1. Stereotactic Radiosurgery for Brainstem Metastases: An International Cooperative Study to Define Response and Toxicity
- Author
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Daniel M. Trifiletti, Cheng-Chia Lee, Hideyuki Kano, Jonathan Cohen, James Janopaul-Naylor, Michelle Alonso-Basanta, John Y.K. Lee, Gabriela Simonova, Roman Liscak, Amparo Wolf, Svetlana Kvint, Inga S. Grills, Matthew Johnson, Kang-Du Liu, Chung-Jung Lin, David Mathieu, France Héroux, Danilo Silva, Mayur Sharma, Christopher P. Cifarelli, Christopher N. Watson, Joshua D. Hack, John G. Golfinos, Douglas Kondziolka, Gene Barnett, L. Dade Lunsford, and Jason P. Sheehan
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,International Cooperation ,Radiography ,medicine.medical_treatment ,Comorbidity ,Radiosurgery ,Metastasis ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Risk Factors ,parasitic diseases ,medicine ,Brain Stem Neoplasms ,Humans ,Radiology, Nuclear Medicine and imaging ,Sex Distribution ,Radiation Injuries ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,Radiation ,business.industry ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Causality ,Survival Rate ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Toxicity ,Female ,Radiology ,Brainstem ,Cranial Irradiation ,business ,030217 neurology & neurosurgery - Abstract
Purpose To pool data across multiple institutions internationally and report on the cumulative experience of brainstem stereotactic radiosurgery (SRS). Methods and Materials Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation. Clinical, radiographic, and dosimetric characteristics were compared for factors prognostic for local control (LC) and overall survival (OS) using univariate and multivariate analyses. Results Of 547 patients with 596 brainstem metastases treated with SRS, treatment of 7.4% of tumors resulted in severe SRS-induced toxicity (grade ≥3, increased odds with increasing tumor volume, margin dose, and whole-brain irradiation). Local control at 12 months after SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months after SRS was 32.7% and impacted by age, gender, number of metastases, tumor histology, and performance score. Conclusions Our study provides additional evidence that SRS has become an option for patients with brainstem metastases, with an excellent benefit-to-risk ratio in the hands of experienced clinicians. Prior whole-brain irradiation increases the risk of severe toxicity in brainstem metastasis patients undergoing SRS.
- Published
- 2016
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