Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway

Radiation Oncology

Riccardo Maurizi Enrici⁴  Mattia Falchetto Osti⁴  Maurizio Valeriani⁴  Maurizio Maurizi Enrici¹  Vitaliana De Sanctis⁴  Teresa Falco⁴  Alessandro Bozzao³  Claudia Scaringi⁴  Enrico Clarke⁴  Vincenzo Esposito²  Giuseppe Minniti⁴ 

[1] Ophthalmology Unit, S. Andrea Hospital, University Sapienza, 00189 Rome, Italy;IRCCS Neuromed, 86077 Pozzilli, IS, Italy;Neuroradiology Unit, Sant’ Andrea Hospital, University Sapienza, 00189 Rome, Italy;Radiation Oncology Unit, Sant’ Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy

关键词: Radiation-induced optic neuropathy;    Hypofractionated stereotactic radiosurgery;    Skull base metastases;    Stereotactic radiosurgery;   

Others  :  805265
DOI  :  10.1186/1748-717X-9-110

 received in 2014-01-29, accepted in 2014-03-16,  发布年份 2014

【 摘 要 】

Background

To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway.

Patients and methods

We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses.

Results

At a median follow-up of 13 months (range, 2–36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6–27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up.

Conclusions

Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.

【 授权许可】

   
2014 Minniti et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Laigle-Donadey F, Taillibert S, Martin-Duverneuil N, Hildebrand J, Delattre JY: Skull-base metastases. J Neurooncol 2005, 75:63-69.
• [2]Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, DeSa GM, Donald P, Fliss D, Gullane P, Janecka I, Kamata SE, Kowalski LP, Kraus DH, Levine PA, Dos Santos LR, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP: Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003, 98:1179-1187.
• [3]Preusser M, Berghoff AS, Schadendorf D, Lin NU, Stupp R: Brain metastasis: opportunity for drug development? Curr Opin Neurol 2012, 25:786-794.
• [4]Vikram B, Chu FC: Radiation therapy for metastases to the base of the skull. Radiology 1979, 130:465-468.
• [5]Greenberg HS, Deck MD, Vikram B, Chu FC, Posner JB: Metastasis to the base of the skull: clinical findings in 43 patients. Neurology 1981, 31:530-537.
• [6]Svare A, Fosså SD, Heier MS: Cranial nerve dysfunction in metastatic cancer of the prostate. Br J Urol 1988, 61:441-444.
• [7]Seymore CH, Peeples WJ: Cranial nerve involvement with carcinoma of prostate. Urology 1988, 31:211-213.
• [8]Ransom DT, Dinapoli RP, Richardson RL: Cranial nerve lesions due to base of the skull metastases in prostate carcinoma. Cancer 1990, 65:586-589.
• [9]Bumpous JM, Maves MD, Gomez SM, Levy BK, Johnson F: Cavernous sinus involvement in head and neck cancer. Head Neck 1993, 15:62-66.
• [10]Crossen JR, Garwood D, Glatstein E, Neuwelt EA: Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy. J Clin Oncol 1994, 12:627-642.
• [11]Sun A, Bae K, Gore EM, Movsas B, Wong SJ, Meyers CA, Bonner JA, SE S d, Gaspar LE, Bogart JA, Werner-Wasik M, Choy H: Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: neurocognitive and quality-of-life analysis. J Clin Oncol 2011, 29:279-286.
• [12]Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Mueller RP, Tridello G, Collette L, Bottomley A: A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 2013, 31:65-72.
• [13]Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA: Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 2009, 10:1037-1044.
• [14]Cmelak AJ, Cox RS, Adler JR, Fee WE Jr, Goffinet DR: Radiosurgery for skull base malignancies and nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1997, 37:997-1003.
• [15]Iwai Y, Yamanaka K, Yoshimura M: Gamma knife radiosurgery for cavernous sinus metastases and invasion. Surg Neurol 2005, 64:406-410.
• [16]Mori Y, Kobayashi T, Shibamoto Y: Stereotactic radiosurgery for metastatic tumors in the pituitary gland and the cavernous sinus. J Neurosurg 2006, 105(Suppl):37-42.
• [17]Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD: The role of palliative radiosurgery when cancer invades the cavernous sinus. Int J Radiat Oncol Biol Phys 2009, 73:709-715.
• [18]Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N: Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 2000, 47:291-298.
• [19]Blonigen BJ, Steinmetz RD, Levin L, Lamba MA, Warnick RE, Breneman JC: Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2010, 77:996-1001.
• [20]Minniti G, Clarke E, Lanzetta G, Osti MF, Trasimeni G, Bozzao A, Romano A, Enrici RM: Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol 2011, 6:48. BioMed Central Full Text
• [21]Lindvall P, Bergström P, Löfroth PO, Henriksson R, Bergenheim AT: Hypofractionated conformal stereotactic radiotherapy alone or in combination with whole-brain radiotherapy in patients with cerebral metastases. Int J Radiat Oncol Biol Phys 2005, 61:1460-1466.
• [22]Ernst-Stecken A, Ganslandt O, Lambrecht U, Sauer R, Grabenbauer G: Phase II trial of hypofractionated stereotactic radiotherapy for brain metastases: results and toxicity. Radiother Oncol 2006, 81:18-24.
• [23]Fahrig A, Ganslandt O, Lambrecht U, Grabenbauer G, Kleinert G, Sauer R, Hamm K: Hypofractionated stereotactic radiotherapy for brain metastases–results from three different dose concepts. Strahlenther Onkol 2007, 183:625-630.
• [24]Narayana A, Chang J, Yenice K, Chan K, Lymberis S, Brennan C, Gutin PH: Hypofractionated stereotactic radiotherapy using intensity-modulated radiotherapy in patients with one or two brain metastases. Stereotact Funct Neurosurg 2007, 85:82-87.
• [25]Kwon AK, Dibiase SJ, Wang B, Hughes SL, Milcarek B, Zhu Y: Hypofractionated stereotactic radiotherapy for the treatment of brain metastases. Cancer 2009, 115:890-898.
• [26]Minniti G, Scaringi C, Clarke E, Valeriani M, Osti M, Enrici RM: Frameless linac-based stereotactic radiosurgery (SRS) for brain metastases: analysis of patient repositioning using a mask fixation system and clinical outcomes. Radiat Oncol 2011, 6:158. BioMed Central Full Text
• [27]Mori Y, Hashizume C, Kobayashi T, Shibamoto Y, Kosaki K, Nagai A: Stereotactic radiotherapy using Novalis for skull base metastases developing with cranial nerve symptoms. J Neurooncol 2010, 98:213-219.
• [28]Leber KA, Berglöff J, Pendl G: Dose–response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg 1998, 88:43-50.
• [29]Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E 3rd, Kooy HM, Flickinger JC: Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993, 27:215-221.
• [30]Stafford SL, Pollock BE, Leavitt JA, Foote RL, Brown PD, Link MJ, Gorman DA, Schomberg PJ: A study on the radiation tolerance of the optic nerves and chiasm after stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2003, 55:1177-1181.
• [31]Leavitt JA, Stafford SL, Link MJ, Pollock BE: Long-term evaluation of radiation-induced optic neuropathy after single-fraction stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2013, 87:524-527.