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13-03-2023 | Metastasis | Research

Hypofractionated stereotactic radiosurgery (HSRS) as a salvage treatment for brain metastases failing prior stereotactic radiosurgery (SRS)

Authors: Michael Yan, Minha Lee, Sten Myrehaug, Chia-Lin Tseng, Jay Detsky, Hanbo Chen, Sunit Das, Collins Yeboah, Nir Lipsman, Leodante Da Costa, Lori Holden, Chinthaka Heyn, Pejman Maralani, Mark Ruschin, Arjun Sahgal, Hany Soliman

Published in: Journal of Neuro-Oncology | Issue 1/2023

Abstract

Introduction

Various treatment options exist to salvage stereotactic radiosurgery (SRS) failures for brain metastases, including repeat SRS and hypofractionated SRS (HSRS). Our objective was to report outcomes specific to salvage HSRS for brain metastases that failed prior HSRS/SRS.

Methods

Patients treated with HSRS to salvage local failures (LF) following initial HSRS/SRS, between July 2010 and April 2020, were retrospectively reviewed. The primary outcomes were the rates of LF, radiation necrosis (RN), and symptomatic radiation necrosis (SRN). Univariable (UVA) and multivariable (MVA) analyses using competing risk regression were performed to identify predictive factors for each endpoint.

Results

120 Metastases in 91 patients were identified. The median clinical follow up was 13.4 months (range 1.1–111.1), and the median interval between SRS courses was 13.1 months (range 3.0–56.5). 115 metastases were salvaged with 20–35 Gy in 5 fractions and the remaining five with a total dose ranging from 20 to 24 Gy in 3-fractions. 67 targets (56%) were postoperative cavities. The median re-treatment target volume and biological effective dose (BED₁₀) was 9.5 cc and 37.5 Gy, respectively. The 6- and 12- month LF rates were 18.9% and 27.7%, for RN 13% and 15.6%, and for SRN were 6.1% and 7.0%, respectively. MVA identified larger re-irradiation volume (hazard ratio [HR] 1.02, p = 0.04) and shorter interval between radiosurgery courses (HR 0.93, p < 0.001) as predictors of LF. Treatment of an intact target was associated with a higher risk of RN (HR 2.29, p = 0.04).

Conclusion

Salvage HSRS results in high local control rates and toxicity rates that compare favorably to those single fraction SRS re-irradiation experiences reported in the literature.

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Title: Hypofractionated stereotactic radiosurgery (HSRS) as a salvage treatment for brain metastases failing prior stereotactic radiosurgery (SRS)
Authors: Michael Yan
Minha Lee
Sten Myrehaug
Chia-Lin Tseng
Jay Detsky
Hanbo Chen
Sunit Das
Collins Yeboah
Nir Lipsman
Leodante Da Costa
Lori Holden
Chinthaka Heyn
Pejman Maralani
Mark Ruschin
Arjun Sahgal
Hany Soliman
Publication date: 13-03-2023
Publisher: Springer US
Keyword: Metastasis
Published in: Journal of Neuro-Oncology / Issue 1/2023
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-023-04265-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hypofractionated stereotactic radiosurgery (HSRS) as a salvage treatment for brain metastases failing prior stereotactic radiosurgery (SRS)

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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