Repeated stereotactic radiosurgery (SRS) using a non-coplanar mono-isocenter (HyperArc™) technique versus upfront whole-brain radiotherapy (WBRT): a matched-pair analysis
Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been report...
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| Veröffentlicht in: | Clinical & experimental metastasis 2020-02, Vol.37 (1), p.77-83 |
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| creator | Nicosia, Luca Figlia, Vanessa Mazzola, Rosario Napoli, Giuseppe Giaj-Levra, Niccolò Ricchetti, Francesco Rigo, Michele Lunardi, Gianluigi Tomasini, Davide Bonù, Marco L. Corradini, Stefanie Ruggieri, Ruggero Alongi, Filippo |
| description | Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2–10) for HyperArc™ and 5 (range 2–10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3–40 months). The median OS was not reached (range 5–22 months) for HyperArc™ patients and 8 months (range 3–40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62–14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT. |
| doi_str_mv | 10.1007/s10585-019-10004-3 |
| format | Article |
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Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2–10) for HyperArc™ and 5 (range 2–10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3–40 months). The median OS was not reached (range 5–22 months) for HyperArc™ patients and 8 months (range 3–40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62–14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.</description><identifier>ISSN: 0262-0898</identifier><identifier>EISSN: 1573-7276</identifier><identifier>DOI: 10.1007/s10585-019-10004-3</identifier><identifier>PMID: 31691873</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Adult ; Aged ; Biomedical and Life Sciences ; Biomedicine ; Brain ; Brain - pathology ; Brain - radiation effects ; Brain cancer ; Brain Neoplasms - mortality ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Cancer Research ; Cranial Irradiation - adverse effects ; Cranial Irradiation - methods ; Disease Progression ; Female ; Follow-Up Studies ; Hematology ; Humans ; Kaplan-Meier Estimate ; Male ; Matched-Pair Analysis ; Metastases ; Metastasis ; Middle Aged ; Necrosis - epidemiology ; Necrosis - etiology ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - radiotherapy ; Oncology ; Patients ; Progression-Free Survival ; Radiation Injuries - epidemiology ; Radiation Injuries - etiology ; Radiation therapy ; Radiology ; Radiosurgery ; Radiosurgery - adverse effects ; Radiosurgery - methods ; Research Paper ; Retreatment - adverse effects ; Retreatment - methods ; Retrospective Studies ; Surgery ; Surgical Oncology ; Survival ; Toxicity ; Treatment Outcome</subject><ispartof>Clinical & experimental metastasis, 2020-02, Vol.37 (1), p.77-83</ispartof><rights>Springer Nature B.V. 2019</rights><rights>Clinical and Experimental Metastasis is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-8aa3d426e18e0db960e2e2fe4e12ea00035b2a925660e843ad125692d2b3ddb33</citedby><cites>FETCH-LOGICAL-c375t-8aa3d426e18e0db960e2e2fe4e12ea00035b2a925660e843ad125692d2b3ddb33</cites><orcidid>0000-0002-0731-8041</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10585-019-10004-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10585-019-10004-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31691873$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nicosia, Luca</creatorcontrib><creatorcontrib>Figlia, Vanessa</creatorcontrib><creatorcontrib>Mazzola, Rosario</creatorcontrib><creatorcontrib>Napoli, Giuseppe</creatorcontrib><creatorcontrib>Giaj-Levra, Niccolò</creatorcontrib><creatorcontrib>Ricchetti, Francesco</creatorcontrib><creatorcontrib>Rigo, Michele</creatorcontrib><creatorcontrib>Lunardi, Gianluigi</creatorcontrib><creatorcontrib>Tomasini, Davide</creatorcontrib><creatorcontrib>Bonù, Marco L.</creatorcontrib><creatorcontrib>Corradini, Stefanie</creatorcontrib><creatorcontrib>Ruggieri, Ruggero</creatorcontrib><creatorcontrib>Alongi, Filippo</creatorcontrib><title>Repeated stereotactic radiosurgery (SRS) using a non-coplanar mono-isocenter (HyperArc™) technique versus upfront whole-brain radiotherapy (WBRT): a matched-pair analysis</title><title>Clinical & experimental metastasis</title><addtitle>Clin Exp Metastasis</addtitle><addtitle>Clin Exp Metastasis</addtitle><description>Stereotactic radiosurgery (SRS) is an effective treatment option for multiple brain metastases (BMs). Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2–10) for HyperArc™ and 5 (range 2–10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3–40 months). The median OS was not reached (range 5–22 months) for HyperArc™ patients and 8 months (range 3–40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62–14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.</description><subject>Adult</subject><subject>Aged</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Brain</subject><subject>Brain - pathology</subject><subject>Brain - radiation effects</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Cancer Research</subject><subject>Cranial Irradiation - adverse effects</subject><subject>Cranial Irradiation - methods</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Matched-Pair Analysis</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Necrosis - 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Modern mono-isocentric techniques allow the delivery of multiple stereotactic courses, in the event of intracranial failure. Nevertheless, limited data on effectiveness and toxicity have been reported in comparison to WBRT. Aim of this retrospective matched-pair analysis was to compare patients affected by limited BMs treated with multiple SRS courses using a mono-isocentric, non-coplanar technique (HyperArc™, Varian Medical System) to upfront WBRT. One hundred and two patients accounting for 677 BMs were treated with HyperArc™. In case of further intracranial progression, 44 treatment courses of 201 metastases in 19 patients, were treated by subsequent HyperArc™ courses. This population was matched with 38 patients treated with WBRT. The median BMs number was 4 (range 2–10) for HyperArc™ and 5 (range 2–10) for WBRT. Overall survival (OS) and toxicity were evaluated. The median follow-up was 9 months (range 3–40 months). The median OS was not reached (range 5–22 months) for HyperArc™ patients and 8 months (range 3–40 months) for WBRT patients, while the 1-year OS was 77% and 34.6% for HyperArc™ and WBRT, respectively (p = 0.001; HR 4.77, 95% CI 1.62–14.00). There was one case of radionecrosis. HyperArc™ is an effective and safe technique for the treatment of multiple BMs. In selected cases of intracranial oligorecurrence, further subsequent courses can be safely delivered with the same technical approach. Moreover, in patients with a limited number of BMs, SRS showed an improved survival outcome when compared to WBRT.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>31691873</pmid><doi>10.1007/s10585-019-10004-3</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0731-8041</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0262-0898 |
| ispartof | Clinical & experimental metastasis, 2020-02, Vol.37 (1), p.77-83 |
| issn | 0262-0898 1573-7276 |
| language | eng |
| recordid | cdi_proquest_journals_2352636825 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Biomedical and Life Sciences Biomedicine Brain Brain - pathology Brain - radiation effects Brain cancer Brain Neoplasms - mortality Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Cancer Research Cranial Irradiation - adverse effects Cranial Irradiation - methods Disease Progression Female Follow-Up Studies Hematology Humans Kaplan-Meier Estimate Male Matched-Pair Analysis Metastases Metastasis Middle Aged Necrosis - epidemiology Necrosis - etiology Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - radiotherapy Oncology Patients Progression-Free Survival Radiation Injuries - epidemiology Radiation Injuries - etiology Radiation therapy Radiology Radiosurgery Radiosurgery - adverse effects Radiosurgery - methods Research Paper Retreatment - adverse effects Retreatment - methods Retrospective Studies Surgery Surgical Oncology Survival Toxicity Treatment Outcome |
| title | Repeated stereotactic radiosurgery (SRS) using a non-coplanar mono-isocenter (HyperArc™) technique versus upfront whole-brain radiotherapy (WBRT): a matched-pair analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T15%3A55%3A11IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Repeated%20stereotactic%20radiosurgery%20(SRS)%20using%20a%20non-coplanar%20mono-isocenter%20(HyperArc%E2%84%A2)%20technique%20versus%20upfront%20whole-brain%20radiotherapy%20(WBRT):%20a%20matched-pair%20analysis&rft.jtitle=Clinical%20&%20experimental%20metastasis&rft.au=Nicosia,%20Luca&rft.date=2020-02-01&rft.volume=37&rft.issue=1&rft.spage=77&rft.epage=83&rft.pages=77-83&rft.issn=0262-0898&rft.eissn=1573-7276&rft_id=info:doi/10.1007/s10585-019-10004-3&rft_dat=%3Cproquest_cross%3E2352636825%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2352636825&rft_id=info:pmid/31691873&rfr_iscdi=true |