Anussara Prayongrat1, Randa Tao2, Pamela K Allen2, Nandita Guha3, Ganesh Rao4, Zhongxiang Zhao5, Jing Li2, Paul D Brown2, Susan L McGovern2. 1. Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Abstract
BACKGROUND: Stereotactic radiosurgery (SRS) is an established treatment for brain metastases, yet little is known about SRS for neuroendocrine tumors given their unique natural history. OBJECTIVE: To determine outcomes and toxicity from SRS in patients with brain metastases arising from neuroendocrine tumors. METHODS: Thirty-three patients with brain metastases from neuroendocrine tumors who underwent SRS were retrospectively reviewed. Median age was 61 years and median Karnofsky performance status was 80. Primary sites were lung (87.9%), cervix (6.1%), esophagus (3%), and prostate (3%). Ten patients (30.3%) received upfront SRS, 7 of whom had neuroendocrine tumors other than small cell lung carcinoma. Kaplan-Meier survival and Cox regression analyses were performed to determine prognostic factors for survival. RESULTS: With median follow-up after SRS of 5.3 months, local and distant brain recurrence developed in 5 patients (16.7%) and 20 patients (66.7%), respectively. Median overall survival (OS) after SRS was 6.9 months. Patients with progressive disease per Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) criteria at 4 to 6 weeks after SRS had shorter median time to developing recurrence at a distant site in the brain and shorter OS than patients without progressive disease: 1.4 months and 3.3 months vs 11.4 months and 12 months, respectively (both P < .001). Toxicity was more likely in lesions of small cell histology than in lesions of other neuroendocrine tumor histology, 15.7% vs 3.3% (P = .021). No cases of grade 3 to 5 necrosis occurred. CONCLUSIONS: SRS is an effective treatment option for patients with brain metastases from neuroendocrine tumors with excellent local control despite slightly higher toxicity rates than expected. Progressive disease at 4 to 6 weeks after SRS portends a poor prognosis.
BACKGROUND: Stereotactic radiosurgery (SRS) is an established treatment for brain metastases, yet little is known about SRS for neuroendocrine tumors given their unique natural history. OBJECTIVE: To determine outcomes and toxicity from SRS in patients with brain metastases arising from neuroendocrine tumors. METHODS: Thirty-three patients with brain metastases from neuroendocrine tumors who underwent SRS were retrospectively reviewed. Median age was 61 years and median Karnofsky performance status was 80. Primary sites were lung (87.9%), cervix (6.1%), esophagus (3%), and prostate (3%). Ten patients (30.3%) received upfront SRS, 7 of whom had neuroendocrine tumors other than small cell lung carcinoma. Kaplan-Meier survival and Cox regression analyses were performed to determine prognostic factors for survival. RESULTS: With median follow-up after SRS of 5.3 months, local and distant brain recurrence developed in 5 patients (16.7%) and 20 patients (66.7%), respectively. Median overall survival (OS) after SRS was 6.9 months. Patients with progressive disease per Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) criteria at 4 to 6 weeks after SRS had shorter median time to developing recurrence at a distant site in the brain and shorter OS than patients without progressive disease: 1.4 months and 3.3 months vs 11.4 months and 12 months, respectively (both P < .001). Toxicity was more likely in lesions of small cell histology than in lesions of other neuroendocrine tumor histology, 15.7% vs 3.3% (P = .021). No cases of grade 3 to 5 necrosis occurred. CONCLUSIONS: SRS is an effective treatment option for patients with brain metastases from neuroendocrine tumors with excellent local control despite slightly higher toxicity rates than expected. Progressive disease at 4 to 6 weeks after SRS portends a poor prognosis.
Authors: A Aupérin; R Arriagada; J P Pignon; C Le Péchoux; A Gregor; R J Stephens; P E Kristjansen; B E Johnson; H Ueoka; H Wagner; J Aisner Journal: N Engl J Med Date: 1999-08-12 Impact factor: 91.245
Authors: E Weltman; J V Salvajoli; R A Brandt; R de Morais Hanriot; F E Prisco; J C Cruz; S R de Oliveira Borges; D B Wajsbrot Journal: Int J Radiat Oncol Biol Phys Date: 2000-03-15 Impact factor: 7.038
Authors: R Arriagada; T Le Chevalier; A Rivière; P Chomy; I Monnet; E Bardet; J A Santos-Miranda; C Le Péhoux; M Tarayre; S Benhamou; A Laplanche Journal: Ann Oncol Date: 2002-05 Impact factor: 32.976