Stereotactic radiosurgery for brainstem metastases: An international cooperative study to define response and toxicity

• Published in: International journal of radiation oncology, biology, physics Vol. 96; no. 2; pp. 280 - 288
• Main Authors: Trifiletti, Daniel M., MD, Lee, Cheng-Chia, MD, Kano, Hideyuki, MD, PhD, Cohen, Jonathan, Janopaul-Naylor, James, Alonso-Basanta, Michelle, MD PhD, Lee, John Y.K., MD, Simonova, Gabriela, MD, PhD, Liscak, Roman, MD, PhD, Wolf, Amparo, MD, PhD, Kvint, Svetlana, MD, Grills, Inga S., MD, Johnson, Matthew, MD, Liu, Kang-Du, MD, Lin, Chung-Jung, MD, Mathieu, David, MD, Héroux, France, MD, Silva, Danilo, MD, Sharma, Mayur, MD, Cifarelli, Christopher P., MD, PhD, Watson, Christopher N., MD, Hack, Joshua D., MS, Golfinos, John G., MD, Kondziolka, Douglas, MD, MSc, Barnett, Gene, MD, MBA, Lunsford, L. Dade, MD, Sheehan, Jason P., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Brain Stem Neoplasms - mortality; Brain Stem Neoplasms - radiotherapy; Brain Stem Neoplasms - secondary; Causality; Comorbidity; Cranial Irradiation; Dose-Response Relationship, Radiation; DOSIMETRY; Female; Hematology, Oncology and Palliative Medicine; Humans; International Cooperation; Male; Middle Aged; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIATION HAZARDS; Radiation Injuries; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery; RADIOTHERAPY; Radiotherapy Dosage; Retrospective Studies; Risk Factors; Sex Distribution; SURGERY; Survival Rate; TOXICITY; Treatment Outcome; pons; midbrain; metastasis; IGKRF; brainstem; gamma knife radiosurgery; medulla oblongata; stereotactic radiosurgery
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2016.06.009

Abstract Purpose/Objectives Stereotactic radiosurgery (SRS) is an effective therapeutic option for many patients with brain metastases. Because of the smaller volume and abundance of critical structures, some providers are fearful of the possible toxicity resultant from SRS for brainstem metastases. Our objective was to pool data across multiple institutions internationally and report on the cumulative experience of brainstem SRS. Methods and Materials Data on patients with brainstem metastases treated with SRS were collected through the International Gamma Knife Research Foundation (IGKRF). 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 following SRS was 81.8% and was improved with increasing margin dose and maximum dose. Overall survival at 12 months following 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.