Repeated stereotactic radiosurgery for patients with progressive brain metastases

Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Enrico Clarke, Francesco Cicone, Vincenzo Esposito, Andrea Romano, Mattia Osti, Riccardo Maurizi Enrici

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

In the present study we have evaluated the efficacy and toxicity of repeated stereotactic radiosurgery (SRS) in patients with recurrent/progressive brain metastases. Between March 2006 and October 2014, 43 patients (21 men and 22 women) with 47 lesions received a second course of SRS given in three daily fractions of 7–8 Gy. With a follow-up study of 19 months, the 1- and 2-year survival rates from repeated SRS were 37 and 20 %, respectively, and the 1- and 2-year local control rates were 70 and 60 %, respectively. Actuarial local control was significantly better for breast and lung metastases as compared with melanoma metastases; specifically, 1-year local control rates were 38 % for melanoma, 78 % for breast carcinoma and 73 % for non-small cell lung cancer (NSCLC) metastases (p = 0.01). The cause of death was progressive systemic disease in 25 patients and progressive brain disease in 11 patients. Stable extracranial disease (p = 0.01) and Karnofsky performance status (KPS; p = 0.03) were predictive of longer survival. Radiologic changes suggestive of brain radionecrosis were observed in 9 (19 %) out of 47 lesions, with an actuarial risk of 34 % at 12 months. Neurological deficits (RTOG Grade 2 or 3) associated with brain necrosis occurred in 14 % of patients. In conclusion, a second course of SRS given in three daily fractions is a feasible treatment for selected patients with recurrent/progressive brain metastases. Further studies are needed to explore the efficacy and safety of different dose-fractionation schedules, especially in patients with melanoma or large metastases.

Original languageEnglish
Pages (from-to)91-97
Number of pages7
JournalJournal of Neuro-Oncology
Volume126
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Fingerprint

Radiosurgery
Neoplasm Metastasis
Brain
Melanoma
Dose Fractionation
Karnofsky Performance Status
Brain Diseases
Non-Small Cell Lung Carcinoma
Appointments and Schedules
Breast
Necrosis
Survival Rate
Breast Neoplasms
Safety
Lung
Survival

Keywords

  • Brain metastases
  • Brain radionecrosis
  • Fractionated stereotactic radiotherapy
  • Reirradiation
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology

Cite this

Repeated stereotactic radiosurgery for patients with progressive brain metastases. / Minniti, Giuseppe; Scaringi, Claudia; Paolini, Sergio; Clarke, Enrico; Cicone, Francesco; Esposito, Vincenzo; Romano, Andrea; Osti, Mattia; Enrici, Riccardo Maurizi.

In: Journal of Neuro-Oncology, Vol. 126, No. 1, 01.01.2016, p. 91-97.

Research output: Contribution to journalArticle

Minniti, G, Scaringi, C, Paolini, S, Clarke, E, Cicone, F, Esposito, V, Romano, A, Osti, M & Enrici, RM 2016, 'Repeated stereotactic radiosurgery for patients with progressive brain metastases', Journal of Neuro-Oncology, vol. 126, no. 1, pp. 91-97. https://doi.org/10.1007/s11060-015-1937-4
Minniti, Giuseppe ; Scaringi, Claudia ; Paolini, Sergio ; Clarke, Enrico ; Cicone, Francesco ; Esposito, Vincenzo ; Romano, Andrea ; Osti, Mattia ; Enrici, Riccardo Maurizi. / Repeated stereotactic radiosurgery for patients with progressive brain metastases. In: Journal of Neuro-Oncology. 2016 ; Vol. 126, No. 1. pp. 91-97.
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