Hitoshi Aiyama1, Masaaki Yamamoto2, Takuya Kawabe3, Shinya Watanabe4, Takao Koiso5, Yasunori Sato6, Yoshinori Higuchi7, Eiichi Ishikawa5, Tetsuya Yamamoto8, Akira Matsumura5, Hidetoshi Kasuya9, Bierta E Barfod10. 1. Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 2. Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. Electronic address: bcd06275@nifty.com. 3. Department of Neurosurgery, Rakusai Shimizu Hospital, Kyoto, Japan. 4. Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan. 5. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 6. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan. 7. Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 8. Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokoyama, Japan. 9. Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 10. Katsuta Hospital Mito GammaHouse, Hitachi-naka, Japan.
Abstract
BACKGROUND AND PURPOSE: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. MATERIALS AND METHODS: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998-2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. RESULTS: The overall median survival time after SRS was 7.8 (95% CI; 7.4-8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9-211.4 (median; 24.0, IQR; 12.0-64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381-0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646-4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028-2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245-5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318-0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. CONCLUSION: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.
BACKGROUND AND PURPOSE: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. MATERIALS AND METHODS: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998-2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. RESULTS: The overall median survival time after SRS was 7.8 (95% CI; 7.4-8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9-211.4 (median; 24.0, IQR; 12.0-64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381-0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646-4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028-2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245-5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318-0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. CONCLUSION: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.
Authors: Amelia Jardim; Justin Scott; Zachery Drew; Matthew C Foote; Ananthababu P Sadasivan; Bruce Hall; Sarah L Olson; Mihir Shanker; Mark B Pinkham Journal: J Neurooncol Date: 2019-11-05 Impact factor: 4.130
Authors: Felix Ehret; David Kaul; Lucas Mose; Volker Budach; Peter Vajkoczy; Christoph Fürweger; Alfred Haidenberger; Alexander Muacevic; Felix Mehrhof; Markus Kufeld Journal: Cancers (Basel) Date: 2022-01-18 Impact factor: 6.639
Authors: Zaid A Siddiqui; Bryan S Squires; Matt D Johnson; Andrew M Baschnagel; Peter Y Chen; Daniel J Krauss; Ricky E Olson; Kurt D Meyer; Inga S Grills Journal: Neurooncol Pract Date: 2019-12-06