Michael C LeCompte1, Ryan T Hughes2, Michael Farris2, Adrianna Masters3, Michael H Soike4, Claire Lanier2, Chase Glenn2, Christina K Cramer2, Kounosuke Watabe5, Jing Su5,6, Jimmy Ruiz7,8, Christopher T Whitlow9, Ge Wang10, Adrian W Laxton11, Stephen B Tatter11, Michael D Chan2. 1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. mlecompt@wakehealth.edu. 2. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. 3. Department of Radiation Oncology, University Radiologists, S.C., Southern Illinois School of Medicine, Springfield, IL, 62781, USA. 4. Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, AL, 35233, USA. 5. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. 6. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. 7. Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. 8. W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, 28144, USA. 9. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. 10. Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA. 11. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
Abstract
PURPOSE: Patients with high rates of developing new brain metastases have an increased likelihood of dying of neurologic death. It is unclear, however, whether this risk is affected by treatment choice following failure of primary stereotactic radiosurgery (SRS). METHODS: From July 2000 to March 2017, 440 patients with brain metastasis were treated with SRS and progressed to have a distant brain failure (DBF). Eighty-seven patients were treated within the immunotherapy era. Brain metastasis velocity (BMV) was calculated for each patient. In general, the institutional philosophy for use of salvage SRS vs whole brain radiotherapy (WBRT) was to postpone the use of WBRT for as long as possible and to treat with salvage SRS when feasible. No further treatment was reserved for patients with poor life expectancy and who were not expected to benefit from salvage treatment. RESULTS: Two hundred and eighty-five patients were treated with repeat SRS, 91 patients were treated with salvage WBRT, and 64 patients received no salvage radiation therapy. One-year cumulative incidence of neurologic death after salvage SRS vs WBRT was 15% vs 23% for the low- (p = 0.06), 30% vs 37% for the intermediate- (p < 0.01), and 31% vs 48% (p < 0.01) for the high-BMV group. Salvage WBRT was associated with increased incidence of neurologic death on multivariate analysis (HR 1.64, 95% CI 1.13-2.39, p = 0.01) when compared to repeat SRS. One-year cumulative incidence of neurologic death for patients treated within the immunotherapy era was 9%, 38%, and 38% for low-, intermediate-, and high-BMV groups, respectively (p = 0.01). CONCLUSION: Intermediate and high risk BMV groups are predictive of neurologic death. The association between BMV and neurologic death remains strong for patients treated within the immunotherapy era.
PURPOSE:Patients with high rates of developing new brain metastases have an increased likelihood of dying of neurologic death. It is unclear, however, whether this risk is affected by treatment choice following failure of primary stereotactic radiosurgery (SRS). METHODS: From July 2000 to March 2017, 440 patients with brain metastasis were treated with SRS and progressed to have a distant brain failure (DBF). Eighty-seven patients were treated within the immunotherapy era. Brain metastasis velocity (BMV) was calculated for each patient. In general, the institutional philosophy for use of salvage SRS vs whole brain radiotherapy (WBRT) was to postpone the use of WBRT for as long as possible and to treat with salvage SRS when feasible. No further treatment was reserved for patients with poor life expectancy and who were not expected to benefit from salvage treatment. RESULTS: Two hundred and eighty-five patients were treated with repeat SRS, 91 patients were treated with salvage WBRT, and 64 patients received no salvage radiation therapy. One-year cumulative incidence of neurologic death after salvage SRS vs WBRT was 15% vs 23% for the low- (p = 0.06), 30% vs 37% for the intermediate- (p < 0.01), and 31% vs 48% (p < 0.01) for the high-BMV group. Salvage WBRT was associated with increased incidence of neurologic death on multivariate analysis (HR 1.64, 95% CI 1.13-2.39, p = 0.01) when compared to repeat SRS. One-year cumulative incidence of neurologic death for patients treated within the immunotherapy era was 9%, 38%, and 38% for low-, intermediate-, and high-BMV groups, respectively (p = 0.01). CONCLUSION: Intermediate and high risk BMV groups are predictive of neurologic death. The association between BMV and neurologic death remains strong for patients treated within the immunotherapy era.
Authors: E McTyre; D Ayala-Peacock; J Contessa; C Corso; V Chiang; C Chung; J Fiveash; M Ahluwalia; R Kotecha; S Chao; A Attia; A Henson; J Hepel; S Braunstein; M Chan Journal: Ann Oncol Date: 2018-02-01 Impact factor: 32.976
Authors: Diandra N Ayala-Peacock; Ann M Peiffer; John T Lucas; Scott Isom; J Griff Kuremsky; James J Urbanic; J Daniel Bourland; Adrian W Laxton; Stephen B Tatter; Edward G Shaw; Michael D Chan Journal: Neuro Oncol Date: 2014-02-20 Impact factor: 12.300
Authors: Emory R McTyre; Adam G Johnson; Jimmy Ruiz; Scott Isom; John T Lucas; William H Hinson; Kounosuke Watabe; Adrian W Laxton; Stephen B Tatter; Michael D Chan Journal: Neuro Oncol Date: 2017-04-01 Impact factor: 12.300
Authors: Riccardo Soffietti; Martin Kocher; Ufuk M Abacioglu; Salvador Villa; François Fauchon; Brigitta G Baumert; Laura Fariselli; Tzahala Tzuk-Shina; Rolf-Dieter Kortmann; Christian Carrie; Mohamed Ben Hassel; Mauri Kouri; Egils Valeinis; Dirk van den Berge; Rolf-Peter Mueller; Gloria Tridello; Laurence Collette; Andrew Bottomley Journal: J Clin Oncol Date: 2012-12-03 Impact factor: 44.544
Authors: Emory R McTyre; Michael H Soike; Michael Farris; Diandra N Ayala-Peacock; Jaroslaw T Hepel; Brandi R Page; Colette Shen; Lawrence Kleinberg; Joseph N Contessa; Christopher Corso; Veronica Chiang; Adrianna Henson-Masters; Christina K Cramer; Jimmy Ruiz; Boris Pasche; Kounosuke Watabe; Ralph D'Agostino; Jing Su; Adrian W Laxton; Stephen B Tatter; John B Fiveash; Manmeet Ahluwalia; Rupesh Kotecha; Samuel T Chao; Steve E Braunstein; Albert Attia; Caroline Chung; Michael D Chan Journal: Radiother Oncol Date: 2019-09-13 Impact factor: 6.280
Authors: Claire M Lanier; Ryan Hughes; Tamjeed Ahmed; Michael LeCompte; Adrianna H Masters; William J Petty; Jimmy Ruiz; Pierre Triozzi; Jing Su; Stacy O'Neill; Kuonosuke Watabe; Christina K Cramer; Adrian W Laxton; Stephen B Tatter; Ge Wang; Christopher Whitlow; Michael D Chan Journal: Neurooncol Pract Date: 2019-02-05
Authors: Hannah-Marie Devoid; Emory R McTyre; Brandi R Page; Linda Metheny-Barlow; Jimmy Ruiz; Michael D Chan Journal: Front Biosci (Schol Ed) Date: 2016-01-01