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Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity

DM. Trifiletti, CC. Lee, H. Kano, J. Cohen, J. Janopaul-Naylor, M. Alonso-Basanta, JYK. Lee, G. Simonova, R. Liscak, A. Wolf, S. Kvint, IS. Grills, M. Johnson, KD. Liu, CJ. Lin, D. Mathieu, F. Héroux, D. Silva, M. Sharma, CP. Cifarelli, CN....

. 2016 ; 96 (2) : 280-288. [pub] 20160615

Language English Country United States

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc17031546

PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.

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$a Trifiletti, Daniel M $u Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia. Electronic address: daniel.trifiletti@gmail.com.
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$a Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity / $c DM. Trifiletti, CC. Lee, H. Kano, J. Cohen, J. Janopaul-Naylor, M. Alonso-Basanta, JYK. Lee, G. Simonova, R. Liscak, A. Wolf, S. Kvint, IS. Grills, M. Johnson, KD. Liu, CJ. Lin, D. Mathieu, F. Héroux, D. Silva, M. Sharma, CP. Cifarelli, CN. Watson, JD. Hack, JG. Golfinos, D. Kondziolka, G. Barnett, LD. Lunsford, JP. Sheehan,
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$a PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.
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$a Lee, Cheng-Chia $u Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, People's Republic of China.
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$a Kano, Hideyuki $u Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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$a Cohen, Jonathan $u Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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$a Janopaul-Naylor, James $u Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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$a Alonso-Basanta, Michelle $u Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. $7 gn_A_00004726
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$a Lee, John Y K $u Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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$a Simonova, Gabriela $u Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
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$a Liscak, Roman $u Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
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$a Wolf, Amparo $u Department of Neurosurgery, New York University Lagone Medical Center, New York, New York.
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$a Kvint, Svetlana $u Department of Neurosurgery, New York University Lagone Medical Center, New York, New York.
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$a Grills, Inga S $u Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
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$a Johnson, Matthew $u Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
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$a Liu, Kang-Du $u Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, People's Republic of China.
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$a Lin, Chung-Jung $u Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, People's Republic of China.
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$a Mathieu, David $u Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada.
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$a Héroux, France $u Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada.
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$a Silva, Danilo $u Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
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$a Sharma, Mayur $u Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
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$a Cifarelli, Christopher P $u Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, West Virginia.
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$a Watson, Christopher N $u Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, West Virginia.
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$a Hack, Joshua D $u Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, West Virginia.
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$a Golfinos, John G $u Department of Neurosurgery, New York University Lagone Medical Center, New York, New York.
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$a Kondziolka, Douglas $u Department of Neurosurgery, New York University Lagone Medical Center, New York, New York.
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$a Barnett, Gene $u Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
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$a Lunsford, L Dade $u Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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$a Sheehan, Jason P $u Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia; Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
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