Five-fraction stereotactic radiosurgery (SRS) for single inoperable high-risk non-small cell lung cancer (NSCLC) brain metastases

Radiation Oncology

Brian T. Collins²  Keith Unger²  Sonali Rudra²  Jean-Marc Voyadzis¹  Richa Bhasin²  Vikram V. Nayar¹  Mani N. Nair¹  Sean P. Collins²  Eric Oermann²  Jonathan W. Lischalk² 

[1] Department of Neurosurgery, Georgetown University Hospital, Pasquerilla Healthcare Center (PHC), 7th floor, 3800 Reservoir Road, N.W., Washington 20007, DC, USA;Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Lower Level Bles, 3800 Reservoir Road, N.W., Washington 20007, DC, USA

关键词: Radiosurgery;    Lung neoplasm;    Carcinoma non-small-cell;    Brain neoplasm;   

Others  :  1232603
DOI  :  10.1186/s13014-015-0525-2

 received in 2015-08-12, accepted in 2015-10-19,  发布年份 2015

【 摘 要 】

Background

Achieving durable local control while limiting normal tissue toxicity with definitive radiation therapy in the management of high-risk brain metastases remains a radiobiological challenge. The objective of this study was to examine the local control and toxicity of a 5-fraction stereotactic radiosurgical approach for treatment of patients with inoperable single high-risk NSCLC brain metastases.

Methods

This retrospective analysis examines 20 patients who were deemed to have “high-risk” brain metastases. High-risk tumors were defined as those with a maximum diameter greater than 2 cm and/or those located within an eloquent cortex. Patients were evaluated by a neurosurgeon prior to treatment and determined to be inoperable due to tumor or patient characteristics. Patients were treated using the CyberKnife® SRS system in 5 fractions to a total dose of 30 Gy, 35 Gy, or 40 Gy.

Results

Twenty patients with a median age of 65.5 years were treated from April 2010 to August 2014 in 5 fractions to a median total dose of 35 Gy. At a median follow up of 11.3 months local tumor control was observed in 18 of 20 metastases (90 %). Both local failures were observed in patients receiving a lower dose of 30 Gy. Median pre-treatment dexamethasone dose was 10 mg/day and median post-treatment nadir dose was 0 mg/day. Salvage intracranial therapy was required in 45 % of patients. Symptomatic radionecrosis was observed in 4 of 20 patients (20 %), two of which were treated to 40 Gy and the remainder to 35 Gy. Kaplan-Meier 1-year, 2-year, and median survival were calculated to be 45 %, 20 %, and 13.2 months, respectively.

Conclusions

Five-fraction SRS to a total dose of 35 Gy appears to be a safe and effective management strategy for single high-risk NSCLC brain metastases, while a total dose of 40 Gy leads to an excess risk of neurotoxicity.

【 授权许可】

   
2015 Lischalk et al.

【 图 表 】

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