Browse > Article
http://dx.doi.org/10.3857/roj.2015.33.3.207

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)
Publication Information
Radiation Oncology Journal / v.33, no.3, 2015 , pp. 207-216 More about this Journal
Abstract
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.
Keywords
Brain neoplasm; Neoplasm metastasis; Non-small-cell lung carcinoma; Radiosurgery; Prognosis;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 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.   DOI
2 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.   DOI
3 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.   DOI
4 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.   DOI
5 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.   DOI
6 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.   DOI
7 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.   DOI
8 Peacock KH, Lesser GJ. Current therapeutic approaches in patients with brain metastases. Curr Treat Options Oncol 2006;7:479-89.   DOI
9 Cairncross JG, Kim JH, Posner JB. Radiation therapy for brain metastases. Ann Neurol 1980;7:529-41.   DOI
10 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.   DOI
11 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.   DOI
12 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.   DOI
13 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.   DOI
14 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.   DOI
15 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.   DOI
16 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.
17 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.   DOI
18 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.   DOI
19 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.   DOI
20 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.   DOI
21 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.   DOI
22 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.   DOI
23 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.   DOI
24 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.   DOI
25 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.
26 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.   DOI
27 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.   DOI
28 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.   DOI
29 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.   DOI
30 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.   DOI
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.   DOI
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.   DOI