Advertisement

International Journal of Clinical Oncology

, Volume 22, Issue 2, pp 250–256 | Cite as

Fractionated stereotactic radiotherapy for metastatic brain tumors that recurred after gamma knife radiosurgery results in acceptable toxicity and favorable local control

  • Akifumi MiyakawaEmail author
  • Yuta Shibamoto
  • Shinya Takemoto
  • Toru Serizawa
  • Shinya Otsuka
  • Tatsuo Hirai
Original Article

Abstract

Background

To treat local recurrence of brain metastases after gamma knife radiosurgery (GKS), we have used fractionated stereotactic radiotherapy (SRT). The purpose of this study was to evaluate the efficacy and toxicity of SRT in these patients.

Methods

Fifty locally recurrent metastatic brain tumors in 47 patients were treated with SRT. The median prescribed dose of GKS was 20 Gy at the periphery. The median interval between the GKS (the last session in cases in which multiple GKS procedures were performed) and recurrence was 7.5 (range 1–33) months. Several dose-fractionation protocols were used for SRT, depending on the size and location of the tumor and previous GKS dose. The median prescribed dose of the SRT at the isocenter was 30 Gy with a median of ten fractions.

Results

Among the 50 lesions treated with SRT, 26 did not recur locally before the patient’s death or the last follow-up examination, and 24 recurred locally. The median follow-up period for the surviving patients was 24 months after the first GKS procedure, and the overall survival rate was 80% at 1 year and 57% at 2 years. The median time to local re-recurrence after the SRT (16 months) was significantly longer than the median interval between the last GKS and recurrence (7.5 months; P < 0.001). Only two patients developed ≥grade 2 radiation necrosis.

Conclusions

Stereotactic radiotherapy appeared to be an effective treatment for recurrent metastatic brain tumors and yielded relatively good local control. The associated adverse events were generally acceptable.

Keywords

Stereotactic radiotherapy Metastatic brain tumor Re-radiation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Flickinger JC, Kondziolka D, Lunsford LD et al (1994) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802CrossRefPubMedGoogle Scholar
  2. 2.
    Kida Y, Kobayashi T, Tanaka T (1995) Radiosurgery of the metastatic brain tumours with gamma-knife. Acta Neurochir Suppl 63:89–94PubMedGoogle Scholar
  3. 3.
    Shibamoto Y, Sugie C, Iwata H (2009) Radiotherapy for metastatic brain tumors. Int J Clin Oncol 14:281–288CrossRefPubMedGoogle Scholar
  4. 4.
    Serizawa T (2009) Radiosurgery for metastatic brain tumors. Int J Clin Oncol 14:289–298CrossRefPubMedGoogle Scholar
  5. 5.
    Hazuka MB, Kinzie JJ (1988) Brain metastases: results and effects of re-irradiation. Int J Radiat Oncol Biol Phys 15:433–437CrossRefPubMedGoogle Scholar
  6. 6.
    Gaspar LE, Mehta MP, Patchell RA et al (2010) The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:17–32CrossRefPubMedGoogle Scholar
  7. 7.
    Shibamoto Y, Baba F, Oda K et al (2008) Incidence of brain atrophy and decline in mini-mental state examination score after whole-brain radiotherapy in patients with brain metastases: a prospective study. Int J Radiat Oncol Biol Phys 72:1168–1173CrossRefPubMedGoogle Scholar
  8. 8.
    Kayama T, Sato S, Sakurada K et al (2016) JCOG0504: A phase III randomized trial of surgery with whole brain radiation therapy versus surgery with salvage stereotactic radiosurgery in patients with 1 to 4 brain metastases. J Clin Oncol 34 suppl; abstr 2003Google Scholar
  9. 9.
    Raimbault A, Cazals X, Lauvin MA et al (2014) Radionecrosis of malignant glioma and cerebral metastasis: a diagnostic challenge in MRI Diagn Interv. Imaging 95:985–1000Google Scholar
  10. 10.
    Reddy K, Westerly D, Chen C (2013) MRI patterns of T1 enhancing radiation necrosis versus tumour recurrence in high-grade gliomas. J Med Imaging Radiat Oncol 57:349–355CrossRefPubMedGoogle Scholar
  11. 11.
    Penny KS, Norbert K, James LR (2014) Brain metastases and neoplastic meningitis. In: Niederhuber JE (ed) Abeloff’s clinical oncology, 5th edn. Elsevier, Amsterdam, pp 725–738.e4Google Scholar
  12. 12.
    Mori Y, Kobayashi T, Shibamoto Y (2006) Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus. J Neurosurg 105:37–42PubMedGoogle Scholar
  13. 13.
    Serizawa T, Higuchi Y, Ono J et al (2006) Gamma knife surgery for metastatic brain tumors without prophylactic whole-brain radiotherapy: results in 1000 consecutive cases. J Neurosurg 105:86–90PubMedGoogle Scholar
  14. 14.
    Miyakawa A, Shibamoto Y, Otsuka S et al (2014) Applicability of the linear-quadratic model to single and fractionated radiotherapy schedules: an experimental study. J Radiat Res 55:451–454CrossRefPubMedGoogle Scholar
  15. 15.
    Shibamoto Y, Miyakawa A, Otsuka S et al (2016) Radiobiology of hypofractionated stereotactic radiotherapy: what are the optimal fractionation schedules? J Radiat Res 57(Suppl 1):i76–i82CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mario A, Charles SC, Mark EL et al (2010) The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:85–96CrossRefGoogle Scholar
  17. 17.
    Shibamoto Y, Yamashita J, Takahashi M et al (1994) Intraoperative radiation therapy for brain tumors with emphasis on retreatment for recurrence following full-dose external beam irradiation. Am J Clin Oncol 17:396–399CrossRefPubMedGoogle Scholar
  18. 18.
    Kwon KY, Kong DS, Lee JI et al (2007) Outcome of repeated radiosurgery for recurrent metastatic brain tumors. Clin Nerol Neurosurg 109:132–137CrossRefGoogle Scholar
  19. 19.
    Shuto T, Fujino H, Inomori S et al (2004) Repeated gamma knife radiosurgery for multiple metastatic brain tumours. Acta Neurochir (Wein) 146:989–993CrossRefGoogle Scholar
  20. 20.
    Yamanaka K, Iwai Y, Yasui T et al (1999) Gamma Knife radiosurgery for metastatic brain tumor: the usefulness of repeated Gamma Knife radiosurgery for recurrent cases. Stereotact Funct Neurosurg 72[Suppl 1]:73–80CrossRefPubMedGoogle Scholar
  21. 21.
    Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395CrossRefPubMedGoogle Scholar
  22. 22.
    Murai T, Ogino H, Manabe Y et al (2014) Fractionated stereotactic radiotherapy using CyberKnife for the treatment of large brain metastases: a dose escalation study. Clin Oncol (R Coll Radiol) 26:151–158CrossRefGoogle Scholar
  23. 23.
    Higuchi Y, Serizawa T, Nagano O et al (2009) Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 74:1543–1548CrossRefPubMedGoogle Scholar
  24. 24.
    Yomo S, Hayashi M, Nicholson C (2012) A prospective pilot study of two-session Gamma Knife surgery for large metastatic brain tumors. J Neurooncol 109:159–165CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rampling R, Cruickshank G, Lewis AD et al (1994) Direct measurement of pO2 distribution and bioreductive enzymes in human malignant brain tumors. Int J Radiat Oncol Biol Phys 29:427–431CrossRefPubMedGoogle Scholar
  26. 26.
    Shibamoto Y, Yukawa Y, Tsutsui K et al (1986) Variation in the hypoxic fraction among mouse tumors of different types, sizes, and sites. Jpn J Cancer Res 77:908–915PubMedGoogle Scholar
  27. 27.
    Murata R, Shibamoto Y, Sasai K et al (1996) Reoxygenation after single irradiation in rodent tumors of different types and sizes. Int J Radiat Oncol Biol Phys 34:859–865CrossRefPubMedGoogle Scholar
  28. 28.
    Chang WS, Mi-Sook K, Chinsoo Cho L et al (2014) Radiobiological basis of SBRT and SRS. Int J Clin Oncol 19:570–578CrossRefGoogle Scholar
  29. 29.
    Shibamoto Y, Hashizume C, Baba F et al (2012) Stereotactic body radiotherapy using a radiobiology-based regimen for stage I nonsmall cell lung cancer. A multicenter study. Cancer 118:2078–2084CrossRefPubMedGoogle Scholar
  30. 30.
    Engenhart R, Kimmig BN, Höver KH et al (1993) Long-term follow-up for brain metastases treated by percutaneous stereotactic single high-dose irradiation. Cancer 71:1353–1356CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2016

Authors and Affiliations

  1. 1.Department of RadiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of RadiologyFujieda Heisei Memorial HospitalShizuokaJapan
  3. 3.Tokyo Gamma Unit CenterTsukiji Neurological ClinicTokyoJapan
  4. 4.Department of RadiologyOkazaki City HospitalAichiJapan
  5. 5.Stereotaxis and Gamma Unit CenterFujieda Heisei Memorial HospitalShizuokaJapan

Personalised recommendations