021, https://doi.org/10.3233/kca-210126