Highlights
- •This survey defines practice patterns for patients with limited brain metastases.
- •Neurosurgeons were more likely to recommend radiosurgery than radiation oncologists.
- •Performance score, tumor volume, and tumor number were key clinical factors.
Abstract
Objective
Currently no firm consensus exists regarding utilization of stereotactic radiosurgery
(SRS) alone versus whole brain radiation (WBRT) ± SRS in patients with multiple brain
metastases. The International Gamma Knife Research Foundation conducted a survey to
review international practice patterns.
Methods
Through 2 international radiosurgery societies, clinicians who are involved in the
radiosurgical management of patients with brain metastases were invited to complete
a questionnaire. Respondents selected therapeutic options based on brief case vignettes
and could select (1) SRS alone, (2) SRS with adjuvant WBRT, (3) WBRT alone, or (4)
omission of upfront local radiation.
Results
A total of 71 respondents replied to the survey, including 41 radiation oncologists
(57%), 24 neurosurgeons (34%), and 6 (8%) other clinicians. For a patient with 7 brain
metastases (NSCLC), all under 1 cm, and stable extracranial disease, 77% would perform
SRS alone and 17% would recommend WBRT alone. For a patient with 7 or more brain metastases,
the majority selected SRS alone, irrespective of tumor histology (p > 0.5). However, neurosurgeons would more often utilize SRS alone or SRS combined
with WBRT compared to radiation oncologists (p = 0.002). Key clinical factors in selection were KPS (82% of respondents), total
tumor volume (81%), number (80%), and less-so histology (42%).
Conclusion
Regardless of number of metastases, patients with small total volume of brain disease,
high KPS, or who are receiving novel therapies are often recommended to undergo SRS.
Neurosurgeons more often recommend SRS, emphasizing the importance of additional studies
to clarify the role of SRS in these patients.
Keywords
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References
- A randomized trial of surgery in the treatment of single metastases to the brain.N Engl J Med. 1990; 322: 494-500
- Distribution of brain metastases.Arch Neurol. 1988; 45: 741-744
- Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases.Cancer J Sci Am. 1996; 2: 335-342
- 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: 1665-1672
- Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases.Int J Radiat Oncol Biol Phys. 1999; 45: 427-434
- Neuropsychological testing and biomarkers in the management of brain metastases.Radiat Oncol. 2008; 3: 26
- Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.JAMA. 2006; 295: 2483-2491
- Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial.JAMA. 2016; 316: 401-409
- Radiosurgery alone for 5 or more brain metastases: expert opinion survey.J Neurosurg. 2010; 113: 84-89
- Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations.Stat Med. 2007; 26: 3661-3675
- Single-fraction stereotactic radiosurgery (SRS) alone versus surgical resection and SRS for large brain metastases: a multi-institutional analysis.Int J Radiat Oncol Biol Phys. 2017; 99: 459-467
- Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American society for radiation oncology evidence-based guideline.Pract Radiat Oncol. 2012; 2: 210-225
- Stereotactic radiosurgery for four or more intracranial metastases.Int J Radiat Oncol Biol Phys. 2006; 64: 898-903
- Role of Gamma Knife surgery in patients with 5 or more brain metastases.J Neurosurg. 2012; 117: 5-12
- Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study.Lancet Oncol. 2014; 15: 387-395
- A multi-institutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901 study update): irradiation-related complications and long-term maintenance of mini-mental state examination scores.Int J Radiat Oncol Biol Phys. 2017; 99: 31-40
- Leukoencephalopathy after stereotactic radiosurgery for brain metastases.Int J Radiat Oncol Biol Phys. 2015; 93: 870-878
- Leukoencephalopathy after whole-brain radiation therapy plus radiosurgery versus radiosurgery alone for metastatic lung cancer.Cancer. 2013; 119: 226-232
- Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis.Radiat Oncol. 2011; 6: 48
- The brain tumor board: lessons to be learned from an interdisciplinary conference.Onkologie. 2005; 28: 22-26
- Treatment trends for patients with brain metastases: Does practice reflect the data?.Cancer. 2017; 123: 2274-2282
- Principles of brain tumor chemotherapy.Semin Oncol. 1986; 13: 56-69
- Phase II trial of gefitinib alone without radiation therapy for Japanese patients with brain metastases from EGFR-mutant lung adenocarcinoma.Lung Cancer. 2013; 82: 282-287
- Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutation.Lung Cancer. 2012; 77: 556-560
- Management of brain metastases in tyrosine kinase inhibitor-naive epidermal growth factor receptor-mutant non-small-cell lung cancer: a retrospective multi-institutional analysis.J Clin Oncol. 2017; 35: 1070-1077
- Improved survival of patients with melanoma brain metastases in the era of targeted BRAF and immune checkpoint therapies.Cancer. 2017;
- Stereotactic radiation therapy augments antigen-specific PD-1-mediated antitumor immune responses via cross-presentation of tumor antigen.Cancer Immunol Res. 2015; 3: 345-355
- Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma.Am J Clin Oncol. 2015; 38: 119-125
- Ipilimumab and stereotactic radiosurgery versus stereotactic radiosurgery alone for newly diagnosed melanoma brain metastases.Am J Clin Oncol. 2017; 40: 444-450
Article info
Publication history
Published online: August 22, 2018
Accepted:
August 13,
2018
Received:
June 8,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
