Gamma knife radiosurgery following whole-brain radiation
In this study, we aimed to determine outcomes for patients requiring salvage stereotactic radiosurgery (SRS) who have progression of brain metastatic disease after initial treatment with whole-brain radiation (WBRT). This is a retrospective analysis of a prospective database of 112 patients who were treated with salvage SRS after experiencing failure following WBRT treatment with salvage SRS. Collectively, the patients had a median overall survival of 7 months after salvage SRS. Patients who had more than two brain metastases had a significantly shorter median survival but were not subjected to increased risk for distant brain failure. We also found that a short intervening time between WBRT and central nervous system (CNS) failure did not seem to worsen the nervous system control or reduce patient survival. Small cell lung cancer (SCLC) was associated with decreased overall survival and CNS control. In conclusion, SRS use following WBRT is safe and effective in the majority of patients. Patients with rapid failure after WBRT can be successfully salvaged with SRS. The findings also shed light on the overall poor outcomes, coupled with low median survival and high rates of CNS failure, in patients suffering multiple metastases stemming from SCLC.
- Amsbaugh MJ, Kim CS. Brain metastasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.
- Wong WW, Schild SE, Sawyer TE, Shaw EG. Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys. 1996;34(3):585-590. doi: 10.1016/0360-3016(95)02156-6
- Yomo S, Hayashi M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol. 2013;113(3):459-465. doi: 10.1007/s11060-013-1138-y
- Son CH, Jimenez R, Niemierko A, Loeffler JS, Oh KS, Shih HA. Outcomes after whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys. 2012;82(2):e167-e172. doi: 10.1016/j.ijrobp.2011.03.020
- McTyre E, Scott J, Chinnaiyan P. Whole brain radiotherapy for brain metastasis. Surg Neurol Int. 2013;4(5):S236-S244. doi: 10.4103/2152-7806.111301
- Suzuki R, Wei X, Allen PK, et al. Outcomes of re-irradiation for brain recurrence after prophylactic or therapeutic whole-brain irradiation for small cell lung Cancer: A retrospective analysis. Radiat Oncol. 2018;13(1):258. doi: 10.1186/s13014-018-1205-9
- Andrews DW, Scott CB, Sperduto PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363(9422):1665-1672. doi: 10.1016/S0140-6736(04)16250-8
- Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. JAMA. 2006;295(21):2483-2491. doi: 10.1001/jama.295.21.2483
- Foo K, Patel A, Richards G, et al. Effects of whole brain radiation on blood counts. J Solid Tumors. 2016;7(1):23. doi: 10.5430/jst.V7n1P23
- Sadikov E, Bezjak A, Yi QL, et al. Value of whole brain re-irradiation for brain metastases--single centre experience. Clin Oncol (R Coll Radiol). 2007;19(7):532-538. doi: 10.1016/j.clon.2007.06.001
- Caballero JA, Sneed PK, Lamborn KR, et al. Prognostic factors for survival in patients treated with stereotactic radiosurgery for recurrent brain metastases after prior whole brain radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):303-309. doi: 10.1016/j.ijrobp.2011.06.1987
- Kubicek GJ, Yocum N, Thomas C, Goldman HW. Neuro-oncology multidisciplinary clinic and improvements in patient outcome. Am J Clin Oncol. 2020;43(11):798-801. doi: 10.1097/COC.0000000000000751
- Chao ST, Barnett GH, Vogelbaum MA, et al. Salvage stereotactic radiosurgery effectively treats recurrences from whole-brain radiation therapy. Cancer. 2008;113(8):2198-2204. doi: 10.1002/cncr.23821
- Giorgio CG, Giuffrida D, Pappalardo A, et al. Oral temozolomide in heavily pre-treated brain metastases from non-small cell lung cancer: Phase II study. Lung Cancer. 2005;50(2):247-254. doi: 10.1016/j.lungcan.2005.05.026
- Langley RE, Stephens RJ, Nankivell M, et al. Interim data from the Medical Research Council QUARTZ Trial: Does whole brain radiotherapy affect the survival and quality of life of patients with brain metastases from non-small cell lung cancer? Clin Oncol (R Coll Radiol). 2013;25(3):e23-e30. doi: 10.1016/j.clon.2012.11.002