What Factors Predict the Response of Larger Brain Metastases to Radiosurgery?
Abstract BACKGROUND: Approximately 20 to 40% of patients with systemic malignancies develop brain metastases. OBJECTIVE: To assess the potential role of stereotactic radiosurgery (SRS) for larger metastatic brain tumors, we reviewed our recent experience. METHODS: Between 2004 and 2008, 70 patients...
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| Veröffentlicht in: | Neurosurgery 2011-03, Vol.68 (3), p.682-690 |
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| creator | Yang, Huai-che Kano, Hideyuki Lunsford, L Dade Niranjan, Ajay Flickinger, John C Kondziolka, Douglas |
| description | Abstract
BACKGROUND:
Approximately 20 to 40% of patients with systemic malignancies develop brain metastases.
OBJECTIVE:
To assess the potential role of stereotactic radiosurgery (SRS) for larger metastatic brain tumors, we reviewed our recent experience.
METHODS:
Between 2004 and 2008, 70 patients with a metastatic brain tumor larger than 3 cm in maximum diameter underwent Gamma knife SRS. Thirty-three patients had received previous whole brain radiation therapy (WBRT) and 37 received only SRS.
RESULTS:
The overall median follow-up was 8.1 months. At the first planned imaging follow-up at 2 months, 29 (41%) tumors had >50% volume reduction, 22 (31%) had 10 to 50% volume reduction, and 19 (28%) were stable or larger. We also evaluated brain edema using MRI T2 images. In 11 patients (16%) the peritumoral edema volume was reduced by more than 50%, in 25 (36%) it was reduced by 10 to 50%, in 21 (30%) it was stable, and in 13 (19%) it was increased. Twenty (36%) discontinued corticosteroids by the time of first imaging follow-up. Because of persistent symptoms, 7 patients (10%) required a craniotomy to remove the tumor. Tumor volume reduction (>50%) was associated with a single metastasis (P = .012), no previous WBRT (P = .002), and a tumor volume 50%) was associated with a single metastasis (P = .024), no previous WBRT (P = .05), and breast cancer histology (P = .044).
CONCLUSION:
Surgical resection remains the primary approach for larger brain metastases if feasible. Tumor volume is a better indicator than maximum diameter. Tumor volume and edema responded better in patients who underwent SRS alone. |
| doi_str_mv | 10.1227/NEU.0b013e318207a58b |
| format | Article |
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BACKGROUND:
Approximately 20 to 40% of patients with systemic malignancies develop brain metastases.
OBJECTIVE:
To assess the potential role of stereotactic radiosurgery (SRS) for larger metastatic brain tumors, we reviewed our recent experience.
METHODS:
Between 2004 and 2008, 70 patients with a metastatic brain tumor larger than 3 cm in maximum diameter underwent Gamma knife SRS. Thirty-three patients had received previous whole brain radiation therapy (WBRT) and 37 received only SRS.
RESULTS:
The overall median follow-up was 8.1 months. At the first planned imaging follow-up at 2 months, 29 (41%) tumors had >50% volume reduction, 22 (31%) had 10 to 50% volume reduction, and 19 (28%) were stable or larger. We also evaluated brain edema using MRI T2 images. In 11 patients (16%) the peritumoral edema volume was reduced by more than 50%, in 25 (36%) it was reduced by 10 to 50%, in 21 (30%) it was stable, and in 13 (19%) it was increased. Twenty (36%) discontinued corticosteroids by the time of first imaging follow-up. Because of persistent symptoms, 7 patients (10%) required a craniotomy to remove the tumor. Tumor volume reduction (>50%) was associated with a single metastasis (P = .012), no previous WBRT (P = .002), and a tumor volume <16 cm3 (P = .002). The better peritumoral edema volume reduction (>50%) was associated with a single metastasis (P = .024), no previous WBRT (P = .05), and breast cancer histology (P = .044).
CONCLUSION:
Surgical resection remains the primary approach for larger brain metastases if feasible. Tumor volume is a better indicator than maximum diameter. Tumor volume and edema responded better in patients who underwent SRS alone.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0b013e318207a58b</identifier><identifier>PMID: 21311296</identifier><identifier>CODEN: NRSRDY</identifier><language>eng</language><publisher>Hagerstown, MD: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Brain cancer ; Brain Neoplasms - complications ; Brain Neoplasms - diagnosis ; Brain Neoplasms - surgery ; Breast cancer ; Edema ; Female ; Humans ; Male ; Medical sciences ; Metastasis ; Middle Aged ; Neurosurgery ; Prognosis ; Radiosurgery - methods ; Risk Assessment ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Tumors</subject><ispartof>Neurosurgery, 2011-03, Vol.68 (3), p.682-690</ispartof><rights>Copyright © 2011 by the Congress of Neurological Surgeons</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-9d11342d6f3bc30efe149a06190698484e473de8bdbb2680684649cbc66874993</citedby><cites>FETCH-LOGICAL-c470t-9d11342d6f3bc30efe149a06190698484e473de8bdbb2680684649cbc66874993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23917879$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21311296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Huai-che</creatorcontrib><creatorcontrib>Kano, Hideyuki</creatorcontrib><creatorcontrib>Lunsford, L Dade</creatorcontrib><creatorcontrib>Niranjan, Ajay</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Kondziolka, Douglas</creatorcontrib><title>What Factors Predict the Response of Larger Brain Metastases to Radiosurgery?</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>Abstract
BACKGROUND:
Approximately 20 to 40% of patients with systemic malignancies develop brain metastases.
OBJECTIVE:
To assess the potential role of stereotactic radiosurgery (SRS) for larger metastatic brain tumors, we reviewed our recent experience.
METHODS:
Between 2004 and 2008, 70 patients with a metastatic brain tumor larger than 3 cm in maximum diameter underwent Gamma knife SRS. Thirty-three patients had received previous whole brain radiation therapy (WBRT) and 37 received only SRS.
RESULTS:
The overall median follow-up was 8.1 months. At the first planned imaging follow-up at 2 months, 29 (41%) tumors had >50% volume reduction, 22 (31%) had 10 to 50% volume reduction, and 19 (28%) were stable or larger. We also evaluated brain edema using MRI T2 images. In 11 patients (16%) the peritumoral edema volume was reduced by more than 50%, in 25 (36%) it was reduced by 10 to 50%, in 21 (30%) it was stable, and in 13 (19%) it was increased. Twenty (36%) discontinued corticosteroids by the time of first imaging follow-up. Because of persistent symptoms, 7 patients (10%) required a craniotomy to remove the tumor. Tumor volume reduction (>50%) was associated with a single metastasis (P = .012), no previous WBRT (P = .002), and a tumor volume <16 cm3 (P = .002). The better peritumoral edema volume reduction (>50%) was associated with a single metastasis (P = .024), no previous WBRT (P = .05), and breast cancer histology (P = .044).
CONCLUSION:
Surgical resection remains the primary approach for larger brain metastases if feasible. Tumor volume is a better indicator than maximum diameter. Tumor volume and edema responded better in patients who underwent SRS alone.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - complications</subject><subject>Brain Neoplasms - diagnosis</subject><subject>Brain Neoplasms - surgery</subject><subject>Breast cancer</subject><subject>Edema</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Prognosis</subject><subject>Radiosurgery - methods</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkElLBDEQhYMoOi7_QCQg4qk1lWSynEQHNxgXRNFbk05Xa8tMZ0y6D_57e5hRwZNQUIf6XlW9R8gusCPgXB_fnj8dsYKBQAGGM-2GplghAxhymUkm2SoZMJAmE1a9bJDNlN4ZAyW1WScbHAQAt2pAbp7fXEsvnG9DTPQ-Yln7lrZvSB8wzUKTkIaKjl18xUjPoqsbeoOtS31hom2gD66sQ-rm88-TbbJWuUnCnWXfIk8X54-jq2x8d3k9Oh1nXmrWZrYEEJKXqhKFFwwrBGkdU2CZskYaiVKLEk1RFgVXhikjlbS-8EoZLa0VW-RwsXcWw0eHqc2ndfI4mbgGQ5dyM4TeqDWqJ_f_kO-hi03_XM4F05pLoaGn5ILyMaQUscpnsZ66-JkDy-dp533a-d-0e9necnlXTLH8EX3H2wMHS8Al7yZVdI2v0y8nLGij536OF1zoZv87_QUI8JTh</recordid><startdate>20110301</startdate><enddate>20110301</enddate><creator>Yang, Huai-che</creator><creator>Kano, Hideyuki</creator><creator>Lunsford, L Dade</creator><creator>Niranjan, Ajay</creator><creator>Flickinger, John C</creator><creator>Kondziolka, Douglas</creator><general>Oxford University Press</general><general>Lippincott Williams & Wilkins</general><general>Wolters Kluwer Health, Inc</general><scope>IQODW</scope><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>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20110301</creationdate><title>What Factors Predict the Response of Larger Brain Metastases to Radiosurgery?</title><author>Yang, Huai-che ; Kano, Hideyuki ; Lunsford, L Dade ; Niranjan, Ajay ; Flickinger, John C ; Kondziolka, Douglas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-9d11342d6f3bc30efe149a06190698484e473de8bdbb2680684649cbc66874993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - complications</topic><topic>Brain Neoplasms - diagnosis</topic><topic>Brain Neoplasms - surgery</topic><topic>Breast cancer</topic><topic>Edema</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Prognosis</topic><topic>Radiosurgery - methods</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Huai-che</creatorcontrib><creatorcontrib>Kano, Hideyuki</creatorcontrib><creatorcontrib>Lunsford, L Dade</creatorcontrib><creatorcontrib>Niranjan, Ajay</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Kondziolka, Douglas</creatorcontrib><collection>Pascal-Francis</collection><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>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Huai-che</au><au>Kano, Hideyuki</au><au>Lunsford, L Dade</au><au>Niranjan, Ajay</au><au>Flickinger, John C</au><au>Kondziolka, Douglas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What Factors Predict the Response of Larger Brain Metastases to Radiosurgery?</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2011-03-01</date><risdate>2011</risdate><volume>68</volume><issue>3</issue><spage>682</spage><epage>690</epage><pages>682-690</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><coden>NRSRDY</coden><abstract>Abstract
BACKGROUND:
Approximately 20 to 40% of patients with systemic malignancies develop brain metastases.
OBJECTIVE:
To assess the potential role of stereotactic radiosurgery (SRS) for larger metastatic brain tumors, we reviewed our recent experience.
METHODS:
Between 2004 and 2008, 70 patients with a metastatic brain tumor larger than 3 cm in maximum diameter underwent Gamma knife SRS. Thirty-three patients had received previous whole brain radiation therapy (WBRT) and 37 received only SRS.
RESULTS:
The overall median follow-up was 8.1 months. At the first planned imaging follow-up at 2 months, 29 (41%) tumors had >50% volume reduction, 22 (31%) had 10 to 50% volume reduction, and 19 (28%) were stable or larger. We also evaluated brain edema using MRI T2 images. In 11 patients (16%) the peritumoral edema volume was reduced by more than 50%, in 25 (36%) it was reduced by 10 to 50%, in 21 (30%) it was stable, and in 13 (19%) it was increased. Twenty (36%) discontinued corticosteroids by the time of first imaging follow-up. Because of persistent symptoms, 7 patients (10%) required a craniotomy to remove the tumor. Tumor volume reduction (>50%) was associated with a single metastasis (P = .012), no previous WBRT (P = .002), and a tumor volume <16 cm3 (P = .002). The better peritumoral edema volume reduction (>50%) was associated with a single metastasis (P = .024), no previous WBRT (P = .05), and breast cancer histology (P = .044).
CONCLUSION:
Surgical resection remains the primary approach for larger brain metastases if feasible. Tumor volume is a better indicator than maximum diameter. Tumor volume and edema responded better in patients who underwent SRS alone.</abstract><cop>Hagerstown, MD</cop><pub>Oxford University Press</pub><pmid>21311296</pmid><doi>10.1227/NEU.0b013e318207a58b</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Brain cancer Brain Neoplasms - complications Brain Neoplasms - diagnosis Brain Neoplasms - surgery Breast cancer Edema Female Humans Male Medical sciences Metastasis Middle Aged Neurosurgery Prognosis Radiosurgery - methods Risk Assessment Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Tumors |
| title | What Factors Predict the Response of Larger Brain Metastases to Radiosurgery? |
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