Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases
Limited data exist quantifying the risk of adverse radiation effect (ARE) specific to hypofractionated stereotactic radiosurgery (HSRS). We present our analyses of the risk of ARE after 5 daily fractions of HSRS to surgical cavities and intact metastases. One hundred and eighty-seven consecutively t...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2020-03, Vol.106 (4), p.772-779 |
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| creator | Faruqi, Salman Ruschin, Mark Soliman, Hany Myrehaug, Sten Zeng, K. Liang Husain, Zain Atenafu, Eshetu Tseng, Chia-Lin Das, Sunit Perry, James Maralani, Pejman Heyn, Chris Mainprize, Todd Sahgal, Arjun |
| description | Limited data exist quantifying the risk of adverse radiation effect (ARE) specific to hypofractionated stereotactic radiosurgery (HSRS). We present our analyses of the risk of ARE after 5 daily fractions of HSRS to surgical cavities and intact metastases.
One hundred and eighty-seven consecutively treated patients with 118 surgical cavities and 132 intact metastases were retrospectively reviewed. All patients were treated with 5 daily fractions with a 2 mm planning target volume applied. Clinical and dosimetric variables were assessed to identify predictors of ARE.
The median total prescribed dose was 30 Gy (range, 20-35 Gy) and median follow-up was 12 months. One hundred forty-four patients (77%) received treatment to a single target. Median planning target volumes for resection cavity and intact metastases were 24.9 cm3 and 7.7 cm3, respectively. ARE and symptomatic ARE were observed 21.2% and 10.8% of targets, respectively, and the median time to ARE was 8 months. Time to ARE was 12 months for 19% of targets. Multivariable analysis identified intact metastases versus cavities (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.33-10) as a significant predictor of symptomatic ARE. Specific to cavity HSRS, prior whole brain radiation therapy (OR 7.73; 95% CI, 1.67-35.69) and prior stereotactic radiosurgery (OR 8.66; 95% CI, 1.14-65.7) were significant predictors of symptomatic ARE. For intact metastases, the total brain minus gross tumor volume (GTV) receiving 30 Gy (BMC30) was a significant predictor of symptomatic ARE (OR, 1.21; 95% CI, 1.02-1.43), and a volume-based BMC30 threshold of 10.5 cm3 was significant with an OR of 7.21 (95% CI, 1.31-39.45).
The risk of ARE was greater for intact metastases compared with cavities after HSRS. For intact lesions, the BMC30 was predictive for symptomatic necrosis, and a threshold of 10.5 cm3 may guide treatment planning. |
| doi_str_mv | 10.1016/j.ijrobp.2019.12.002 |
| format | Article |
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One hundred and eighty-seven consecutively treated patients with 118 surgical cavities and 132 intact metastases were retrospectively reviewed. All patients were treated with 5 daily fractions with a 2 mm planning target volume applied. Clinical and dosimetric variables were assessed to identify predictors of ARE.
The median total prescribed dose was 30 Gy (range, 20-35 Gy) and median follow-up was 12 months. One hundred forty-four patients (77%) received treatment to a single target. Median planning target volumes for resection cavity and intact metastases were 24.9 cm3 and 7.7 cm3, respectively. ARE and symptomatic ARE were observed 21.2% and 10.8% of targets, respectively, and the median time to ARE was 8 months. Time to ARE was <6 months for 38%, 6 to 12 months for 43%, and >12 months for 19% of targets. Multivariable analysis identified intact metastases versus cavities (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.33-10) as a significant predictor of symptomatic ARE. Specific to cavity HSRS, prior whole brain radiation therapy (OR 7.73; 95% CI, 1.67-35.69) and prior stereotactic radiosurgery (OR 8.66; 95% CI, 1.14-65.7) were significant predictors of symptomatic ARE. For intact metastases, the total brain minus gross tumor volume (GTV) receiving 30 Gy (BMC30) was a significant predictor of symptomatic ARE (OR, 1.21; 95% CI, 1.02-1.43), and a volume-based BMC30 threshold of 10.5 cm3 was significant with an OR of 7.21 (95% CI, 1.31-39.45).
The risk of ARE was greater for intact metastases compared with cavities after HSRS. For intact lesions, the BMC30 was predictive for symptomatic necrosis, and a threshold of 10.5 cm3 may guide treatment planning.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2019.12.002</identifier><identifier>PMID: 31928848</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Female ; Humans ; Male ; Radiation Dose Hypofractionation ; Radiosurgery - adverse effects ; Retrospective Studies</subject><ispartof>International journal of radiation oncology, biology, physics, 2020-03, Vol.106 (4), p.772-779</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-189ec1537f8fc4617d8890f6d83e44736ecd69f67a3178a6472338b640aade193</citedby><cites>FETCH-LOGICAL-c428t-189ec1537f8fc4617d8890f6d83e44736ecd69f67a3178a6472338b640aade193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301619344761$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31928848$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Faruqi, Salman</creatorcontrib><creatorcontrib>Ruschin, Mark</creatorcontrib><creatorcontrib>Soliman, Hany</creatorcontrib><creatorcontrib>Myrehaug, Sten</creatorcontrib><creatorcontrib>Zeng, K. Liang</creatorcontrib><creatorcontrib>Husain, Zain</creatorcontrib><creatorcontrib>Atenafu, Eshetu</creatorcontrib><creatorcontrib>Tseng, Chia-Lin</creatorcontrib><creatorcontrib>Das, Sunit</creatorcontrib><creatorcontrib>Perry, James</creatorcontrib><creatorcontrib>Maralani, Pejman</creatorcontrib><creatorcontrib>Heyn, Chris</creatorcontrib><creatorcontrib>Mainprize, Todd</creatorcontrib><creatorcontrib>Sahgal, Arjun</creatorcontrib><title>Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Limited data exist quantifying the risk of adverse radiation effect (ARE) specific to hypofractionated stereotactic radiosurgery (HSRS). We present our analyses of the risk of ARE after 5 daily fractions of HSRS to surgical cavities and intact metastases.
One hundred and eighty-seven consecutively treated patients with 118 surgical cavities and 132 intact metastases were retrospectively reviewed. All patients were treated with 5 daily fractions with a 2 mm planning target volume applied. Clinical and dosimetric variables were assessed to identify predictors of ARE.
The median total prescribed dose was 30 Gy (range, 20-35 Gy) and median follow-up was 12 months. One hundred forty-four patients (77%) received treatment to a single target. Median planning target volumes for resection cavity and intact metastases were 24.9 cm3 and 7.7 cm3, respectively. ARE and symptomatic ARE were observed 21.2% and 10.8% of targets, respectively, and the median time to ARE was 8 months. Time to ARE was <6 months for 38%, 6 to 12 months for 43%, and >12 months for 19% of targets. Multivariable analysis identified intact metastases versus cavities (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.33-10) as a significant predictor of symptomatic ARE. Specific to cavity HSRS, prior whole brain radiation therapy (OR 7.73; 95% CI, 1.67-35.69) and prior stereotactic radiosurgery (OR 8.66; 95% CI, 1.14-65.7) were significant predictors of symptomatic ARE. For intact metastases, the total brain minus gross tumor volume (GTV) receiving 30 Gy (BMC30) was a significant predictor of symptomatic ARE (OR, 1.21; 95% CI, 1.02-1.43), and a volume-based BMC30 threshold of 10.5 cm3 was significant with an OR of 7.21 (95% CI, 1.31-39.45).
The risk of ARE was greater for intact metastases compared with cavities after HSRS. For intact lesions, the BMC30 was predictive for symptomatic necrosis, and a threshold of 10.5 cm3 may guide treatment planning.</description><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Radiation Dose Hypofractionation</subject><subject>Radiosurgery - adverse effects</subject><subject>Retrospective Studies</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9qGzEQh0Vpady0b1CKjr3sRv-s1V4KrpM0gZRA0kJvQpZGRWa9ciXZ4LfoI1dbOzkGBILR980w-iH0kZKWEiov1m1Yp7jatozQvqWsJYS9QjOqur7h8_mv12hGuCQNr_AZepfzmhBCaSfeojNOe6aUUDP0d-H2kDLgB-OCKSGO-Mp7sAUvfIGEbw7b6JOx04sp4PBjrUIsU8X-l2Lepd-QDjiMeI4vTRgO-PpkZOxjwo8VCNYMeGn2oQTI2IwO345TE_w1mSp-h2JyPZDfozfeDBk-nO5z9PP66sfyprm7_3a7XNw1VjBVGqp6sHTOO6-8FZJ2TqmeeOkUByE6LsE62XvZGU47ZaToGOdqJQUxxgHt-Tn6fOy7TfHPDnLRm5AtDIMZIe6ynnAiWc9ERcURtSnmnMDrbQobkw6aEj1lodf6mIWestCU6ZpF1T6dJuxWG3DP0tPnV-DLEYC65z5A0tkGGC24kGoC2sXw8oR__tGeWg</recordid><startdate>20200315</startdate><enddate>20200315</enddate><creator>Faruqi, Salman</creator><creator>Ruschin, Mark</creator><creator>Soliman, Hany</creator><creator>Myrehaug, Sten</creator><creator>Zeng, K. 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Liang</au><au>Husain, Zain</au><au>Atenafu, Eshetu</au><au>Tseng, Chia-Lin</au><au>Das, Sunit</au><au>Perry, James</au><au>Maralani, Pejman</au><au>Heyn, Chris</au><au>Mainprize, Todd</au><au>Sahgal, Arjun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2020-03-15</date><risdate>2020</risdate><volume>106</volume><issue>4</issue><spage>772</spage><epage>779</epage><pages>772-779</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Limited data exist quantifying the risk of adverse radiation effect (ARE) specific to hypofractionated stereotactic radiosurgery (HSRS). We present our analyses of the risk of ARE after 5 daily fractions of HSRS to surgical cavities and intact metastases.
One hundred and eighty-seven consecutively treated patients with 118 surgical cavities and 132 intact metastases were retrospectively reviewed. All patients were treated with 5 daily fractions with a 2 mm planning target volume applied. Clinical and dosimetric variables were assessed to identify predictors of ARE.
The median total prescribed dose was 30 Gy (range, 20-35 Gy) and median follow-up was 12 months. One hundred forty-four patients (77%) received treatment to a single target. Median planning target volumes for resection cavity and intact metastases were 24.9 cm3 and 7.7 cm3, respectively. ARE and symptomatic ARE were observed 21.2% and 10.8% of targets, respectively, and the median time to ARE was 8 months. Time to ARE was <6 months for 38%, 6 to 12 months for 43%, and >12 months for 19% of targets. Multivariable analysis identified intact metastases versus cavities (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.33-10) as a significant predictor of symptomatic ARE. Specific to cavity HSRS, prior whole brain radiation therapy (OR 7.73; 95% CI, 1.67-35.69) and prior stereotactic radiosurgery (OR 8.66; 95% CI, 1.14-65.7) were significant predictors of symptomatic ARE. For intact metastases, the total brain minus gross tumor volume (GTV) receiving 30 Gy (BMC30) was a significant predictor of symptomatic ARE (OR, 1.21; 95% CI, 1.02-1.43), and a volume-based BMC30 threshold of 10.5 cm3 was significant with an OR of 7.21 (95% CI, 1.31-39.45).
The risk of ARE was greater for intact metastases compared with cavities after HSRS. For intact lesions, the BMC30 was predictive for symptomatic necrosis, and a threshold of 10.5 cm3 may guide treatment planning.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31928848</pmid><doi>10.1016/j.ijrobp.2019.12.002</doi><tpages>8</tpages></addata></record> |
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| subjects | Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Brain Neoplasms - surgery Female Humans Male Radiation Dose Hypofractionation Radiosurgery - adverse effects Retrospective Studies |
| title | Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases |
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