Local recurrence and survival following stereotactic radiosurgery for brain metastases from small cell lung cancer
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Authors
Rava, PaulSioshansi, Shirin
DiPetrillo, Thomas A.
Cosgrove, Rees
Melhus, Christopher
Wu, Julian
Mignano, John
Wazer, David E.
Hepel, Jaroslaw T.
UMass Chan Affiliations
Department of Radiation OncologyDocument Type
Journal ArticlePublication Date
2015-01-01Keywords
AdultAged
Brain Neoplasms
Female
Humans
Lung Neoplasms
Male
Middle Aged
Neoplasm Recurrence, Local
Radiosurgery
Retrospective Studies
Small Cell Lung Carcinoma
Survival Analysis
Treatment Outcome
Neoplasms
Oncology
Radiology
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Show full item recordAbstract
PURPOSE: Stereotactic radiosurgery (SRS) represents a treatment option for patients with brain metastases from small cell lung cancer (SCLC) following prior cranial radiation. Inferior local control has been described. We reviewed our failure patterns following SRS treatment to evaluate this concern. METHODS AND MATERIALS: Individuals with SCLC who received SRS for brain metastases from 2004 to 2011 were identified. Central nervous system (CNS) disease was detected and followed by gadolinium-enhanced, high-resolution magnetic resonance (MR) imaging. SRS dose was prescribed to the tumor periphery. Local recurrence was defined by increasing lesion size or enhancement, MR-spectroscopy, and perfusion changes consistent with recurrent disease or pathologic confirmation. Any new enhancing lesion not identified on the SRS planning scan was considered a regional failure. Overall survival (OS) and CNS control were evaluated using the Kaplan-Meier method. Factors predicted to influence outcome were tested by univariate log-rank analysis and Cox regression. RESULTS: Fifteen males and 25 females (median age of 61 years [range, 36-79]) of which 39 received prior brain irradiation were identified. In all, 132 lesions (3.3 per patient) between 0.4 and 4.7 cm received a median dose of 16 Gy (12-22 Gy). Thirteen metastases (10%) ultimately recurred locally with 6- and 12-month control rates of 81% and 69%, respectively. Only 1 of 110 metastases < 2 cm recurred. Local failure was more likely for size > 2 cm (P < .001) and dose < 16 Gy (P < .001). The median OS was 6.5 months, and the time to regional CNS recurrence was 5.2 months. For patients with single brain metastases, both OS (P = .037) and regional CNS recurrence (P = .003) were improved. CNS control (P = .001), and survival (P = .057), were also longer for patients with controlled systemic disease. CONCLUSIONS: Local control following SRS for SCLC metastases is achievable for lesions < 2 cm. For metastases > 2 cm, local failure is more common than expected. Patients with controlled systemic disease and limited CNS involvement would benefit most from aggressive treatment. Inc.Source
Pract Radiat Oncol. 2015 Jan-Feb;5(1):e37-44. doi: 10.1016/j.prro.2014.03.006. Epub 2014 May 3. Link to article on publisher's siteDOI
10.1016/j.prro.2014.03.006Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47977PubMed ID
25413429Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.prro.2014.03.006