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RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches
PURPOSE: To measure the value of early initial surveillance MRI scans in patients with brain metastases undergoing stereotactic radiosurgery (SRS), as MRI scans are a significant cost and patient stressor. METHODS: We identified a retrospective cohort of patients with brain metastases treated with S...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351280/ http://dx.doi.org/10.1093/noajnl/vdab071.093 |
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author | Lin, Timothy Siu, Catherine Redmond, Kristin Jackson, Christopher Bettegowda, Chetan Lim, Michael Kleinberg, Lawrence |
author_facet | Lin, Timothy Siu, Catherine Redmond, Kristin Jackson, Christopher Bettegowda, Chetan Lim, Michael Kleinberg, Lawrence |
author_sort | Lin, Timothy |
collection | PubMed |
description | PURPOSE: To measure the value of early initial surveillance MRI scans in patients with brain metastases undergoing stereotactic radiosurgery (SRS), as MRI scans are a significant cost and patient stressor. METHODS: We identified a retrospective cohort of patients with brain metastases treated with SRS and followed at a single institution with scheduled 6-week or 12-week initial surveillance MRI. Imaging interval was based on policy of different providers. Outcome measures included new/progressive lesions, salvage treatment, detection of new lesions before symptoms, and use of surgical resection. RESULTS: Two hundred patients were included: 100 consecutive patients scanned with 6-week and 12-week imaging. Eighty-seven and 74 patients in each group had available follow-up imaging and were analyzed. Median time to MRI was 6.7 weeks and 13.5 (p<.001). No difference in primary site, prior SRS, number of treated brain metastases, or use of targeted therapy/immune checkpoint inhibitors was detected. A lower percentage of patients with 6-week MRI had controlled extracranial disease at initial treatment (30% vs 47%,p=.003). Twenty-eight percent with 6-week MRI had findings concerning for new/progressive disease, compared to 47% with 3-month MRI (p=0.01). Fifteen percent (10/87) with 6-week MRI underwent intervention (i.e. SRS, whole brain radiotherapy, or surgery) compared to 34% (20/74) with 12-week MRI (p=0.004). Of patients receiving SRS, a higher percentage had new/worsening neurologic symptoms (45% vs 30%) at follow-up although a lower percentage had new lesions >1cm (20% vs 50%) when discovered. One patient in each group underwent surgical salvage. CONCLUSION: While shorter 6-week interval MRI surveillance post-SRS may detect new/progressive disease less frequently than 12-week MRI surveillance intervals, short interval MRI may be more likely to detect new/progressive lesions before symptoms develop. Surgical salvage was uncommon with either schedule. Further study may identify a high-risk subgroup who would benefit from early surveillance. |
format | Online Article Text |
id | pubmed-8351280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-83512802021-08-09 RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches Lin, Timothy Siu, Catherine Redmond, Kristin Jackson, Christopher Bettegowda, Chetan Lim, Michael Kleinberg, Lawrence Neurooncol Adv Supplement Abstracts PURPOSE: To measure the value of early initial surveillance MRI scans in patients with brain metastases undergoing stereotactic radiosurgery (SRS), as MRI scans are a significant cost and patient stressor. METHODS: We identified a retrospective cohort of patients with brain metastases treated with SRS and followed at a single institution with scheduled 6-week or 12-week initial surveillance MRI. Imaging interval was based on policy of different providers. Outcome measures included new/progressive lesions, salvage treatment, detection of new lesions before symptoms, and use of surgical resection. RESULTS: Two hundred patients were included: 100 consecutive patients scanned with 6-week and 12-week imaging. Eighty-seven and 74 patients in each group had available follow-up imaging and were analyzed. Median time to MRI was 6.7 weeks and 13.5 (p<.001). No difference in primary site, prior SRS, number of treated brain metastases, or use of targeted therapy/immune checkpoint inhibitors was detected. A lower percentage of patients with 6-week MRI had controlled extracranial disease at initial treatment (30% vs 47%,p=.003). Twenty-eight percent with 6-week MRI had findings concerning for new/progressive disease, compared to 47% with 3-month MRI (p=0.01). Fifteen percent (10/87) with 6-week MRI underwent intervention (i.e. SRS, whole brain radiotherapy, or surgery) compared to 34% (20/74) with 12-week MRI (p=0.004). Of patients receiving SRS, a higher percentage had new/worsening neurologic symptoms (45% vs 30%) at follow-up although a lower percentage had new lesions >1cm (20% vs 50%) when discovered. One patient in each group underwent surgical salvage. CONCLUSION: While shorter 6-week interval MRI surveillance post-SRS may detect new/progressive disease less frequently than 12-week MRI surveillance intervals, short interval MRI may be more likely to detect new/progressive lesions before symptoms develop. Surgical salvage was uncommon with either schedule. Further study may identify a high-risk subgroup who would benefit from early surveillance. Oxford University Press 2021-08-09 /pmc/articles/PMC8351280/ http://dx.doi.org/10.1093/noajnl/vdab071.093 Text en © The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Supplement Abstracts Lin, Timothy Siu, Catherine Redmond, Kristin Jackson, Christopher Bettegowda, Chetan Lim, Michael Kleinberg, Lawrence RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title | RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title_full | RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title_fullStr | RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title_full_unstemmed | RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title_short | RADI-23. Exploring the optimal timing of routine initial surveillance MRI following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
title_sort | radi-23. exploring the optimal timing of routine initial surveillance mri following treatment of brain metastases with stereotactic radiosurgery: a comparison of two approaches |
topic | Supplement Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351280/ http://dx.doi.org/10.1093/noajnl/vdab071.093 |
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