Top

Published in:

01-09-2015 | Clinical Study

Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery

Authors: Andrew Yaeh, Tavish Nanda, Ashish Jani, Tzlil Rozenblat, Yasir Qureshi, Shumaila Saad, Jeraldine Lesser, Andrew B. Lassman, Steven R. Isaacson, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann II, Tony J. C. Wang

Published in: Journal of Neuro-Oncology | Issue 3/2015

Abstract

Renal cell carcinoma, sarcoma, and melanoma are considered to be “radioresistant” tumor histologies. Brain metastases (BM) from these tumors are considered unlikely to be controlled using the relatively low doses used in whole brain radiotherapy (WBRT). Our objective was to analyze the efficacy of stereotactic radiosurgery (SRS) on local control and overall survival of BM from radioresistant primary tumors. We reviewed all patients who received Gamma Knife Radiosurgery (GKRS) for BM at Columbia University Medical Center between January 2009 and April 2014. All patients were treated using the Gamma Knife Perfexion System. Dosimetric data was collected from treatment plans and metastases were categorized as radioresistant or not. Response was assessed by reviewing follow-up brain imaging studies and classified according to RECIST. Local control and median overall survival were calculated using the Kaplan–Meier method. In total, 373 tumors were analyzed from 126 patients. Of these tumors, 49 (13.1 %) originated from radioresistant cancers. The overall local control rate in the radioresistant cohort was 89.8 and 90.1 % in the non-radioresistant cohort. Univariate and multivariate analyses demonstrated that radioresistance status of the primary tumor had no statistically significant effect on local control with hazard ratios of 1.0 (p = 1.0, 95 % CI 0.388–2.576) and 0.954 (p = 0.926, 95 % CI 0.349–2.603) respectively. Median overall survival for both radioresistant and non-radioresistant cohorts was 20.0 months, with a p value of 0.926. There was no significant difference in local control of BM from radioresistant and non-radioresistant primary tumors treated with GKRS. Both cohorts showed excellent response and local control, suggesting that SRS upfront or in addition to WBRT may be an appropriate strategy in the treatment of BM from radioresistant cancers. Median overall survival for both cohorts was equal, suggesting that improved local control may be associated with an improvement in long-term survival.

Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K et al (2006) Stereotactic radiosurgery plus whole brain radiation therapy vs. stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trail. JAMA 295:2483–2491CrossRefPubMed

Clarke JW, Register S, McGregor JM, Grecula JC, Mayr NA, Wang JZ et al (2010) Stereotactic radiosurgery with or without whole brain radiotherapy for patients with a single radioresistant brain metastasis. Am J Clin Oncol 33:70–74CrossRefPubMed

Sneed PK, Suh JH, Goetsch SJ, Sanghavi SN, Chappell R et al (1993) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 53:209–214

Grob JJ, Regis J, Laurans R, Delaunay M, Wolkenstein P, Paul K et al (1998) Radiosurgery without whole brain radiotherapy in melanoma brain metastases. Eur J Cancer 34:1187–1192CrossRefPubMed

Saad A, Wang T (2014) Neurocognitive deficits after radiation therapy for brain malignancies. Am J Clin Oncol. doi:10.1097/COC.0000000000000158

Mehta M, Noyes W, Craig B, Lamond J, Auchter R, French M (1997) A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single brain metastases. Int J Radiat Oncol Biol Phys 39:445–454CrossRefPubMed

Regine WF, Huhn JL, Pathcell RA, St Clair WH, Strottmann J, Meigooni A et al (2002) Risk of symptomatic brain tumor recurrence and neurologic deficit after radiosurgery alone in patients with newly diagnosed brain metastases: results and implications. Int J Radiat Oncol Biol Phys 52:333–338CrossRefPubMed

Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG (2009) Neuro-cognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole brain irradiation: a randomized controlled trial. Lancet Oncol 10:1037–1044CrossRefPubMed

Adler JR, Cox RS, Kaplan I, Martin DP et al (1992) Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444–449CrossRefPubMed

10.

Auchter RM, Lamond JP, Alexander D, Buatti JM, Chappell R, Friedman WA et al (1996) A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35CrossRefPubMed

11.

Engenhart R, Kimmig BN, Hover KH, Wowra B, Romahn J, Lorenz WJ et al (1993) Long-term follow-up for brain metastases treated by percutaneous sterotactic single high-dose irradiation. Cancer 71:1353–1361CrossRefPubMed

12.

Flickinger JC, Kondziolka D, Lunsford LD, Coffery RJ, Goodman ML, Shaw EG et al (2005) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802CrossRef

13.

Kihlstrom L, Karlsson B, Lindquist C (1993) Gamma knife surgery for cerebral metastases. Implications for survival based on 16 years experience. Stereotact Funct Neurosurg 61(Suppl 1):45–50CrossRefPubMed

14.

Mehta MP, Rozental JM, Levin AB, Mackie TR, Kubsad SS, Gehring MA et al (1992) Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 24:619–625CrossRefPubMed

15.

Soffietti R, Ruda R, Mutani R (2002) Management of brain metastases. J Neurol 249:1357–1369CrossRefPubMed

16.

Posner J (1992) Management of brain metastases. Rev Neurol 148:477–487PubMed

17.

Chowdry VK, Hahn SS (2014) Intracranial stereotactic radiosurgery in high risk patients with metastases from radioresistant primary tumors. In: Hayat MA (ed) Tumors of the central nervous system, vol 11. Springer, New York, pp 163–172

18.

Ries LAG, Melbert D, Karpcho M, Stinchcomb DG, Howlander N, Horner MJ et al (2008) SEER cancer statistics review, 1975–2005. National Cancer Institute, Bethesda

19.

Wronski M, Maor MH, Davis BJ, Sawaya R, Levin VA (1997) External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M.D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 37:753–759CrossRefPubMed

20.

Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S et al (2007) Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactice radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 68:1388–1395CrossRefPubMed

21.

Flannery T, Kano H, Niranjan A, Monaca EA, Flickinger JC, Kofler J, Lunsford LD et al (2010) Gamma knife radiosurgery as a therapeutic strategy for intracranial sacromatous metastases. Int J Radiat Oncol Biol Phys 76(2):513–519CrossRefPubMed

22.

Hyool K, Tae-Young J, In-Young K, Shin J, Kyung-Sub M, Seung-Jin P (2013) The usefulness of stereotactic radiosurgery for radioresistant brain metastases. J Korean Neurosurg Soc 54:107–111CrossRef

23.

Lavine SD, Petrovich Z, Cohen-Gadol AA, Masri LS, Morton DL, O’Day SJ et al (1999) Gamma knife radiosurgery for metastatic melanoma: an analysis of survival, outcome, and complications. Neurosurgery 44:59–64CrossRefPubMed

24.

Mori Y, Kondziolka D, Flickinger JC, Kirkwood JM, Agarwala S, Lunsford LD (1998) Stereotactic radiosurgery for cerebral metastatic melanoma: factors affecting local disease control and survival. Int J Radiat Oncol Biol Phys 42:581–589CrossRefPubMed

25.

Powell JW, Chung CT, Hemangini SR, Canute GW, Hodge CJ, Bassano DA (2008) Gamma Knife surgery in the management of radioresistant brain metastases in high-risk patients with melanoma, renal cell carcinoma, and sarcoma. J Neurosurg 109(Suppl):122–128PubMed

26.

Sheehan JP, Ming-His S, Kondziolka D, Flickinger J, Lunsford LD (2003) Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 98:342–349CrossRefPubMed

27.

Sin AH, Cardens RJ, Vannemreddy P, Nanda A (2009) Gamma knife stereotactic radiosurgery for intracranial metastases from conventionally radioresistant primary cancers: outcome analysis of survival and control of brain disease. South Med J 102:41–44CrossRef

28.

Shaw E, Scott C, Souhami L, Dinapoli R, Bahary JP, Kline R et al (1996) Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: initial report of radiation therapy oncology group protocol 90-05. Int J Radiat Oncol Biol Phys 34:647–654CrossRefPubMed

29.

Eisnehauer EA, Therasse P, Bogaerts J, Schawartz LH, Sargent D, Ford R et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRef

30.

Muacevic A, Wowra B, Siefert A, Tonn JC, Steiger HJ, Kreth FW (2008) Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicenter phase III trial. J Neuroncol 87:299–307CrossRef

31.

Gavrilovic IT, Posner JB (2005) Brain metastases: epidemiology and pathophysiology. J Neurooncol 75:5–14CrossRefPubMed

32.

Goyal LK, Suh JH, Reddy CA, Barnett GH (2000) The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 47:1007–1012CrossRefPubMed

33.

Selek U, Change EL, Hassenbusch SJ III, Shiu AS, Lang FF et al (2004) Stereotactic radiosurgical treatment in 103 patients with 153 cerebral melanoma metastases. Int J Radiat Oncol Biol Phys 59:1097–1106CrossRefPubMed

34.

Davies MA, Liu P, McIntyre S, Kim K, Papadopoulos N, Hwu W, Hwu P, Bedikian A et al (2011) Prognostic factors for survival in melanoma patients with brain metastases. Cancer 117(8):1687–1696CrossRefPubMed

35.

Chang EL, Selek U, Ugur MD, Hassenbusch SJ III, Maor MH, Allen PK et al (2005) Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56:936–945CrossRefPubMed

36.

Brown PD, Brown CA, Pollock BE, Gorman DA, Foote RL (2002) Stereotactic radiosurgery for patients with “radioresistant” brain metastases. Neurosurgery 51:656–665PubMed

Title: Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery
Authors: Andrew Yaeh
Tavish Nanda
Ashish Jani
Tzlil Rozenblat
Yasir Qureshi
Shumaila Saad
Jeraldine Lesser
Andrew B. Lassman
Steven R. Isaacson
Michael B. Sisti
Jeffrey N. Bruce
Guy M. McKhann II
Tony J. C. Wang
Publication date: 01-09-2015
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 3/2015
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-015-1871-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2015

Genetic imprinting suggested by maternal DNA methylation in CNS hemangioblastoma with clinical phenotypes of VHL disease

Voxel-based evidence of perfusion normalization in glioblastoma patients included in a phase I–II trial of radiotherapy/tipifarnib combination

Stereotactic radiosurgery in the treatment of brain metastases from gastrointestinal primaries

Salvage whole brain radiotherapy or stereotactic radiosurgery after initial stereotactic radiosurgery for 1–4 brain metastases

Clinical presentation and long-term outcome of primary spinal peripheral primitive neuroectodermal tumors

RETRACTED ARTICLE: Relationship between inflammatory cytokines and risk of depression, and effect of depression on the prognosis of high grade glioma patients