Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Repeat Stereotactic Radiosurgery for Recurred Metastatic Brain Tumors

  • Kim, In-Young (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Jung, Shin (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Jung, Tae-Young (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Moon, Kyung-Sub (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Jang, Woo-Youl (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Park, Jae-Young (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Song, Tae-Wook (Department of Neurosurgery, Brain Tumor Clinic & Gamma Knife Center, Chonnam National University Hwasun Hospital, Chonnam National University College of Medecine) ;
  • Lim, Sa-Hoe (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University School of Medicine)
  • Received : 2017.08.25
  • Accepted : 2017.11.24
  • Published : 2018.09.01
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Abstract

Objective : We investigated the outcomes of repeat stereotactic radiosurgery (SRS) for metastatic brain tumors that locally recurred despite previous SRS, focusing on the tumor control. Methods : A total of 114 patients with 176 locally recurring metastatic brain tumors underwent repeat SRS after previous SRS. The mean age was 59.4 years (range, 33 to 85), and there were 68 male and 46 female patients. The primary cancer types were non-small cell lung cancer (n=67), small cell lung cancer (n=12), gastrointestinal tract cancer (n=15), breast cancer (n=10), and others (n=10). The number of patients with a single recurring metastasis was 95 (79.8%), and another 19 had multiple recurrences. At the time of the repeat SRS, the mean volume of the locally recurring tumors was 5.94 mL (range, 0.42 to 29.94). We prescribed a mean margin dose of 17.04 Gy (range, 12 to 24) to the isodose line at the tumor border primarily using a 50% isodose line. Results : After the repeat SRS, we obtained clinical and magnetic resonance imaging follow-up data for 84 patients (73.7%) with a total of 108 tumors. The tumor control rate was 53.5% (58 of the 108), and the median and mean progression-free survival (PFS) periods were 246 and 383 days, respectively. The prognostic factors that were significantly related to better tumor control were prescription radiation dose of 16 Gy (p=0.000) and tumor volume less than both 4 mL (p=0.001) and 10 mL at the repeat SRS (p=0.008). The overall survival (OS) periods for all 114 patients after repeat SRS varied from 1 to 56 months, and median and mean OS periods were 229 and 404 days after the repeat SRS, respectively. The main cause of death was systemic problems including pulmonary dysfunction (n=58, 51%), and the identified direct or suspected brain-related death rate was around 20%. Conclusion : The tumor control following repeat SRS for locally recurring metastatic brain tumors after a previous SRS is relatively lower than that for primary SRS. However, both low tumor volume and high prescription radiation dose were significantly related to the tumor control following repeat SRS for these tumors after previous SRS, which is a general understanding of primary SRS for metastatic brain tumors.

Keywords

References

  1. Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, et al. : The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96 : 85-96, 2010 https://doi.org/10.1007/s11060-009-0055-6
  2. Baschnagel AM, Meyer KD, Chen PY, Krauss DJ, Olson RE, Pieper DR, et al. : Tumor volume as a predictor of survival and local control in patients with brain metastases treated with gamma knife surgery. J Neurosurg 119 : 1139-1144, 2013 https://doi.org/10.3171/2013.7.JNS13431
  3. Chen JC, Petrovich Z, Giannotta SL, Yu C, Apuzzo ML : Radiosurgical salvage therapy for patients presenting with recurrence of metastatic disease to the brain. Neurosurg 46 : 860-866; discussion 866-867, 2000
  4. Cho KR, Lee MH, Kong DS, Seol HJ, Nam DH, Sun JM, et al. : Outcome of gamma knife radiosurgery for metastatic brain tumors derived from non-small cell lung cancer. J Neurooncol 125 : 331-338, 2015 https://doi.org/10.1007/s11060-015-1915-x
  5. Jensen CA, Chan MD, McCoy TP, Bourland JD, deGuzman AF, Ellis TL, et al. : Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg 114 : 1585-1591, 2011 https://doi.org/10.3171/2010.11.JNS10939
  6. Kwon KY, Kong DS, Lee JI, Nam DH, Park K, Kim JH : Outcome of repeated radiosurgery for recurrent metastatic brain tumors. Clin Neurol Neurosurg 109 : 132-137, 2007 https://doi.org/10.1016/j.clineuro.2006.06.007
  7. Lucas JT Jr, Colmer HG 4th, White L, Fitzgerald N, Isom S, Bourland JD, et al. : Competing risk analysis of neurologic versus nonneurologic death in patients undergoing radiosurgical salvage after whole-brain radiation therapy failure: who actually dies of their brain metastases? Int J Radat Oncol Biol Phys 92 : 1008-1015, 2015 https://doi.org/10.1016/j.ijrobp.2015.04.032
  8. Mariya Y, Sekizawa G, Matsuoka Y, Seki H, Sugawara T, Sasaki Y : Repeat stereotactic radiosurgery in the management of brain metastases from non-small cell lung cancer. Tohoku J Exp Med 223 : 125-131, 2011 https://doi.org/10.1620/tjem.223.125
  9. Marvaso G, Barone A, Vaccaro C, Bruzzaniti V, Grespi S, Scotti V, et al. : Repeat stereotactic radiosurgery in the management of brain metastases from NSCLC: a case report and review of the literature. Oncol Lett 6 : 897-900, 2013 https://doi.org/10.3892/ol.2013.1509
  10. McKay WH, McTyre ER, Okoukoni C, Alphonse-Sullivan NK, Ruiz J, Munley MT, et al. : Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery. J Neurosurg 127 : 148-156, 2017 https://doi.org/10.3171/2016.5.JNS153051
  11. Shuto T, Fujino H, Inomori S, Nagano H : Repeated gamma knife radiosurgery for multiple metastatic brain tumours. Acta Neurochirurg (Wien) 146 : 989-993; discussion 993, 2004
  12. Sperduto PW, Wang M, Robins HI, Schell MC, Werner-Wasik M, Komaki R, et al. : A phase 3 trial of whole brain radiation therapy and stereotactic radiosurgery alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: Radiation Therapy Oncology Group 0320. Int J Radat Oncol Biol Phys 85 : 1312-1318, 2013 https://doi.org/10.1016/j.ijrobp.2012.11.042
  13. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, et al. : Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15 : 387-395, 2014 https://doi.org/10.1016/S1470-2045(14)70061-0
  14. Yamanaka K, Iwai Y, Yasui T, Nakajima H, Komiyama M, Nishikawa M, et al. : Gamma knife radiosurgery for metastatic brain tumor: the usefulness of repeated gamma knife radiosurgery for recurrent cases. Stereotact Funct Neurosurg 72 Suppl 1 : 73-80, 1999

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