Cargando…

The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity

PURPOSE: Stereotactic radiation therapy (SRT) enables focused, short course, high dose per fraction radiation delivery to brain tumors that are less ideal for single fraction treatment because of size, shape, or close proximity to sensitive structures. We sought to identify optimal SRT treatment reg...

Descripción completa

Detalles Bibliográficos
Autores principales: Jimenez, Rachel B., Alexander, Brian M., Mahadevan, Anand, Niemierko, Andrzej, Rajakesari, Selvan, Arvold, Nils D., Floyd, Scott R., Oh, Kevin S., Loeffler, Jay S., Shih, Helen A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605319/
https://www.ncbi.nlm.nih.gov/pubmed/29114607
http://dx.doi.org/10.1016/j.adro.2017.05.008
_version_ 1783264966573293568
author Jimenez, Rachel B.
Alexander, Brian M.
Mahadevan, Anand
Niemierko, Andrzej
Rajakesari, Selvan
Arvold, Nils D.
Floyd, Scott R.
Oh, Kevin S.
Loeffler, Jay S.
Shih, Helen A.
author_facet Jimenez, Rachel B.
Alexander, Brian M.
Mahadevan, Anand
Niemierko, Andrzej
Rajakesari, Selvan
Arvold, Nils D.
Floyd, Scott R.
Oh, Kevin S.
Loeffler, Jay S.
Shih, Helen A.
author_sort Jimenez, Rachel B.
collection PubMed
description PURPOSE: Stereotactic radiation therapy (SRT) enables focused, short course, high dose per fraction radiation delivery to brain tumors that are less ideal for single fraction treatment because of size, shape, or close proximity to sensitive structures. We sought to identify optimal SRT treatment regimens for maximizing local control while minimizing morbidity. METHODS AND MATERIALS: We performed a retrospective review of patients treated with SRT for solid brain metastases using variable dose schedules between 2001 and 2011 at 3 academic hospitals. Endpoints included (1) local control, (2) acute toxicity (Common Toxicity Criteria for Adverse Events v3.0), and (3) symptomatic radionecrosis. Kaplan-Meier and a competing risks methodology were used to estimate the actuarial rate of local failure and assess the association of clinical and treatment covariates with time to local failure. RESULTS: A total of 156 patients was identified. Common tumor histologies included breast (21%), non-small cell lung (32%), melanoma (22%), small cell lung (9%), and renal cell carcinoma (6%). The majority of lesions were supratentorial (57%). Median target volume was 3.99 mL (range, 0.04-58.42). Median total SRT dose was 25 Gy (range, 12-36), median fractional dose was 5 Gy (range, 2.5-11), and median number of fractions was 5 (range, 2-10). Cumulative incidence of local progression at 3, 6, 12, 18, and 24 months was 11%, 22%, 29%, 34%, and 36%. Total prescription dose was the only factor significantly associated with time to local progression on univariate (P = .02) and multivariable analysis (P = .01, adjusted hazards ratio, 0.87). Five patients experienced seizures within 10 days of SRT and 5 patients developed radionecrosis. All patients with documented radionecrosis received prior radiation to the index lesion. CONCLUSIONS: Our series of SRT for brain metastases found total prescription dose to be the only factor associated with local control. Both acute and long-term toxicity events from SRT were modest.
format Online
Article
Text
id pubmed-5605319
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-56053192017-11-07 The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity Jimenez, Rachel B. Alexander, Brian M. Mahadevan, Anand Niemierko, Andrzej Rajakesari, Selvan Arvold, Nils D. Floyd, Scott R. Oh, Kevin S. Loeffler, Jay S. Shih, Helen A. Adv Radiat Oncol Scientific Article PURPOSE: Stereotactic radiation therapy (SRT) enables focused, short course, high dose per fraction radiation delivery to brain tumors that are less ideal for single fraction treatment because of size, shape, or close proximity to sensitive structures. We sought to identify optimal SRT treatment regimens for maximizing local control while minimizing morbidity. METHODS AND MATERIALS: We performed a retrospective review of patients treated with SRT for solid brain metastases using variable dose schedules between 2001 and 2011 at 3 academic hospitals. Endpoints included (1) local control, (2) acute toxicity (Common Toxicity Criteria for Adverse Events v3.0), and (3) symptomatic radionecrosis. Kaplan-Meier and a competing risks methodology were used to estimate the actuarial rate of local failure and assess the association of clinical and treatment covariates with time to local failure. RESULTS: A total of 156 patients was identified. Common tumor histologies included breast (21%), non-small cell lung (32%), melanoma (22%), small cell lung (9%), and renal cell carcinoma (6%). The majority of lesions were supratentorial (57%). Median target volume was 3.99 mL (range, 0.04-58.42). Median total SRT dose was 25 Gy (range, 12-36), median fractional dose was 5 Gy (range, 2.5-11), and median number of fractions was 5 (range, 2-10). Cumulative incidence of local progression at 3, 6, 12, 18, and 24 months was 11%, 22%, 29%, 34%, and 36%. Total prescription dose was the only factor significantly associated with time to local progression on univariate (P = .02) and multivariable analysis (P = .01, adjusted hazards ratio, 0.87). Five patients experienced seizures within 10 days of SRT and 5 patients developed radionecrosis. All patients with documented radionecrosis received prior radiation to the index lesion. CONCLUSIONS: Our series of SRT for brain metastases found total prescription dose to be the only factor associated with local control. Both acute and long-term toxicity events from SRT were modest. Elsevier 2017-06-06 /pmc/articles/PMC5605319/ /pubmed/29114607 http://dx.doi.org/10.1016/j.adro.2017.05.008 Text en © 2017 The Authors on behalf of the American Society for Radiation Oncology http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Scientific Article
Jimenez, Rachel B.
Alexander, Brian M.
Mahadevan, Anand
Niemierko, Andrzej
Rajakesari, Selvan
Arvold, Nils D.
Floyd, Scott R.
Oh, Kevin S.
Loeffler, Jay S.
Shih, Helen A.
The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title_full The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title_fullStr The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title_full_unstemmed The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title_short The impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
title_sort impact of different stereotactic radiation therapy regimens for brain metastases on local control and toxicity
topic Scientific Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605319/
https://www.ncbi.nlm.nih.gov/pubmed/29114607
http://dx.doi.org/10.1016/j.adro.2017.05.008
work_keys_str_mv AT jimenezrachelb theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT alexanderbrianm theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT mahadevananand theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT niemierkoandrzej theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT rajakesariselvan theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT arvoldnilsd theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT floydscottr theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT ohkevins theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT loefflerjays theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT shihhelena theimpactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT jimenezrachelb impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT alexanderbrianm impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT mahadevananand impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT niemierkoandrzej impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT rajakesariselvan impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT arvoldnilsd impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT floydscottr impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT ohkevins impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT loefflerjays impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity
AT shihhelena impactofdifferentstereotacticradiationtherapyregimensforbrainmetastasesonlocalcontrolandtoxicity