Christopher P Cifarelli1,2, John A Vargo1,2, Wei Fang3, Roman Liscak4, Khumar Guseynova4, Ronald E Warnick5, Cheng-Chia Lee6, Huai-Che Yang6, Hamid Borghei-Razavi7, Tonmoy Maiti7, Zaid A Siddiqui8, Justin C Yuan8, Inga S Grills8, David Mathieu9, Charles J Touchette9, Diogo Cordeiro10, Veronica Chiang11,12, Judith Hess11,12, Christopher J Tien11,12, Andrew Faramand13, Hideyuki Kano13, Gene H Barnett7, Jason P Sheehan10, L Dade Lunsford13. 1. Department of Neurosurgery, School of Medicine, West Virginia University, Morgantown, West Virginia. 2. Department of Radiation Oncology, School of Medicine, West Virginia University, Morgantown, West Virginia. 3. West Virginia Clinical and Translational Science Institute, School of Medicine, West Virginia University, Morgantown, West Virginia. 4. Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic. 5. Mayfield Clinic, Jewish Hospital, Cincinnati, Ohio. 6. Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan. 7. Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio. 8. Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan. 9. Division of Neurosurgery, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Canada. 10. Department of Neurosurgery, School of Medicine, University of Virginia, Charlottesville, Virginia. 11. Department of Neurosurgery, Yale School of Medicine, Yale University, New Haven, Connecticut. 12. Department of Radiation Oncology, Yale School of Medicine, Yale University, New Haven, Connecticut. 13. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. OBJECTIVE: To provide a detailed analysis of SCLC patients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). METHODS: A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collection was performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazard models, Kaplan-Meier survival analysis, and competing risks analysis. RESULTS: Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). CONCLUSION: SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brain metastases and potentially challenge the standard application of WBRT in SCLC patients.
BACKGROUND: Despite a high incidence of brain metastases in patients with small-cell lung cancer (SCLC), limited data exist on the use of stereotactic radiosurgery (SRS), specifically Gamma Knife™ radiosurgery (Elekta AB), for SCLC brain metastases. OBJECTIVE: To provide a detailed analysis of SCLCpatients treated with SRS, focusing on local failure, distant brain failure, and overall survival (OS). METHODS: A multi-institutional retrospective review was performed on 293 patients undergoing SRS for SCLC brain metastases at 10 medical centers from 1991 to 2017. Data collection was performed according to individual institutional review boards, and analyses were performed using binary logistic regression, Cox-proportional hazard models, Kaplan-Meier survival analysis, and competing risks analysis. RESULTS: Two hundred thirty-two (79%) patients received SRS as salvage following prior whole-brain irradiation (WBRT) or prophylactic cranial irradiation, with a median marginal dose of 18 Gy. At median follow-up after SRS of 6.4 and 18.0 mo for surviving patients, the 1-yr local failure, distant brain failure, and OS were 31%, 49%, and 28%. The interval between WBRT and SRS was predictive of improved OS for patients receiving SRS more than 1 yr after initial treatment (21%, <1 yr vs 36%, >1 yr, P = .01). On multivariate analysis, older age was the only significant predictor for OS (hazard ratio 1.63, 95% CI 1.16-2.29, P = .005). CONCLUSION: SRS plays an important role in the management of brain metastases from SCLC, especially in salvage therapy following WBRT. Ongoing prospective trials will better assess the value of radiosurgery in the primary management of SCLC brain metastases and potentially challenge the standard application of WBRT in SCLCpatients.
Authors: P E Postmus; H Haaxma-Reiche; A Gregor; H J Groen; T Lewinski; T Scolard; A Kirkpatrick; D Curran; T Sahmoud; G Giaccone Journal: Radiother Oncol Date: 1998-01 Impact factor: 6.280
Authors: Tyler P Robin; Bernard L Jones; Arya Amini; Matthew Koshy; Laurie E Gaspar; Arthur K Liu; Sameer K Nath; Brian D Kavanagh; D Ross Camidge; Chad G Rusthoven Journal: Lung Cancer Date: 2018-04-02 Impact factor: 5.705
Authors: Mayur Sharma; Xuefei Jia; Manmeet Ahluwalia; Gene H Barnett; Michael A Vogelbaum; Samuel T Chao; John H Suh; Erin S Murphy; Jennifer S Yu; Lilyana Angelov; Alireza M Mohammadi Journal: Cancer Med Date: 2017-08-04 Impact factor: 4.452
Authors: Ali Rae; Daniel Gorovets; Paul Rava; Daniel Ebner; Deus Cielo; Timothy J Kinsella; Thomas A DiPetrillo; Jaroslaw T Hepel Journal: Adv Radiat Oncol Date: 2016-08-24
Authors: Joseph A Miccio; Andrew Barsky; Sarah Gao; Vivek Verma; Sonal S Noticewala; Vikram Jairam; Skyler B Johnson; James B Yu; James E Hansen; Sanjay Aneja; Yi An; Roy H Decker; S Bulent Omay; Jing Li; Goldie A Kurtz; Michelle Alonso-Basanta; John Y K Lee; Veronica L Chiang; Henry S Park Journal: J Radiosurg SBRT Date: 2020
Authors: Chad G Rusthoven; Masaaki Yamamoto; Denise Bernhardt; Derek E Smith; Dexiang Gao; Toru Serizawa; Shoji Yomo; Hitoshi Aiyama; Yoshinori Higuchi; Takashi Shuto; Atsuya Akabane; Yasunori Sato; Ajay Niranjan; Andrew M Faramand; L Dade Lunsford; James McInerney; Leonard C Tuanquin; Brad E Zacharia; Veronica Chiang; Charu Singh; James B Yu; Steve Braunstein; David Mathieu; Charles J Touchette; Cheng-Chia Lee; Huai-Che Yang; Ayal A Aizer; Daniel N Cagney; Michael D Chan; Douglas Kondziolka; Kenneth Bernstein; Joshua S Silverman; Inga S Grills; Zaid A Siddiqui; Justin C Yuan; Jason P Sheehan; Diogo Cordeiro; Kename Nosaki; Takahashi Seto; Christopher P Deibert; Vivek Verma; Samuel Day; Lia M Halasz; Ronald E Warnick; Daniel M Trifiletti; Joshua D Palmer; Albert Attia; Benjamin Li; Christopher P Cifarelli; Paul D Brown; John A Vargo; Stephanie E Combs; Kerstin A Kessel; Stefan Rieken; Samir Patel; Matthias Guckenberger; Nicolaus Andratschke; Brian D Kavanagh; Tyler P Robin Journal: JAMA Oncol Date: 2020-07-01 Impact factor: 31.777