Raj Singh1, Prabhanjan Didwania2, Eric J Lehrer3, Joshua D Palmer4, Daniel M Trifiletti5, Jason P Sheehan6. 1. Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA, USA. 2. Rady School of Management, University of California at San Diego, San Diego, CA, USA. 3. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 4. Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. 5. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA. 6. Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Abstract
Objectives: To perform a systematic review and meta-analysis of outcomes for patients with locally recurrent brain metastases treated with a repeat course of stereotactic radiosurgery (rSRS). Method: Primary outcomes were 1-year local control(LC) and radionecrosis (RN). Secondary outcomes were 1-year overall survival (OS) and 1-year distant brain control (DBC). Weighted random effects meta-analyses utilizing the DerSimonian and Laird methods were conducted to characterize summary effect sizes. Mixed effects regression models were utilized to analyze potential correlations between prognostic factors and outcomes. Results: In total, 347 patients with 462 brain metastases treated with rSRS were included. Estimated 1-year LC, OS, and DBC rates were 69.0% (95% CI: 61.0-77.0%), 49.7% (95% CI: 28.9-70.6%), and 41.6% (95% CI: 33.0-50.4%), respectively. The estimated RN rate was 16.1% (95% CI: 6.3-25.9%). Every 1 Gy increase in prescription dose was estimated to result in roughly 5% increase in 1-year LC (p = 0.14). Conclusions: rSRS was well-tolerated with reasonable 1-year LC and OS. Dose escalation may result in improved LC.
Objectives: To perform a systematic review and meta-analysis of outcomes for patients with locally recurrent brain metastases treated with a repeat course of stereotactic radiosurgery (rSRS). Method: Primary outcomes were 1-year local control(LC) and radionecrosis (RN). Secondary outcomes were 1-year overall survival (OS) and 1-year distant brain control (DBC). Weighted random effects meta-analyses utilizing the DerSimonian and Laird methods were conducted to characterize summary effect sizes. Mixed effects regression models were utilized to analyze potential correlations between prognostic factors and outcomes. Results: In total, 347 patients with 462 brain metastases treated with rSRS were included. Estimated 1-year LC, OS, and DBC rates were 69.0% (95% CI: 61.0-77.0%), 49.7% (95% CI: 28.9-70.6%), and 41.6% (95% CI: 33.0-50.4%), respectively. The estimated RN rate was 16.1% (95% CI: 6.3-25.9%). Every 1 Gy increase in prescription dose was estimated to result in roughly 5% increase in 1-year LC (p = 0.14). Conclusions: rSRS was well-tolerated with reasonable 1-year LC and OS. Dose escalation may result in improved LC.
Authors: Paul W Sperduto; Norbert Kased; David Roberge; Zhiyuan Xu; Ryan Shanley; Xianghua Luo; Penny K Sneed; Samuel T Chao; Robert J Weil; John Suh; Amit Bhatt; Ashley W Jensen; Paul D Brown; Helen A Shih; John Kirkpatrick; Laurie E Gaspar; John B Fiveash; Veronica Chiang; Jonathan P S Knisely; Christina Maria Sperduto; Nancy Lin; Minesh Mehta Journal: J Clin Oncol Date: 2011-12-27 Impact factor: 44.544
Authors: Paul D Brown; Kurt Jaeckle; Karla V Ballman; Elana Farace; Jane H Cerhan; S Keith Anderson; Xiomara W Carrero; Fred G Barker; Richard Deming; Stuart H Burri; Cynthia Ménard; Caroline Chung; Volker W Stieber; Bruce E Pollock; Evanthia Galanis; Jan C Buckner; Anthony L Asher Journal: JAMA Date: 2016-07-26 Impact factor: 56.272