Daniel M Trifiletti1, Cheng-Chia Lee2, Hideyuki Kano3, Jonathan Cohen3, James Janopaul-Naylor4, Michelle Alonso-Basanta4, John Y K Lee4, Gabriela Simonova5, Roman Liscak5, Amparo Wolf6, Svetlana Kvint6, Inga S Grills7, Matthew Johnson7, Kang-Du Liu2, Chung-Jung Lin2, David Mathieu8, France Héroux8, Danilo Silva9, Mayur Sharma9, Christopher P Cifarelli10, Christopher N Watson10, Joshua D Hack10, John G Golfinos6, Douglas Kondziolka6, Gene Barnett9, L Dade Lunsford3, Jason P Sheehan11. 1. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia. Electronic address: daniel.trifiletti@gmail.com. 2. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan, People's Republic of China. 3. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. 5. Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 6. Department of Neurosurgery, New York University Lagone Medical Center, New York, New York. 7. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan. 8. Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Québec, Canada. 9. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio. 10. Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown, West Virginia. 11. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia; Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
Abstract
PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.
PURPOSE: To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. RESULTS: Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. CONCLUSIONS: Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasispatients undergoing SRS.
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