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Open Access 01-12-2011 | Research

Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis

Authors: Giuseppe Minniti, Enrico Clarke, Gaetano Lanzetta, Mattia Falchetto Osti, Guido Trasimeni, Alessandro Bozzao, Andrea Romano, Riccardo Maurizi Enrici

Published in: Radiation Oncology | Issue 1/2011

Abstract

Purpose

to investigate the factors affecting survival and toxicity in patients treated with stereotactic radiosurgery (SRS), with special attention to volumes of brain receiving a specific dose (V10 - V16 Gy) as predictors for brain radionecrosis.

Patients and Methods

Two hundred six consecutive patients with 310 cerebral metastases less than 3.5 cm were treated with SRS as primary treatment and followed prospectively at University of Rome La Sapienza Sant'Andrea Hospital. Overall survival, brain control, and local control were estimated using the Kaplan-Meier method calculated from the time of SRS. Univariate and multivariate analysis using a Cox proportional hazards regression model were performed to determine the predictive value of prognostic factors for treatment outcome and SRS-related complications.

Results

Median overall survival and brain control were 14.1 months and 10 months, respectively. The 1-year and 2-year survival rates were 58% and 24%, and respective brain control were 43% and 22%. Sixteen patients recurred locally after SRS, with 1-year and 2-year local control rates of 92% and 84%, respectively. On multivariate analysis, stable extracranial disease and KPS >70 were associated with the most significant survival benefit. Neurological complications were recorded in 27 (13%) patients. Severe neurological complications (RTOG Grade 3 and 4) occurred in 5.8% of patients. Brain radionecrosis occurred in 24% of treated lesions, being symptomatic in 10% and asymptomatic in 14%. On multivariate analysis, V10 through V16 Gy were independent risk factors for radionecrosis, with V10 Gy and V12 Gy being the most predictive (p = 0.0001). For V10 Gy >12.6 cm³ and V12 Gy >10.9 cm³ the risk of radionecrosis was 47%.

Conclusions

SRS alone represents a feasible option as initial treatment for patients with brain metastases, however a significant subset of patients may develop neurological complications. Lesions with V12 Gy >8.5 cm³ carries a risk of radionecrosis >10% and should be considered for hypofractionated stereotactic radiotherapy especially when located in/near eloquent areas.

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Title: Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis
Authors: Giuseppe Minniti
Enrico Clarke
Gaetano Lanzetta
Mattia Falchetto Osti
Guido Trasimeni
Alessandro Bozzao
Andrea Romano
Riccardo Maurizi Enrici
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2011
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-6-48

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis

Abstract

Purpose

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and Methods

Results

Conclusions

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