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Published in: Clinical & Experimental Metastasis 6-7/2017

01-10-2017 | Research Paper

Radiobiology and radiotherapy of brain metastases

Authors: Anuradha Thiagarajan, Yoshiya Yamada

Published in: Clinical & Experimental Metastasis | Issue 6-7/2017

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Abstract

Brain metastases are the most common intracranial tumors in adults, accounting for more than 50% of all such cases. The approach to and management of brain metastases have evolved significantly in recent years due to several reasons. These include advances in neurosurgical and radiotherapeutic techniques, improved systemic therapy options offering better systemic and intracranial disease control and prolongation of survival as a result of these improvements, making side-effects of proposed therapies (e.g. neurocognitive decline from whole brain radiotherapy) an important consideration. In this article, we review the the primary therapeutic approaches to the management of brain metastases, namely, surgery, stereotactic radiosurgery, and whole brain radiation therapy and the primary factors dictating choice.
Literature
1.
go back to reference Al-Zabin M, Ullrich WO, Brawanski A, Proescholdt MA (2010) Recurrent brain metastases from lung cancer: the impact of reoperation. Acta Neurochir 152:1887–1892CrossRefPubMed Al-Zabin M, Ullrich WO, Brawanski A, Proescholdt MA (2010) Recurrent brain metastases from lung cancer: the impact of reoperation. Acta Neurochir 152:1887–1892CrossRefPubMed
2.
go back to reference Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491CrossRefPubMed Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295:2483–2491CrossRefPubMed
3.
go back to reference Auchter RM, Lamond JP, Alexander E, Buatti JM, Chappell R, Friedman WA, Kinsella TJ, Levin AB, Noyes WR, Schultz CJ, Loeffler JS, Mehta MP (1996) A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35CrossRefPubMed Auchter RM, Lamond JP, Alexander E, Buatti JM, Chappell R, Friedman WA, Kinsella TJ, Levin AB, Noyes WR, Schultz CJ, Loeffler JS, Mehta MP (1996) A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35CrossRefPubMed
4.
go back to reference Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG, 2nd, Deming R, Burri SH, Menard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial JAMA 316: 401–409CrossRefPubMedPubMedCentral Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG, 2nd, Deming R, Burri SH, Menard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial JAMA 316: 401–409CrossRefPubMedPubMedCentral
5.
go back to reference Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C, Choucair A, Fox S, Suh JH, Roberge D, Kavadi V, Bentzen SM, Mehta MP, Watkins-Bruner D, Group Radiation Therapy Oncology (2013) Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol 15: 1429–1437CrossRefPubMedPubMedCentral Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C, Choucair A, Fox S, Suh JH, Roberge D, Kavadi V, Bentzen SM, Mehta MP, Watkins-Bruner D, Group Radiation Therapy Oncology (2013) Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol 15: 1429–1437CrossRefPubMedPubMedCentral
6.
go back to reference Brown PD, Ballman KV, Cerhan J, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NN, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG, Farace II, E., Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2016) N107C/CEC.3: a phase III trial of post-operative stereotactic radiosurgery (SRS) compared with whole brain radiotherapy (wbrt) for resected metastatic brain disease. Int J Radiat Oncol Biol Phys 96:937CrossRef Brown PD, Ballman KV, Cerhan J, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NN, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG, Farace II, E., Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D (2016) N107C/CEC.3: a phase III trial of post-operative stereotactic radiosurgery (SRS) compared with whole brain radiotherapy (wbrt) for resected metastatic brain disease. Int J Radiat Oncol Biol Phys 96:937CrossRef
7.
go back to reference Chang EL, Selek U, Hassenbusch SJ, 3rd, Maor MH, Allen PK, Mahajan A, Sawaya R, Woo SY (2005) Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56:936–945CrossRefPubMed Chang EL, Selek U, Hassenbusch SJ, 3rd, Maor MH, Allen PK, Mahajan A, Sawaya R, Woo SY (2005) Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56:936–945CrossRefPubMed
8.
go back to reference Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044CrossRefPubMed Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044CrossRefPubMed
9.
go back to reference Corre I, Guillonneau M, Paris F (2013) Membrane signaling induced by high doses of ionizing radiation in the endothelial compartment. Relevance in radiation toxicity. Int J Mol Sci 14:22678–22696CrossRefPubMedPubMedCentral Corre I, Guillonneau M, Paris F (2013) Membrane signaling induced by high doses of ionizing radiation in the endothelial compartment. Relevance in radiation toxicity. Int J Mol Sci 14:22678–22696CrossRefPubMedPubMedCentral
10.
go back to reference Garcia-Barros M, Lacorazza D, Petrie H, Haimovitz-Friedman A, Cardon-Cardo C, Nimer S, Fuks Z, Kolesnick R (2004) Host acid sphingomyelinase regulates microvascular function not tumor immunity. Cancer Res 64:8285–8291CrossRefPubMed Garcia-Barros M, Lacorazza D, Petrie H, Haimovitz-Friedman A, Cardon-Cardo C, Nimer S, Fuks Z, Kolesnick R (2004) Host acid sphingomyelinase regulates microvascular function not tumor immunity. Cancer Res 64:8285–8291CrossRefPubMed
11.
go back to reference Garcia-Barros M, Paris F, Cordon-Cardo C, Lyden D, Rafii S, Haimovitz-Friedman A, Fuks Z, Kolesnick R (2003) Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 300:1155–1159CrossRefPubMed Garcia-Barros M, Paris F, Cordon-Cardo C, Lyden D, Rafii S, Haimovitz-Friedman A, Fuks Z, Kolesnick R (2003) Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 300:1155–1159CrossRefPubMed
12.
go back to reference Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751CrossRefPubMed Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751CrossRefPubMed
13.
go back to reference Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Shah S, Shi W, Wendland M, Kachnic L, Mehta MP (2014) Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol 32: 3810–3816CrossRefPubMedPubMedCentral Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A, Rowley H, Kundapur V, DeNittis A, Greenspoon JN, Konski AA, Bauman GS, Shah S, Shi W, Wendland M, Kachnic L, Mehta MP (2014) Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. J Clin Oncol 32: 3810–3816CrossRefPubMedPubMedCentral
14.
go back to reference Heisterkamp C, Haatanen T, Schild SE, Rades D (2010) Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer. Strahlenther Onkol 186:70–75CrossRefPubMed Heisterkamp C, Haatanen T, Schild SE, Rades D (2010) Dose escalation in patients receiving whole-brain radiotherapy for brain metastases from colorectal cancer. Strahlenther Onkol 186:70–75CrossRefPubMed
16.
go back to reference Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study. J Clin Oncol 29:134–141CrossRefPubMed Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study. J Clin Oncol 29:134–141CrossRefPubMed
17.
18.
go back to reference Lee Y, Auh SL, Wang Y, Burnette B, Wang Y, Meng Y, Beckett M, Sharma R, Chin R, Tu T, Weichselbaum RR, Fu YX (2009) Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood 114:589–595CrossRefPubMedPubMedCentral Lee Y, Auh SL, Wang Y, Burnette B, Wang Y, Meng Y, Beckett M, Sharma R, Chin R, Tu T, Weichselbaum RR, Fu YX (2009) Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood 114:589–595CrossRefPubMedPubMedCentral
19.
go back to reference Loeffler JS, Barker FG, Chapman PH. 1999. Role of radiosurgery in the management of central nervous system metastases. Cancer Chemother Pharmacol 43: S11–S14CrossRefPubMed Loeffler JS, Barker FG, Chapman PH. 1999. Role of radiosurgery in the management of central nervous system metastases. Cancer Chemother Pharmacol 43: S11–S14CrossRefPubMed
20.
go back to reference Mehta MP, Rodrigus P, Terhaard CH, Rao A, Suh J, Roa W, Souhami L, Bezjak A, Leibenhaut M, Komaki R, Schultz C, Timmerman R, Curran W, Smith J, Phan SC, Miller RA, Renschler MF (2003) Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol 21:2529–2536CrossRefPubMed Mehta MP, Rodrigus P, Terhaard CH, Rao A, Suh J, Roa W, Souhami L, Bezjak A, Leibenhaut M, Komaki R, Schultz C, Timmerman R, Curran W, Smith J, Phan SC, Miller RA, Renschler MF (2003) Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol 21:2529–2536CrossRefPubMed
21.
go back to reference Muacevic A, Kreth FW, Mack A, Tonn JC, Wowra B (2004) Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg 47:203–208CrossRefPubMed Muacevic A, Kreth FW, Mack A, Tonn JC, Wowra B (2004) Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg 47:203–208CrossRefPubMed
22.
go back to reference Nieder C, Berberich W, Schnabel K (1997) Tumor-related prognostic factors for remission of brain metastases after radiotherapy. Int J Radiat Oncol Biol Phys 39:25–30CrossRefPubMed Nieder C, Berberich W, Schnabel K (1997) Tumor-related prognostic factors for remission of brain metastases after radiotherapy. Int J Radiat Oncol Biol Phys 39:25–30CrossRefPubMed
23.
go back to reference Rodrigues G, Zindler J, Warner A, Lagerwaard F. (2013) Recursive partitioning analysis for the prediction of stereotactic radiosurgery brain metastases lesion control. Oncologist 18:330–335CrossRefPubMedPubMedCentral Rodrigues G, Zindler J, Warner A, Lagerwaard F. (2013) Recursive partitioning analysis for the prediction of stereotactic radiosurgery brain metastases lesion control. Oncologist 18:330–335CrossRefPubMedPubMedCentral
24.
go back to reference Schomas DA, Roeske JC, MacDonald RL, Sweeney PJ, Mehta N, Mundt AJ (2005) Predictors of tumor control in patients treated with linac-based stereotactic radiosurgery for metastatic disease to the brain. Am J Clin Oncol 28:180–187CrossRefPubMed Schomas DA, Roeske JC, MacDonald RL, Sweeney PJ, Mehta N, Mundt AJ (2005) Predictors of tumor control in patients treated with linac-based stereotactic radiosurgery for metastatic disease to the brain. Am J Clin Oncol 28:180–187CrossRefPubMed
25.
go back to reference Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90- 05. Int J Radiat Oncol Biol Phys 47:291–298CrossRefPubMed Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90- 05. Int J Radiat Oncol Biol Phys 47:291–298CrossRefPubMed
26.
go back to reference Shuto T, Inomori S, Fujino H, Nagano H (2006) Gamma knife surgery for metastatic brain tumors from renal cell carcinoma. J Neurosurg 105:555–560CrossRefPubMed Shuto T, Inomori S, Fujino H, Nagano H (2006) Gamma knife surgery for metastatic brain tumors from renal cell carcinoma. J Neurosurg 105:555–560CrossRefPubMed
27.
go back to reference Skeie BS, Enger PO, Ganz JC, Skeie GO, Parr E, Hatteland S, Ystevik B, Heggdal JI, Pedersen PH (2013). Gamma knife surgery of colorectal brain metastases: a high prescription dose of 25 Gy may improve growth control. World Neurosurg 79:525–536CrossRefPubMed Skeie BS, Enger PO, Ganz JC, Skeie GO, Parr E, Hatteland S, Ystevik B, Heggdal JI, Pedersen PH (2013). Gamma knife surgery of colorectal brain metastases: a high prescription dose of 25 Gy may improve growth control. World Neurosurg 79:525–536CrossRefPubMed
28.
go back to reference Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425CrossRefPubMed Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425CrossRefPubMed
29.
go back to reference Suh JH, Stea B, Nabid A, Kresl JJ, Fortin A, Mercier JP, Senzer N, Chang EL, Boyd AP, Cagnoni PJ, Shaw E (2006) Phase III study of efaproxiral as an adjunct to whole-brain radiation therapy for brain metastases. J Clin Oncol 24:106–114CrossRefPubMed Suh JH, Stea B, Nabid A, Kresl JJ, Fortin A, Mercier JP, Senzer N, Chang EL, Boyd AP, Cagnoni PJ, Shaw E (2006) Phase III study of efaproxiral as an adjunct to whole-brain radiation therapy for brain metastases. J Clin Oncol 24:106–114CrossRefPubMed
30.
go back to reference Wowra B, Siebels M, Muacevic A, Kreth FW, Mack A, Hofstetter A (2002) Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma. J Neurosurg 97:785–793CrossRefPubMed Wowra B, Siebels M, Muacevic A, Kreth FW, Mack A, Hofstetter A (2002) Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma. J Neurosurg 97:785–793CrossRefPubMed
31.
go back to reference Yamamoto M, Kawabe T, Sato Y, Higuchi Y, Nariai T, Watanabe S, Kasuya H (2014) Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2–9 versus 10 or more tumors. J Neurosurg 121(Suppl):16–25PubMed Yamamoto M, Kawabe T, Sato Y, Higuchi Y, Nariai T, Watanabe S, Kasuya H (2014) Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2–9 versus 10 or more tumors. J Neurosurg 121(Suppl):16–25PubMed
Metadata
Title
Radiobiology and radiotherapy of brain metastases
Authors
Anuradha Thiagarajan
Yoshiya Yamada
Publication date
01-10-2017
Publisher
Springer Netherlands
Published in
Clinical & Experimental Metastasis / Issue 6-7/2017
Print ISSN: 0262-0898
Electronic ISSN: 1573-7276
DOI
https://doi.org/10.1007/s10585-017-9865-7

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