Pierina Navarria1, Giuseppe Minniti2, Elena Clerici1, Tiziana Comito1, Salvatore Cozzi1, Valentina Pinzi3, Laura Fariselli3, Patrizia Ciammella4, Silvia Scoccianti5, Valentina Borzillo6, Paola Anselmo7, Ernesto Maranzano7, Veronica Dell'acqua8, Barbara Jereczek-Fossa8,9, Niccolò Giaj Levra10, Anna Maria Podlesko11, Emilia Giudice12, Michela Buglione di Monale E Bastia13, Sara Pedretti13, Alessio Bruni14, Isa Bossi Zanetti15, Simona Borghesi16, Fabio Busato17, Francesco Pasqualetti18, Fabiola Paiar18, Marta Scorsetti1,19. 1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Rozzano (MI), Italy. 2. Advanced Radiotherapy Center, UPMC San Pietro FBF, Roma, Italy. 3. Radiotherapy Unit, Istituto Neurologico Fondazione "Carlo Besta", Milan, Italy. 4. Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera Arcispedale S Maria Nuova, Reggio Emilia, Italy. 5. Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 6. UOC Radiation Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori - Fondazione "Giovanni Pascale", Milan, Italy. 7. Radiotherapy Oncology Centre, "S. Maria" Hospital, Terni, Italy. 8. Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy. 9. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy. 10. Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy. 11. SC Radioterapia Oncologica, Perugia, Italy. 12. Radiation Therapy unit, Policlinico Universitario Tor Vergata, Roma, Italy. 13. Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy. 14. Radiation Therapy unit, Modena, Italy. 15. Radiation Therapy unit, CDI, Milano, Italy. 16. Radiotherapy Department, Arezzo, Valdarno, Italy. 17. Radiation Therapy unit, IOV, Padova, Italy. 18. Department of Radiation Oncology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy. 19. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Abstract
OBJECTIVES: The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery (SRS). METHODS: 185 BMCRC patients for a total of 262 lesions treated were evaluated. Treatments included surgery followed by post-operative SRS to the resection cavity, and SRS, either single-fraction, then hypofractionated SRS (HSRS). Outcomes was measured in terms of local control (LC), toxicities, brain distant failure (BDF), and overall survival (OS). Prognostic factors influencing survival were assed too. RESULTS: The median follow-up time was 33 months (range 3-183 months). Surgery plus SRS have been performed in 28 (10.7%) cases, SRS in 141 (53.8%), and HSRS in 93 (35.5%). 77 (41.6%) patients received systemic therapy. The main total dose and fractionation used were 24 Gy in single fraction or 24 Gy in three daily fractions. Local recurrence occurred in 32 (17.3%) patients. Median, 6 months,1-year-LC were 86 months (95%CI 36-86), 87.2% ± 2.8, 77.8% ± 4.1. Median,6 months,1-year-BDF were 23 months (95%CI 9-44), 66.4% ± 3.9, 55.3% ± 4.5. Median,6 months,1-year-OS were 7 months (95% CI 6-9), 52.7% ± 3.6, 33% ± 3.5. No severe neurological toxicity occurred. Stage at diagnosis, Karnofsky Performance Status (KPS), presence and number of extracranial metastases, and disease-specific-graded-prognostic-assessment (DS-GPA) score were observed as conditioning survival. CONCLUSION: SRS/HSRS have proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors as well as a multidisciplinary evaluation is a valid aid to manage the optimal therapeutic strategy for CTC patients with BMs. ADVANCES IN KNOWLEDGE: The prognosis of BMCRC is poor. Several local treatments was used, but optimal treatment choice remains undefined. Radiosurgery has proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors and a multidisciplinary evaluation needed.
OBJECTIVES: The prognosis of brain metastatic colorectal cancer patients (BMCRC) is poor. Several local treatments have been used, but the optimal treatment choice remains an unresolved issue. We evaluated the clinical outcomes of a large series of BMCRC patients treated in several Italian centers using stereotactic radiosurgery (SRS). METHODS: 185 BMCRC patients for a total of 262 lesions treated were evaluated. Treatments included surgery followed by post-operative SRS to the resection cavity, and SRS, either single-fraction, then hypofractionated SRS (HSRS). Outcomes was measured in terms of local control (LC), toxicities, brain distant failure (BDF), and overall survival (OS). Prognostic factors influencing survival were assed too. RESULTS: The median follow-up time was 33 months (range 3-183 months). Surgery plus SRS have been performed in 28 (10.7%) cases, SRS in 141 (53.8%), and HSRS in 93 (35.5%). 77 (41.6%) patients received systemic therapy. The main total dose and fractionation used were 24 Gy in single fraction or 24 Gy in three daily fractions. Local recurrence occurred in 32 (17.3%) patients. Median, 6 months,1-year-LC were 86 months (95%CI 36-86), 87.2% ± 2.8, 77.8% ± 4.1. Median,6 months,1-year-BDF were 23 months (95%CI 9-44), 66.4% ± 3.9, 55.3% ± 4.5. Median,6 months,1-year-OS were 7 months (95% CI 6-9), 52.7% ± 3.6, 33% ± 3.5. No severe neurological toxicity occurred. Stage at diagnosis, Karnofsky Performance Status (KPS), presence and number of extracranial metastases, and disease-specific-graded-prognostic-assessment (DS-GPA) score were observed as conditioning survival. CONCLUSION: SRS/HSRS have proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors as well as a multidisciplinary evaluation is a valid aid to manage the optimal therapeutic strategy for CTC patients with BMs. ADVANCES IN KNOWLEDGE: The prognosis of BMCRC is poor. Several local treatments was used, but optimal treatment choice remains undefined. Radiosurgery has proven to be an effective local treatment for BMCRC. A careful evaluation of prognostic factors and a multidisciplinary evaluation needed.
Authors: Alexander K Kwon; Steven J Dibiase; Brian Wang; Samuel L Hughes; Barry Milcarek; Yunping Zhu Journal: Cancer Date: 2009-02-15 Impact factor: 6.860
Authors: Eric L Chang; Jeffrey S Wefel; Kenneth R Hess; Pamela K Allen; Frederick F Lang; David G Kornguth; Rebecca B Arbuckle; J Michael Swint; Almon S Shiu; Moshe H Maor; Christina A Meyers Journal: Lancet Oncol Date: 2009-10-02 Impact factor: 41.316