Stereotactic radiosurgery for treatment of brain metastases: A report of the DEGRO Working Group on Stereotactic Radiotherapy
Background This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology ( Deutsche Gesellschaft für Radioonkologie , DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers exist...
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| Veröffentlicht in: | Strahlentherapie und Onkologie 2014-06, Vol.190 (6), p.521-532 |
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| creator | Kocher, Martin Wittig, Andrea Piroth, Marc Dieter Treuer, Harald Seegenschmiedt, Heinrich Ruge, Maximilian Grosu, Anca-Ligia Guckenberger, Matthias |
| description | Background
This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (
Deutsche Gesellschaft für Radioonkologie
, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.
Results and discussion
The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases—all less than 2.5 cm in diameter—in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible.
Conclusion
A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22–25 Gy) may be used for smaller ( |
| doi_str_mv | 10.1007/s00066-014-0648-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1526102024</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3308996231</sourcerecordid><originalsourceid>FETCH-LOGICAL-c324t-a7ae9715a2f88e6b07a0df567a97c49ee2956eb2ea46239cc46ad065fb59c7693</originalsourceid><addsrcrecordid>eNp1kE9LxDAQxYMo7rr6AbxIwXN0kqZJgydZ_AcLHlTwFtJ0Kl1suybpYb-9WbqKF2FgYObNe8yPkHMGVwxAXQcAkJICExSkKKk6IHMmck1B6_dDMgemNFWsKGfkJIQ1AJNCi2My4yJNueBzcvMS0eMQrYuty7yt2yGM_gP9NmsGn0WPNnbYx2xossrbts86jDakwnBKjhr7GfBs3xfk7f7udflIV88PT8vbFXU5F5FaZVGnPMubskRZgbJQN4VUVisnNCLXhcSKoxWS59o5IW0NsmiqQjsldb4gl5Pvxg9fI4Zo1sPo-xRp0heSAQcukopNKueHEDw2ZuPbzvqtYWB2uMyEyyRcZofLqHRzsXceqw7r34sfPknAJ0FIqz5h-RP9r-s3id11JQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1526102024</pqid></control><display><type>article</type><title>Stereotactic radiosurgery for treatment of brain metastases: A report of the DEGRO Working Group on Stereotactic Radiotherapy</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Kocher, Martin ; Wittig, Andrea ; Piroth, Marc Dieter ; Treuer, Harald ; Seegenschmiedt, Heinrich ; Ruge, Maximilian ; Grosu, Anca-Ligia ; Guckenberger, Matthias</creator><creatorcontrib>Kocher, Martin ; Wittig, Andrea ; Piroth, Marc Dieter ; Treuer, Harald ; Seegenschmiedt, Heinrich ; Ruge, Maximilian ; Grosu, Anca-Ligia ; Guckenberger, Matthias</creatorcontrib><description>Background
This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (
Deutsche Gesellschaft für Radioonkologie
, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.
Results and discussion
The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases—all less than 2.5 cm in diameter—in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible.
Conclusion
A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22–25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5–3 cm. As the infiltration zone of the brain metastases is usually small, the GTV–CTV (gross tumor volume–clinical target volume) margin should be in the range of 0–1 mm. The CTV–PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0–2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.</description><identifier>ISSN: 0179-7158</identifier><identifier>EISSN: 1439-099X</identifier><identifier>DOI: 10.1007/s00066-014-0648-7</identifier><identifier>PMID: 24715242</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Brain - surgery ; Brain Damage, Chronic - diagnosis ; Brain Neoplasms - mortality ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Combined Modality Therapy ; Cranial Irradiation ; Follow-Up Studies ; Germany ; Guideline Adherence ; Humans ; Medicine ; Medicine & Public Health ; Neoplasm, Residual - pathology ; Neoplasm, Residual - surgery ; Oncology ; Original Article ; Postoperative Complications - diagnosis ; Radiation Injuries - diagnosis ; Radiation Oncology ; Radiosurgery ; Radiotherapy ; Radiotherapy, Adjuvant ; Reoperation ; Salvage Therapy ; Societies, Medical ; Survival Rate</subject><ispartof>Strahlentherapie und Onkologie, 2014-06, Vol.190 (6), p.521-532</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><rights>Springer Heidelberg Berlin 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c324t-a7ae9715a2f88e6b07a0df567a97c49ee2956eb2ea46239cc46ad065fb59c7693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00066-014-0648-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00066-014-0648-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24715242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kocher, Martin</creatorcontrib><creatorcontrib>Wittig, Andrea</creatorcontrib><creatorcontrib>Piroth, Marc Dieter</creatorcontrib><creatorcontrib>Treuer, Harald</creatorcontrib><creatorcontrib>Seegenschmiedt, Heinrich</creatorcontrib><creatorcontrib>Ruge, Maximilian</creatorcontrib><creatorcontrib>Grosu, Anca-Ligia</creatorcontrib><creatorcontrib>Guckenberger, Matthias</creatorcontrib><title>Stereotactic radiosurgery for treatment of brain metastases: A report of the DEGRO Working Group on Stereotactic Radiotherapy</title><title>Strahlentherapie und Onkologie</title><addtitle>Strahlenther Onkol</addtitle><addtitle>Strahlenther Onkol</addtitle><description>Background
This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (
Deutsche Gesellschaft für Radioonkologie
, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.
Results and discussion
The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases—all less than 2.5 cm in diameter—in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible.
Conclusion
A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22–25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5–3 cm. As the infiltration zone of the brain metastases is usually small, the GTV–CTV (gross tumor volume–clinical target volume) margin should be in the range of 0–1 mm. The CTV–PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0–2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.</description><subject>Brain - surgery</subject><subject>Brain Damage, Chronic - diagnosis</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - surgery</subject><subject>Combined Modality Therapy</subject><subject>Cranial Irradiation</subject><subject>Follow-Up Studies</subject><subject>Germany</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neoplasm, Residual - pathology</subject><subject>Neoplasm, Residual - surgery</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Postoperative Complications - diagnosis</subject><subject>Radiation Injuries - diagnosis</subject><subject>Radiation Oncology</subject><subject>Radiosurgery</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Reoperation</subject><subject>Salvage Therapy</subject><subject>Societies, Medical</subject><subject>Survival Rate</subject><issn>0179-7158</issn><issn>1439-099X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1kE9LxDAQxYMo7rr6AbxIwXN0kqZJgydZ_AcLHlTwFtJ0Kl1suybpYb-9WbqKF2FgYObNe8yPkHMGVwxAXQcAkJICExSkKKk6IHMmck1B6_dDMgemNFWsKGfkJIQ1AJNCi2My4yJNueBzcvMS0eMQrYuty7yt2yGM_gP9NmsGn0WPNnbYx2xossrbts86jDakwnBKjhr7GfBs3xfk7f7udflIV88PT8vbFXU5F5FaZVGnPMubskRZgbJQN4VUVisnNCLXhcSKoxWS59o5IW0NsmiqQjsldb4gl5Pvxg9fI4Zo1sPo-xRp0heSAQcukopNKueHEDw2ZuPbzvqtYWB2uMyEyyRcZofLqHRzsXceqw7r34sfPknAJ0FIqz5h-RP9r-s3id11JQ</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Kocher, Martin</creator><creator>Wittig, Andrea</creator><creator>Piroth, Marc Dieter</creator><creator>Treuer, Harald</creator><creator>Seegenschmiedt, Heinrich</creator><creator>Ruge, Maximilian</creator><creator>Grosu, Anca-Ligia</creator><creator>Guckenberger, Matthias</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20140601</creationdate><title>Stereotactic radiosurgery for treatment of brain metastases</title><author>Kocher, Martin ; Wittig, Andrea ; Piroth, Marc Dieter ; Treuer, Harald ; Seegenschmiedt, Heinrich ; Ruge, Maximilian ; Grosu, Anca-Ligia ; Guckenberger, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-a7ae9715a2f88e6b07a0df567a97c49ee2956eb2ea46239cc46ad065fb59c7693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Brain - surgery</topic><topic>Brain Damage, Chronic - diagnosis</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - surgery</topic><topic>Combined Modality Therapy</topic><topic>Cranial Irradiation</topic><topic>Follow-Up Studies</topic><topic>Germany</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neoplasm, Residual - pathology</topic><topic>Neoplasm, Residual - surgery</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Postoperative Complications - diagnosis</topic><topic>Radiation Injuries - diagnosis</topic><topic>Radiation Oncology</topic><topic>Radiosurgery</topic><topic>Radiotherapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Reoperation</topic><topic>Salvage Therapy</topic><topic>Societies, Medical</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kocher, Martin</creatorcontrib><creatorcontrib>Wittig, Andrea</creatorcontrib><creatorcontrib>Piroth, Marc Dieter</creatorcontrib><creatorcontrib>Treuer, Harald</creatorcontrib><creatorcontrib>Seegenschmiedt, Heinrich</creatorcontrib><creatorcontrib>Ruge, Maximilian</creatorcontrib><creatorcontrib>Grosu, Anca-Ligia</creatorcontrib><creatorcontrib>Guckenberger, Matthias</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Strahlentherapie und Onkologie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kocher, Martin</au><au>Wittig, Andrea</au><au>Piroth, Marc Dieter</au><au>Treuer, Harald</au><au>Seegenschmiedt, Heinrich</au><au>Ruge, Maximilian</au><au>Grosu, Anca-Ligia</au><au>Guckenberger, Matthias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stereotactic radiosurgery for treatment of brain metastases: A report of the DEGRO Working Group on Stereotactic Radiotherapy</atitle><jtitle>Strahlentherapie und Onkologie</jtitle><stitle>Strahlenther Onkol</stitle><addtitle>Strahlenther Onkol</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>190</volume><issue>6</issue><spage>521</spage><epage>532</epage><pages>521-532</pages><issn>0179-7158</issn><eissn>1439-099X</eissn><abstract>Background
This report from the Working Group on Stereotaktische Radiotherapie of the German Society of Radiation Oncology (
Deutsche Gesellschaft für Radioonkologie
, DEGRO) provides recommendations for the use of stereotactic radiosurgery (SRS) on patients with brain metastases. It considers existing international guidelines and details them where appropriate.
Results and discussion
The main recommendations are: Patients with solid tumors except germ cell tumors and small-cell lung cancer with a life expectancy of more than 3 months suffering from a single brain metastasis of less than 3 cm in diameter should be considered for SRS. Especially when metastases are not amenable to surgery, are located in the brain stem, and have no mass effect, SRS should be offered to the patient. For multiple (two to four) metastases—all less than 2.5 cm in diameter—in patients with a life expectancy of more than 3 months, SRS should be used rather than whole-brain radiotherapy (WBRT). Adjuvant WBRT after SRS for both single and multiple (two to four) metastases increases local control and reduces the frequency of distant brain metastases, but does not prolong survival when compared with SRS and salvage treatment. As WBRT carries the risk of inducing neurocognitive damage, it seems reasonable to withhold WBRT for as long as possible.
Conclusion
A single (marginal) dose of 20 Gy is a reasonable choice that balances the effect on the treated lesion (local control, partial remission) against the risk of late side effects (radionecrosis). Higher doses (22–25 Gy) may be used for smaller (< 1 cm) lesions, while a dose reduction to 18 Gy may be necessary for lesions greater than 2.5–3 cm. As the infiltration zone of the brain metastases is usually small, the GTV–CTV (gross tumor volume–clinical target volume) margin should be in the range of 0–1 mm. The CTV–PTV (planning target volume) margin depends on the treatment technique and should lie in the range of 0–2 mm. Distant brain recurrences fulfilling the aforementioned criteria can be treated with SRS irrespective of previous WBRT.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>24715242</pmid><doi>10.1007/s00066-014-0648-7</doi><tpages>12</tpages></addata></record> |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Brain - surgery Brain Damage, Chronic - diagnosis Brain Neoplasms - mortality Brain Neoplasms - secondary Brain Neoplasms - surgery Combined Modality Therapy Cranial Irradiation Follow-Up Studies Germany Guideline Adherence Humans Medicine Medicine & Public Health Neoplasm, Residual - pathology Neoplasm, Residual - surgery Oncology Original Article Postoperative Complications - diagnosis Radiation Injuries - diagnosis Radiation Oncology Radiosurgery Radiotherapy Radiotherapy, Adjuvant Reoperation Salvage Therapy Societies, Medical Survival Rate |
| title | Stereotactic radiosurgery for treatment of brain metastases: A report of the DEGRO Working Group on Stereotactic Radiotherapy |
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