Alexander Romagna1, Christoph Schwartz1, Rupert Egensperger2, Juliana Watson3, Jörg-Christian Tonn1, Claus Belka3, Friedrich-Wilhelm Kreth4, Silke Birgit Nachbichler3. 1. Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. 2. Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany. 3. Department of Radiation-Oncology, Ludwig-Maximilians-University, Munich, Germany. 4. Department of Neurosurgery, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany. Friedrich-Wilhelm.Kreth@med.uni-muenchen.de.
Abstract
BACKGROUND: Outcome and toxicity profiles of salvage stereotactic ablative radiation strategies for recurrent pre-irradiated brain metastases are poorly defined. This study compared risk-benefit profiles of upfront and salvage iodine-125 brachytherapy (SBT) for small brain metastases. As the applied SBT treatment algorithm required histologic proof of metastatic brain disease in all patients, we additionally aimed to elucidate the value of biopsy before SBT. PATIENTS AND METHODS: Patients with small untreated (n = 20) or pre-irradiated (n =28) suspected metastases intended for upfront or salvage SBT, respectively, were consecutively included. Temporary iodine-125 implants were used (median reference dose: 50 Gy, median dose rate: 15 cGy/h). Cumulative biologically effective doses (BED) were calculated and used for risk assessment. Treatment toxicity was classified according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. RESULTS: Upfront SBT was initiated in 20 patients and salvage SBT in 23. In 5 patients, salvage SBT was withheld because of proven radiation-induced lesions. Treatment groups exhibited similar epidemiologic data except for tumor size (which was slightly smaller in the salvage group). One-year local/distant tumor control rates after upfront and salvage SBT were similar (94 %/65 % vs. 87 %/57 %, p = 0.45, respectively). Grade I/II toxicity was suffered by 2 patients after salvage SBT (cumulative BED: 192.1 Gy3 and 249.6 Gy3). No toxicity-related risk factors were identified. CONCLUSION: SBT combines diagnostic yield with effective treatment in selected patients. The low toxicity rate in the salvage group points to protective radiobiologic characteristics of continuous low-dose rate irradiation. Upfront and salvage SBT are similarly effective and safe. Histologic reevaluation should be reconsidered after previous radiotherapy to avoid under- or overtreatment.
BACKGROUND: Outcome and toxicity profiles of salvage stereotactic ablative radiation strategies for recurrent pre-irradiated brain metastases are poorly defined. This study compared risk-benefit profiles of upfront and salvage iodine-125 brachytherapy (SBT) for small brain metastases. As the applied SBT treatment algorithm required histologic proof of metastatic brain disease in all patients, we additionally aimed to elucidate the value of biopsy before SBT. PATIENTS AND METHODS: Patients with small untreated (n = 20) or pre-irradiated (n =28) suspected metastases intended for upfront or salvage SBT, respectively, were consecutively included. Temporary iodine-125 implants were used (median reference dose: 50 Gy, median dose rate: 15 cGy/h). Cumulative biologically effective doses (BED) were calculated and used for risk assessment. Treatment toxicity was classified according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. RESULTS: Upfront SBT was initiated in 20 patients and salvage SBT in 23. In 5 patients, salvage SBT was withheld because of proven radiation-induced lesions. Treatment groups exhibited similar epidemiologic data except for tumor size (which was slightly smaller in the salvage group). One-year local/distant tumor control rates after upfront and salvage SBT were similar (94 %/65 % vs. 87 %/57 %, p = 0.45, respectively). Grade I/II toxicity was suffered by 2 patients after salvage SBT (cumulative BED: 192.1 Gy3 and 249.6 Gy3). No toxicity-related risk factors were identified. CONCLUSION: SBT combines diagnostic yield with effective treatment in selected patients. The low toxicity rate in the salvage group points to protective radiobiologic characteristics of continuous low-dose rate irradiation. Upfront and salvage SBT are similarly effective and safe. Histologic reevaluation should be reconsidered after previous radiotherapy to avoid under- or overtreatment.
Authors: Hani Malone; Jingyan Yang; Dawn L Hershman; Jason D Wright; Jeffrey N Bruce; Alfred I Neugut Journal: World Neurosurg Date: 2015-05-22 Impact factor: 2.104
Authors: Martin Kocher; Andrea Wittig; Marc Dieter Piroth; Harald Treuer; Heinrich Seegenschmiedt; Maximilian Ruge; Anca-Ligia Grosu; Matthias Guckenberger Journal: Strahlenther Onkol Date: 2014-04-09 Impact factor: 3.621
Authors: Maximilian I Ruge; Philipp Kickingereder; Stefan Grau; Mauritius Hoevels; Harald Treuer; Volker Sturm Journal: J Neurooncol Date: 2011-04-11 Impact factor: 4.130
Authors: Dirk Rades; Dagmar Hornung; Oliver Blanck; Kristina Martens; Mai Trong Khoa; Ngo Thuy Trang; Michael Hüppe; Patrick Terheyden; Jan Gliemroth; Steven E Schild Journal: Strahlenther Onkol Date: 2014-03-25 Impact factor: 3.621
Authors: Christian Hoffmann; Luitpold Distel; Stefan Knippen; Thomas Gryc; Manuel Alexander Schmidt; Rainer Fietkau; Florian Putz Journal: Neuro Oncol Date: 2018-01-22 Impact factor: 12.300
Authors: Romagna Alexander; Christoph Schwartz; Barbara Ladisich; Wolfgang Hitzl; Sarah-Charlotta Heidorn; Peter A Winkler; Alexander Muacevic Journal: Cureus Date: 2018-12-17
Authors: Yuanxuan Xia; Leila A Mashouf; Brock R Baker; Russell Maxwell; Chetan Bettegowda; Kristin J Redmond; Lawrence R Kleinberg; Michael Lim Journal: Cureus Date: 2018-07-30