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FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study
Background: While the role of stereotactic radiotherapy for brain metastases is increasing, evidence on the comparative efficacy and safety of fractionated stereotactic radiotherapy (FSRT) and single-session radiosurgery (SRS) is scarce. Methods: Longitudinal volumetric analysis was performed in a c...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554610/ https://www.ncbi.nlm.nih.gov/pubmed/33102223 http://dx.doi.org/10.3389/fonc.2020.559193 |
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author | Putz, Florian Weissmann, Thomas Oft, Dominik Schmidt, Manuel Alexander Roesch, Johannes Siavooshhaghighi, Hadi Filimonova, Irina Schmitter, Charlotte Mengling, Veit Bert, Christoph Frey, Benjamin Lettmaier, Sebastian Distel, Luitpold Valentin Semrau, Sabine Fietkau, Rainer |
author_facet | Putz, Florian Weissmann, Thomas Oft, Dominik Schmidt, Manuel Alexander Roesch, Johannes Siavooshhaghighi, Hadi Filimonova, Irina Schmitter, Charlotte Mengling, Veit Bert, Christoph Frey, Benjamin Lettmaier, Sebastian Distel, Luitpold Valentin Semrau, Sabine Fietkau, Rainer |
author_sort | Putz, Florian |
collection | PubMed |
description | Background: While the role of stereotactic radiotherapy for brain metastases is increasing, evidence on the comparative efficacy and safety of fractionated stereotactic radiotherapy (FSRT) and single-session radiosurgery (SRS) is scarce. Methods: Longitudinal volumetric analysis was performed in a consecutive cohort of 120 patients and 190 brain metastases (>0.065 cm(3) in volume / > ~5 mm in diameter) treated exclusively with FSRT (n = 98) and SRS (n = 92), respectively. A total of 972 tumor segmentations was used, averaging 5.1 time points per metastasis. Progression was defined using a volumetric extension of the RANO-BM criteria. Local control and radionecrosis were compared for lesions treated with FSRT and SRS, respectively. Results: Metastases treated with FSRT were significantly larger at baseline (mean, 4.66 vs. 0.40 cm(3), p < 0.001). Biologically effective dose (BED) for metastases (α/β = 12, linear-quadratic-cubic model) was significantly associated with local control, whereas BED for normal brain (α/β = 2, linear-quadratic model) was significantly associated with radionecrosis. Median time to local progression was 22.9 months in the FSRT group compared to 14.5 months in the SRS group (p = 0.022). Overall radionecrosis rate at 12 months was 3.4% for FSRT and 14.8% for SRS (p = 0.010). Radionecrosis °IV requiring resection with histologic proof of radiation necrosis also was significantly reduced in the FSRT group (FSRT 0.0% vs. SRS 3.9%, p = 0.041). In multivariate analysis, FSRT was associated with reduced risk of progression (HR 0.47, p = 0.015) and reduced risk of radionecrosis (HR 0.18, p = 0.045). Conclusions: This volumetric study provides initial evidence that the improvements in therapeutic ratio expected for FSRT in larger brain metastases, might equally extend into the domain of smaller metastases, traditionally less considered for fractionated treatment. FSRT might constitute an important tool to further increase local control and reduce radionecrosis risk in stereotactic radiotherapy for brain metastases, that should be assessed in randomized intervention trials. |
format | Online Article Text |
id | pubmed-7554610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-75546102020-10-22 FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study Putz, Florian Weissmann, Thomas Oft, Dominik Schmidt, Manuel Alexander Roesch, Johannes Siavooshhaghighi, Hadi Filimonova, Irina Schmitter, Charlotte Mengling, Veit Bert, Christoph Frey, Benjamin Lettmaier, Sebastian Distel, Luitpold Valentin Semrau, Sabine Fietkau, Rainer Front Oncol Oncology Background: While the role of stereotactic radiotherapy for brain metastases is increasing, evidence on the comparative efficacy and safety of fractionated stereotactic radiotherapy (FSRT) and single-session radiosurgery (SRS) is scarce. Methods: Longitudinal volumetric analysis was performed in a consecutive cohort of 120 patients and 190 brain metastases (>0.065 cm(3) in volume / > ~5 mm in diameter) treated exclusively with FSRT (n = 98) and SRS (n = 92), respectively. A total of 972 tumor segmentations was used, averaging 5.1 time points per metastasis. Progression was defined using a volumetric extension of the RANO-BM criteria. Local control and radionecrosis were compared for lesions treated with FSRT and SRS, respectively. Results: Metastases treated with FSRT were significantly larger at baseline (mean, 4.66 vs. 0.40 cm(3), p < 0.001). Biologically effective dose (BED) for metastases (α/β = 12, linear-quadratic-cubic model) was significantly associated with local control, whereas BED for normal brain (α/β = 2, linear-quadratic model) was significantly associated with radionecrosis. Median time to local progression was 22.9 months in the FSRT group compared to 14.5 months in the SRS group (p = 0.022). Overall radionecrosis rate at 12 months was 3.4% for FSRT and 14.8% for SRS (p = 0.010). Radionecrosis °IV requiring resection with histologic proof of radiation necrosis also was significantly reduced in the FSRT group (FSRT 0.0% vs. SRS 3.9%, p = 0.041). In multivariate analysis, FSRT was associated with reduced risk of progression (HR 0.47, p = 0.015) and reduced risk of radionecrosis (HR 0.18, p = 0.045). Conclusions: This volumetric study provides initial evidence that the improvements in therapeutic ratio expected for FSRT in larger brain metastases, might equally extend into the domain of smaller metastases, traditionally less considered for fractionated treatment. FSRT might constitute an important tool to further increase local control and reduce radionecrosis risk in stereotactic radiotherapy for brain metastases, that should be assessed in randomized intervention trials. Frontiers Media S.A. 2020-09-30 /pmc/articles/PMC7554610/ /pubmed/33102223 http://dx.doi.org/10.3389/fonc.2020.559193 Text en Copyright © 2020 Putz, Weissmann, Oft, Schmidt, Roesch, Siavooshhaghighi, Filimonova, Schmitter, Mengling, Bert, Frey, Lettmaier, Distel, Semrau and Fietkau. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Putz, Florian Weissmann, Thomas Oft, Dominik Schmidt, Manuel Alexander Roesch, Johannes Siavooshhaghighi, Hadi Filimonova, Irina Schmitter, Charlotte Mengling, Veit Bert, Christoph Frey, Benjamin Lettmaier, Sebastian Distel, Luitpold Valentin Semrau, Sabine Fietkau, Rainer FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title | FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title_full | FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title_fullStr | FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title_full_unstemmed | FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title_short | FSRT vs. SRS in Brain Metastases—Differences in Local Control and Radiation Necrosis—A Volumetric Study |
title_sort | fsrt vs. srs in brain metastases—differences in local control and radiation necrosis—a volumetric study |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554610/ https://www.ncbi.nlm.nih.gov/pubmed/33102223 http://dx.doi.org/10.3389/fonc.2020.559193 |
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