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‘Sandwich treatment’ for posterior fossa brain metastases with volume larger than 4cm3: a multicentric retrospective study

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Abstract

Single stereotactic radiosurgery (SRS) for posterior fossa brain metastases (BM) larger than 4cm3 is dangerous. ‘Sandwich treatment’ strategy was developed for these BMs. The strategy was one week treatment course which includes 2-stage SRS and using Bevacizumab once during SRS gap. Patients from four gamma knife center were retrospectively analyzed. The changes of tumor and peri-tumor edema volume were studied. The Dizziness Handicap Inventory (DHI) Vomiting Score (VS) and Glasgow Coma Scale (GCS) were used to evaluate patients’ clinical symptom changes. Karnofsky performance scale (KPS) and Barthel Index (BI) were used to evaluate patients’ overall fitness status and physical activity rehabilitation. Tumor local control (TLC) and patients’ overall survival (OS) rate were also calculated. Forty patients with 45 LBMs received ‘Sandwich treatment’. The mean edema volume reduced remarkably at the course of therapy and 3 months later (P < 0.01). The mean tumor volume greatly decreased 3 months later (P < 0.01). Patients’ clinical symptoms that reflected by median score of DHI, VS, GCS were improved dramatically at the course of therapy and 3 months later (P < 0.01). Similar changes happened in median score of KPS and BI that reflected patients’ overall fitness status and physical activity rehabilitation (P < 0.01). Patients’ median OS was 14.3 months, with 95.4%, 76.2%, and 26.3% survival rate at 6, 12, 24 months. The TLC rate at 6, 12, 24 months was 97.5%, 86.0% and 62.2%.The ‘Sandwich treatment’ is safe and effective for patients with LBM over 4cm3 in the posterior fossa. The strategy could quickly improve patients’ symptoms, well control tumor growth, prolong patient’s OS, and has controllable side effects.

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The data will be made available upon reasonable request.

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Funding

Zhejiang Provincial Department of Education Research Support Project (Y202249332); Zhejiang Provincial Medical and Health Research Support Project (2022KY570); Zhejiang Provincial Medical and Health Research Support Project (2023KY475).

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Authors and Affiliations

  1. Cancer center, Gamma Knife Treatment Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, 310014, China

    Zheng Wang, Min Li & Zhou Jia

  2. Gamma Knife Treatment Center, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China

    Haining Chen

  3. Gamma Knife Treatment Center, Jiangsu Provincial People’s Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Qun Chen

  4. Gamma Knife Treatment Center, Ming ji Hospital Affiliated to Nanjing Medical University, Nanjing, 210009, China

    Yucun Zhu

Authors
  1. Zheng Wang
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  2. Haining Chen
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  3. Qun Chen
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  4. Yucun Zhu
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  5. Min Li
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  6. Zhou Jia
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Contributions

Wang Zheng, Chen Ninghai, Chen Qun, Zhu Yucun contributed to data collection. Wang Zheng contributed the first manuscript draft and prepared figures and tables. Li Min analyzed all data and made statistics. Zhou Jia supervised the whole project and edited the manuscript. All the authors commented on the previous version of the manuscript and have read and approved the final manuscript.

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Correspondence to Zhou Jia.

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All authors declare that they have no conflicts of interest.

Ethical approval

The present study was approved by the Institutional Ethics Committee of Zhejiang Provincial People’s Hospital (ZHRYRS 2022 No. 005)

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Informed consent was obtained from all individual participants included in the study.

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Wang, Z., Chen, H., Chen, Q. et al. ‘Sandwich treatment’ for posterior fossa brain metastases with volume larger than 4cm3: a multicentric retrospective study. Clin Exp Metastasis 40, 415–422 (2023). https://doi.org/10.1007/s10585-023-10220-y

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  • DOI: https://doi.org/10.1007/s10585-023-10220-y

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