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Outcome of Moderately Dosed Radiosurgery for Limited Brain Metastases

Report of a Single-Center Experience

Ergebnisse der stereotaktischen Einzeitbestrahlung mit moderater Dosis bei limitierter Hirnmetastasierung. Ein monozentrischer Erfahrungsbericht

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Purpose:

Efficacy and safety of the own single-center experience with moderately dosed radiosurgery (SRS) for limited (one to four) brain metastases were analyzed and correlated with patient- and treatment-related variables.

Patients and Methods:

Between 05/1998 and 10/2006, 93 patients received SRS for a total of 142 brain metastases. The median number of brain metastases treated per patient was one (range, one to four). 46 patients (49%) received initial SRS alone, 13 patients (14%) SRS with up-front whole-brain radiotherapy (WBRT), and 34 patients (37%) SRS for recurrent metastases after WBRT. Median dose was 16 Gy (range, 10–20 Gy).

Results:

Median overall survival (OS) was 7.5 months. The actuarial 6- and 12-month data for OS were 60% and 35%, for local brain control (LBC) 87% and 79%, and for distant brain control (DBC) 48% and 37%, respectively. Only ten of 46 patients (22%) with initial SRS alone ultimately received WBRT. Ten patients suffered from seizures within 3 months after SRS, six of them showed brain progression on magnetic resonance imaging (MRI). 20 patients required reinstitution of steroids following SRS, 16 of these due to brain progression. Five patients received positron emission tomography scan of the brain revealing radionecrosis in two patients. In uni- and multivariate analysis, only time interval between diagnosis of primary and brain metastases (p = 0.031) and volume of treated metastasis (p = 0.02) were significant predictors of OS. Neither up-front WBRT nor dose had a significant influence on LBC.

Conclusion:

Moderately dosed SRS of limited brain metastases was found to be both effective and safe. Initial SRS only may be offered to informed patients complying with MRI-based follow-up.

Ziel:

Wirksamkeit und Verträglichkeit der moderat dosierten stereotaktischen Einzeitbestrahlung (SRS) bei limitierten (ein bis vier) Hirnmetastasen sollte am eigenen Patientenkollektiv untersucht und mit patienten- und behandlungsbezogenen Parametern verglichen werden.

Patienten und Methodik:

Von 05/1998 bis 10/2006 erhielten 93 Patienten eine SRS von 142 Hirnmetastasen. Median wurde pro Patient eine Hirnmetastase bestrahlt (Streubreite: ein bis vier). Bei 46 Patienten (49%) erfolgte die SRS als alleinige Primärtherapie, bei 13 Patienten (14%) mit früher Ganzhirnbestrahlung (WBRT) und bei 34 Patienten (37%) wegen einer Rezidivmetastase nach WBRT. Die Dosis betrug median 16 Gy (Streubreite: 10–20 Gy).

Ergebnisse:

Das Gesamtüberleben nach SRS lag bei median 7,5 Monaten. Nach 6 bzw. 12 Monaten betrugen das Gesamtüberleben (OS) aktuarisch 60% und 35%, die lokale Kontrolle (LBC) 87% und 79% sowie die distale zerebrale Kontrolle (DBC) 48% und 37%. Nur zehn von 46 Patienten (22%) mit alleiniger SRS erhielten später eine WBRT. Zehn Patienten hatten Krampfanfälle innerhalb von 3 Monaten nach SRS, sechs davon zeigten im Magnetresonanztomogramm einen zerebralen Progress. 20 Patienten benötigten ein Wiedereinsetzen von Steroiden nach der SRS, 16 davon wegen zerebralem Progress. Bei fünf Patienten wurde eine Positronenemissionstomographie des Kopfes durchgeführt, bei zwei wurde eine Radionekrose diagnostiziert. In der uni- und multivariaten Analyse hatten nur das Zeitintervall zwischen Diagnose von Primärtumor und Hirnmetastase (p = 0,031) und das Volumen der bestrahlten Metastase (p = 0,02) signifikanten Einfluss auf das Überleben. Weder der frühe Einsatz der WBRT noch die Dosis beeinflussten die LBC signifikant.

Schlussfolgerung:

Die moderat dosierte SRS bei limitierter Hirnmetastasierung war ausreichend wirksam und verträglich. Die alleinige primäre SRS eignet sich für informierte Patienten, die zu MRT-basierten Verlaufskontrollen bereit sind.

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Authors and Affiliations

  1. Department of Radiation Oncology, Medical School Hannover, Hannover, Germany

    Johanna Meisner, Andreas Meyer, Bernd Polivka, Johann H. Karstens &  Michael Bremer MD

  2. Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Michael Bremer MD

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  1. Johanna Meisner
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  2. Andreas Meyer
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  3. Bernd Polivka
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  4. Johann H. Karstens
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  5. Michael Bremer MD
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Correspondence to Michael Bremer MD.

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Meisner, J., Meyer, A., Polivka, B. et al. Outcome of Moderately Dosed Radiosurgery for Limited Brain Metastases. Strahlenther Onkol 186, 76–81 (2010). https://doi.org/10.1007/s00066-010-2036-2

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  • DOI: https://doi.org/10.1007/s00066-010-2036-2

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