Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Two-Day Fraction Gamma Knife Radiosurgery for Large Brain Metastasis

  • Joo-Hwan Lee (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • In-Young Kim (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Shin Jung (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Tae-Young Jung (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Kyung-Sub Moon (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Yeong-Jin Kim (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Sue-Jee Park (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital) ;
  • Sa-Hoe Lim (Brain Tumor Clinic & Gamma Knife Center, Department of Neurosurgery, Chonnam National University Hwasun Hospital)
  • Received : 2023.10.13
  • Accepted : 2023.12.16
  • Published : 2024.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : We investigated how treating large brain metastasis (LBM) using 2-day fraction Gamma Knife radiosurgery (GKRS) affects tumor control and patient survival. A prescription dose of 10.3 Gy was applied for 2 consecutive days, with a biologically effective dose equivalent to a tumor single-fraction dose of 16.05 Gy and a brain single-fraction dose of 15.12 Gy. Methods : Between November 2017 and December 2021, 42 patients (mean age, 68.3 years; range, 50-84 years; male, 29 [69.1%]; female, 13 [30.9%]) with 44 tumors underwent 2-day fraction GKRS to treat large volume brain metastasis. The main cancer types were non-small cell lung cancer (n=16), small cell lung cancer (n=7), colorectal cancer (n=7), breast cancer (n=3), gastric cancer (n=2), and other cancers (n=7). Twenty-one patients (50.0%) had a single LBM, 19 (46.3%) had a single LBM and other metastases, and two had two (4.7%) large brain metastases. At the time of the 2-day fraction GKRS, the tumors had a mean volume of 23.1 mL (range, 12.5-67.4). On each day, radiation was administered at a dose of 10.3 Gy, mainly using a 50% isodose-line. Results : We obtained clinical and magnetic resonance imaging follow-up data for 34 patients (81%) with 35 tumors, who had undergone 2-day fraction GKRS. These patients did not experience acute or late radiation-induced complications during follow-up. The median and mean progression-free survival (PFS) periods were 188 and 194 days, respectively. The local control rates at 6, 9, and 12 months were 77%, 40%, and 34%, respectively. The prognostic factors related to PFS were prior radiotherapy (p=0.019) and lung cancer origin (p=0.041). Other factors such as tumor volumes, each isodose volumes, and peri-GKRS systemic treatment were not significantly related to PFS. The overall survival period of the 44 patients following repeat stereotactic radiosurgery (SRS) ranged from 15-878 days (median, 263±38 days; mean, 174±43 days) after the 2-day fraction GKRS. Eight patients (18.2%) were still alive. Conclusion : Considering the unsatisfactory tumor control, a higher prescription dose should be needed in this procedure as a salvage management. Moreover, in the treatment for LBM with fractionated SRS, using different isodoses and prescription doses at the treatment planning for LBMs should be important. However, this report might be a basic reference with the same fraction number and prescription dose in the treatment for LBMs with frame-based SRS.

Keywords

References

  1. Angelov L, Mohammadi AM, Bennett EE, Abbassy M, Elson P, Chao ST, et al. : Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm. J Neurosurg 129 : 366-382, 2018 
  2. Arvold ND, Lee EQ, Mehta MP, Margolin K, Alexander BM, Lin NU, et al. : Updates in the management of brain metastases. Neuro Oncol 18 : 1043-1065, 2016 
  3. Barendsen GW : Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys 8 : 1981-1997, 1982 
  4. Cui T, Weiner J, Danish S, Chundury A, Ohri N, Yue N, et al. : Evaluation of biological effective dose in gamma knife staged stereotactic radiosurgery for large brain metastases. Front Oncol 12 : 892139, 2022 
  5. Eaton BR, LaRiviere MJ, Kim S, Prabhu RS, Patel K, Kandula S, et al. : Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases. J Neurooncol 123 : 103-111, 2015 
  6. Feuvret L, Vinchon S, Martin V, Lamproglou I, Halley A, Calugaru V, et al. : Stereotactic radiotherapy for large solitary brain metastases. Cancer Radiother 18 : 97-106, 2014 
  7. Fokas E, Henzel M, Surber G, Kleinert G, Hamm K, Engenhart-Cabillic R : Stereotactic radiosurgery and fractionated stereotactic radiotherapy: comparison of efficacy and toxicity in 260 patients with brain metastases. J Neurooncol 109 : 91-98, 2012 
  8. Fowler JF : Dose response curves for organ function or cell survival. Br J Radiol 56 : 497-500, 1983 
  9. Fowler JF : The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62 : 679-694, 1989 
  10. Han JH, Kim DG, Chung HT, Paek SH, Park CK, Jung HW : Radiosurgery for large brain metastases. Int J Radiat Oncol Biol Phys 83 : 113-120, 2012 
  11. Higuchi Y, Serizawa T, Nagano O, Matsuda S, Ono J, Sato M, et al. : Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 74 : 1543-1548, 2009 
  12. Inoue HK, Sato H, Suzuki Y, Saitoh J, Noda SE, Seto K, et al. : Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study. Radiat Oncol 9 : 231, 2014 
  13. Jeong WJ, Park JH, Lee EJ, Kim JH, Kim CJ, Cho YH : Efficacy and safety of fractionated stereotactic radiosurgery for large brain metastases. J Korean Neurosurg Soc 58 : 217-224, 2015 
  14. Jiang XS, Xiao JP, Zhang Y, Xu YJ, Li XP, Chen XJ, et al. : Hypofractionated stereotactic radiotherapy for brain metastases larger than three centimeters. Radiat Oncol 7 : 36, 2012 
  15. Kim KH, Kong DS, Cho KR, Lee MH, Choi JW, Seol HJ, et al. : Outcome evaluation of patients treated with fractionated gamma knife radiosurgery for large (> 3 cm) brain metastases: a dose-escalation study. J Neurosurg 133 : 675-684, 2019 
  16. Kirkpatrick JP, Soltys SG, Lo SS, Beal K, Shrieve DC, Brown PD : The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro Oncol 19(suppl_2) : ii38-ii49, 2017 
  17. Lee CC, Yen CP, Xu Z, Schlesinger D, Sheehan J : Large intracranial metastatic tumors treated by gamma knife surgery: outcomes and prognostic factors. J Neurosurg 120 : 52-59, 2014 
  18. Lim TK, Kim WK, Yoo CJ, Kim EY, Kim MJ, Yee GT : Fractionated stereotactic radiosurgery for brain metastases using the Novalis Tx® system. J Korean Neurosurg Soc 61 : 525-529, 2018 
  19. Lippitz B, Lindquist C, Paddick I, Peterson D, O'Neill K, Beaney R : Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 40 : 48-59, 2014 
  20. Luther N, Kondziolka D, Kano H, Mousavi SH, Engh JA, Niranjan A, et al. : Predicting tumor control after resection bed radiosurgery of brain metastases. Neurosurgery 73 : 1001-1006; discussion 1006, 2013 
  21. Minniti G, D'Angelillo RM, Scaringi C, Trodella LE, Clarke E, Matteucci P, et al. : Fractionated stereotactic radiosurgery for patients with brain metastases. J Neurooncol 117 : 295-301, 2014 
  22. Minniti G, Scaringi C, Paolini S, Lanzetta G, Romano A, Cicone F, et al. : Single-fraction versus multifraction (3 × 9 Gy) stereotactic radiosurgery for large (>2 cm) brain metastases: a comparative analysis of local control and risk of radiation-induced brain necrosis. Int J Radiat Oncol Biol Phys 95 : 1142-1148, 2016 
  23. Murai T, Ogino H, Manabe Y, Iwabuchi M, Okumura T, Matsushita Y, et al. : Fractionated stereotactic radiotherapy using CyberKnife for the treatment of large brain metastases: a dose escalation study. Clin Oncol (R Coll Radiol) 26 : 151-158, 2014 
  24. Narayana A, Chang J, Yenice K, Chan K, Lymberis S, Brennan C, et al. : Hypofractionated stereotactic radiotherapy using intensity-modulated radiotherapy in patients with one or two brain metastases. Stereotact Funct Neurosurg 85 : 82-87, 2007 
  25. Navarria P, Pessina F, Cozzi L, Ascolese AM, De Rose F, Fogliata A, et al. : Hypo-fractionated stereotactic radiotherapy alone using volumetric modulated arc therapy for patients with single, large brain metastases unsuitable for surgical resection. Radiat Oncol 11 : 76, 2016 
  26. Ogura K, Mizowaki T, Ogura M, Sakanaka K, Arakawa Y, Miyamoto S, et al. : Outcomes of hypofractionated stereotactic radiotherapy for metastatic brain tumors with high risk factors. J Neurooncol 109 : 425-432, 2012 
  27. Park HR, Park KW, Lee JM, Kim JH, Jeong SS, Kim JW, et al. : Frameless fractionated gamma knife radiosurgery with ICON™ for large metastatic brain tumors. J Korean Med Sci 34 : e57, 2019 
  28. Pessina F, Navarria P, Cozzi L, Ascolese AM, Maggi G, Rossi M, et al. : Role of surgical resection in patients with single large brain metastases: feasibility, morbidity, and local control evaluation. World Neurosurg 94 : 6-12, 2016 
  29. Redmond KJ, Gui C, Benedict S, Milano MT, Grimm J, Vargo JA, et al. : Tumor control probability of radiosurgery and fractionated stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 110 : 53-67, 2021 
  30. Serizawa T, Higuchi Y, Yamamoto M, Matsunaga S, Nagano O, Sato Y, et al. : Comparison of treatment results between 3- and 2-stage gamma knife radiosurgery for large brain metastases: a retrospective multi-institutional study. J Neurosurg 131 : 227-237, 2018 
  31. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, 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 47 : 291-298, 2000 
  32. Wegner RE, Leeman JE, Kabolizadeh P, Rwigema JC, Mintz AH, Burton SA, et al. : Fractionated stereotactic radiosurgery for large brain metastases. Am J Clin Oncol 38 : 135-139, 2015 
  33. Wiggenraad R, Verbeek-de Kanter A, Kal HB, Taphoorn M, Vissers T, Struikmans H : Dose-effect relation in stereotactic radiotherapy for brain metastases. A systematic review. Radiother Oncol 98 : 292-297, 2011 
  34. Wiggenraad R, Verbeek-de Kanter A, Mast M, Molenaar R, Kal HB, Lycklama a Nijeholt G, et al. : Local progression and pseudo progression after single fraction or fractionated stereotactic radiotherapy for large brain metastases. A single centre study. Strahlenther Onkol 188 : 696-701, 2012 
  35. Yomo S, Hayashi M : A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session gamma knife stereotactic radiosurgery. Radiat Oncol 9 : 132, 2014 
  36. Yomo S, Hayashi M, Nicholson C : A prospective pilot study of two-session gamma knife surgery for large metastatic brain tumors. J Neurooncol 109 : 159-165, 2012 
  37. Zimmerman AL, Murphy ES, Suh JH, Vogelbaum MA, Barnett GH, Angelov L, et al. : Treatment of large brain metastases with stereotactic radiosurgery. Technol Cancer Res Treat 15 : 186-195, 2016