› Forums › General Melanoma Community › Salvage Radiosurgery for Brain Metastases
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NYKaren.
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- December 25, 2013 at 11:50 pm
Salvage Radiosurgery for Brain Metastases: Prognostic Factors to Consider in Patient Selection
Int. J. Radiat. Oncol. Biol. Phys 2014 Jan 01;88(1)137-142, G Kurtz, G Zadeh, G Gingras-Hill, B-A Millar, NJ Laperriere, M Bernstein, H Jiang, C Ménard, C Chung
Research · December 19, 2013TAKE-HOME MESSAGE
- "Among patients who have received stereotactic radiotherapy for recurrent brain metastases after prior brain radiation therapy, factors predicting for improved overall survival were younger age, extracranial disease control, and interval time from initial radiotherapy to salvage of at least 265 days."
– Chris Tully, MD
- This study highlights the possibility of durable responses in patients with recurrent brain metastases treated with salvage SRS.
ABSTRACT
Purpose
Stereotactic radiosurgery (SRS) is offered to patients for recurrent brain metastases after prior brain radiation therapy (RT), but few studies have evaluated the efficacy of salvage SRS or factors to consider in selecting patients for this treatment. This study reports overall survival (OS), intracranial progression-free survival (PFS), and local control (LC) after salvage SRS, and factors associated with outcomes.
Methods and Materials
This is a retrospective review of patients treated from 2009 to 2011 with salvage SRS after prior brain RT for brain metastases. Survival from salvage SRS and from initial brain metastases diagnosis (IBMD) was calculated. Univariate and multivariable (MVA) analyses included age, performance status, recursive partitioning analysis (RPA) class, extracranial disease control, and time from initial RT to salvage SRS.
Results
There were 106 patients included in the analysis with a median age of 56.9 years (range 32.5-82 years). A median of 2 metastases were treated per patient (range, 1-12) with a median dose of 21 Gy (range, 12-24) prescribed to the 50% isodose. With a median follow-up of 10.5 months (range, 0.1-68.2), LC was 82.8%, 60.1%, and 46.8% at 6 months, 1 year, and 3 years, respectively. Median PFS was 6.2 months (95% confidence interval [CI] = 4.9-7.6). Median OS was 11.7 months (95% CI = 8.1-13) from salvage SRS, and 22.1 months from IBMD (95% CI = 18.4-26.8). On MVA, age (P=.01; hazard ratio [HR] = 1.04; 95% CI = 1.01-1.07), extracranial disease control (P=.004; HR = 0.46; 95% CI = 0.27-0.78), and interval from initial RT to salvage SRS of at least 265 days (P=.001; HR = 2.46; 95% CI = 1.47-4.09) were predictive of OS.
Conclusions
This study demonstrates that patients can have durable local control and survival after salvage SRS for recurrent brain metastases. In particular, younger patients with controlled extracranial disease and a durable response to initial brain RT are likely to benefit from salvage SRS.
International Journal of Radiation Oncology, Biology, PhysicsSalvage Radiosurgery for Brain Metastases: Prognostic Factors to Consider in Patient Selection
Int. J. Radiat. Oncol. Biol. Phys 2014 Jan 01;88(1)137-142, G Kurtz, G Zadeh, G Gingras-Hill, B-A Millar, NJ Laperriere, M Bernstein, H Jiang, C Ménard, C Chung
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- December 27, 2013 at 2:45 am
Can someone please be kind enough to explain this in layman's terms?
thanks,
karen
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- December 27, 2013 at 1:09 pm
Melanoma brain mets are usually treated with radiation– either stereotactic radiosurgery (SRS) or whole brain radiation (WBR). It is quite common that later on, these same patients develop one or more additional brain mets. This report is asking the question; "Which patients are most likely to benefit from treating recurrent brain mets with more radiation? Will another dose of radiation really do them any good?"
What the authors found is that additional SRS is helpful to some patients but not to all patients. The patients most likely to benefit from another round of radiotherapy are:
1. Younger patients (the abstract does not give an age but I suspect younger than 65),
2. Patients whose disease in the rest of their body is well controlled by some type of treatment, and
3. Patients who responded well to the original radiation treatment (i.e., their original brain tumors were killed by the original radiation treatment).
So if someone is relatively young, the tumors in their body are stable or shrinking, and it has been at least 9 months since their original brain mets were treated, additional radiation treatment to new or recurrent brain mets may significantly extend their life. However, if someone is older than 65 or the tumors in their body are progressing or new brain mets appear relatively quickly after the first radiation treatment, another round of radiation treatment is unlikely to do them much good.
I think we all pretty much assumed this all along, but its nice to have it scientifically confirmed.
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- December 27, 2013 at 1:09 pm
Melanoma brain mets are usually treated with radiation– either stereotactic radiosurgery (SRS) or whole brain radiation (WBR). It is quite common that later on, these same patients develop one or more additional brain mets. This report is asking the question; "Which patients are most likely to benefit from treating recurrent brain mets with more radiation? Will another dose of radiation really do them any good?"
What the authors found is that additional SRS is helpful to some patients but not to all patients. The patients most likely to benefit from another round of radiotherapy are:
1. Younger patients (the abstract does not give an age but I suspect younger than 65),
2. Patients whose disease in the rest of their body is well controlled by some type of treatment, and
3. Patients who responded well to the original radiation treatment (i.e., their original brain tumors were killed by the original radiation treatment).
So if someone is relatively young, the tumors in their body are stable or shrinking, and it has been at least 9 months since their original brain mets were treated, additional radiation treatment to new or recurrent brain mets may significantly extend their life. However, if someone is older than 65 or the tumors in their body are progressing or new brain mets appear relatively quickly after the first radiation treatment, another round of radiation treatment is unlikely to do them much good.
I think we all pretty much assumed this all along, but its nice to have it scientifically confirmed.
-
- December 27, 2013 at 1:09 pm
Melanoma brain mets are usually treated with radiation– either stereotactic radiosurgery (SRS) or whole brain radiation (WBR). It is quite common that later on, these same patients develop one or more additional brain mets. This report is asking the question; "Which patients are most likely to benefit from treating recurrent brain mets with more radiation? Will another dose of radiation really do them any good?"
What the authors found is that additional SRS is helpful to some patients but not to all patients. The patients most likely to benefit from another round of radiotherapy are:
1. Younger patients (the abstract does not give an age but I suspect younger than 65),
2. Patients whose disease in the rest of their body is well controlled by some type of treatment, and
3. Patients who responded well to the original radiation treatment (i.e., their original brain tumors were killed by the original radiation treatment).
So if someone is relatively young, the tumors in their body are stable or shrinking, and it has been at least 9 months since their original brain mets were treated, additional radiation treatment to new or recurrent brain mets may significantly extend their life. However, if someone is older than 65 or the tumors in their body are progressing or new brain mets appear relatively quickly after the first radiation treatment, another round of radiation treatment is unlikely to do them much good.
I think we all pretty much assumed this all along, but its nice to have it scientifically confirmed.
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