Comparative analysis of combined treatment methods for patients with single brain lesions

Close metadata

OBJECTIVE

To evaluate own experience of preoperative radiosurgery followed by surgical resection (RS+S) of metastasis regarding local control, leptomeningeal progression, surgical and radiation-induced complications; to compare treatment outcomes with surgical resection and subsequent radiotherapy (S+SRT).

MATERIAL AND METHODS. A

Retrospective study included 66 patients with solitary brain metastasis. Two groups of patients were distinguished: group 1 (n=34) — postoperative irradiation, group 2 (n=32) — preoperative irradiation. The median age was 49.5 years (range 36—75).

RESULTS

Local 3-, 6- and 12-month control among patients with postoperative irradiation was 88.2%, 79.4% and 42.9%, in the group of preoperative irradiation — 100%, 93.3% and 66.7%, respectively (p=0.021). Leptomeningeal progression developed in 11 patients (8 and 3 ones, respectively). The one-year survival rate was 73.5% and 84.4%, respectively (p=0.33). Long-term surgical and radiation-induced complications occurred in 12 (18.2%) patients.

CONCLUSION

Preoperative radiosurgery with subsequent resection provides higher local control and lower incidence of leptomeningeal progression in patients with single brain metastases.

Keywords:

metastasis

preoperative radiation

postoperative radiation

radiosurgery

whole-brain radiation therapy

local control

radiation necrosis

Authors:

Ostapenko M.Yu.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0525-040X

Lukshin V.A.

Burdenko Neurosurgical Center

ORCID: 0000-0001-5787-484X

Usachev D.Yu.

Burdenko Neurosurgical Center;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-9811-9442

Golanov A.V.

Burdenko Neurosurgical Center

ORCID: 0000-0002-0976-4547

Vetlova E.R.

Burdenko Neurosurgical Center

ORCID: 0000-0002-4904-0324

Durgaryan A.A.

Burdenko Neurosurgical Center

ORCID: 0000-0003-3024-2935

Kobyakov N.G.

Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-5975-7188

Received:

23.02.2024

Accepted:

31.05.2024

List of references:

Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Current Oncology Reports. 2012;14(1):48-54. https://doi.org/10.1007/s11912-011-0203-y
Minniti G, Esposito V, Clarke E, Scaringi C, Lanzetta G, Salvati M, Raco A, Bozzao A, Maurizi Enrici R. Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases. International Journal of Radiation Oncology — Biology — Physics. 2013;86(4):623-629. https://doi.org/10.1016/j.ijrobp.2013.03.037
Nishio M, Nakagawa K, Mitsudomi T, Yamamoto N, Tanaka T, Kuriki H, Zeaiter A, Tamura T. Analysis of central nervous system efficacy in the J-ALEX study of alectinib versus crizotinib in ALK-positive non-small-cell lung cancer. Lung Cancer. 2018;121:37-40. https://doi.org/10.1016/j.lungcan.2018.04.015
Soria JC, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, Dechaphunkul A, Imamura F, Nogami N, Kurata T, Okamoto I, Zhou C, Cho BC, Cheng Y, Cho EK, Voon PJ, Planchard D, Su WC, Gray JE, Lee SM, Hodge R, Marotti M, Rukazenkov Y, Ramalingam SS; FLAURA Investigators. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. The New England Journal of Medicine. 2018;378(2):113-125. https://doi.org/10.1056/NEJMoa1713137
Tawbi HA, Forsyth PA, Algazi A, Hamid O, Hodi FS, Moschos SJ, Khushalani NI, Lewis K, Lao CD, Postow MA, Atkins MB, Ernstoff MS, Reardon DA, Puzanov I, Kudchadkar RR, Thomas RP, Tarhini A, Pavlick AC, Jiang J, Avila A, Demelo S, Margolin K. Combined Nivolumab and Ipilimumab in Melanoma Metastatic to the Brain. The New England Journal of Medicine. 2018;379(8):722-730. https://doi.org/10.1056/NEJMoa1805453
Bander ED, Yuan M, Reiner AS, Panageas KS, Ballangrud ÅM, Brennan CW, Beal K, Tabar V, Moss NS. Durable 5-year local control for resected brain metastases with early adjuvant SRS: the effect of timing on intended-field control. Neuro-Oncology Practice. 2021;8(3):278-289. https://doi.org/10.1093/nop/npab005
Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG 2nd, Deming R, Burri SH, Ménard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL. Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA. 2016;316(4):401-409. https://doi.org/10.1001/jama.2016.9839
Gaspar LE, Mehta MP, Patchell RA, Burri SH, Robinson PD, Morris RE, Ammirati M, Andrews DW, Asher AL, Cobbs CS, Kondziolka D, Linskey ME, Loeffler JS, McDermott M, Mikkelsen T, Olson JJ, Paleologos NA, Ryken TC, Kalkanis SN. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Journal of Neuro-Oncology. 2010;96(1):17-32. https://doi.org/10.1007/s11060-009-0060-9
Soffietti R, Kocher M, Abacioglu UM, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Mueller RP, Tridello G, Collette L, Bottomley A. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. Journal of Clinical Oncology. 2013;31(1):65-72. https://doi.org/10.1200/JCO.2011.41.0639
Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, Butowski N, Campian JL, Clark SW, Fabiano AJ, Forsyth P, -Hattangadi-Gluth J, Holdhoff M, Horbinski C, Junck L, Kaley T, Kumthekar P, Loeffler JS, Mrugala MM, Nagpal S, Pandey M, Parney I, Peters K, Puduvalli VK, Robins I, Rockhill J, Rusthoven C, Shonka N, Shrieve DC, Swinnen LJ, Weiss S, Wen PY, Willmarth NE, Bergman MA, Darlow SD. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2020;18(11):1537-1570. https://doi.org/10.6004/jnccn.2020.0052
Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. Journal of Clinical Oncology. 2011;29(2):134-141. https://doi.org/10.1200/JCO.2010.30.165
Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, Settle S, Prabhu SS, Lang FF, Levine N, McGovern S, Sulman E, McCutcheon IE, Azeem S, Cahill D, Tatsui C, Heimberger AB, Ferguson S, Ghia A, Demonte F, Raza S, Guha-Thakurta N, Yang J, Sawaya R, Hess KR, Rao G. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. The Lancet Oncology. 2017;18(8):1040-1048. https://doi.org/10.1016/S1470-2045(17)30414-X
Brennan C, Yang TJ, Hilden P, Zhang Z, Chan K, Yamada Y, Chan TA, Lymberis SC, Narayana A, Tabar V, Gutin PH, Ballangrud Å, Lis E, Beal K. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. International Journal of Radiation Oncology — Biology — Physics. 2014;88(1):130-136. https://doi.org/10.1016/j.ijrobp.2013.09.051
Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, Greenspoon J, Parney IF, Laack NNI, Ashman JB, Bahary JP, Hadjipanayis CG, Urbanic JJ, Barker FG 2nd, Farace E, Khuntia D, Giannini C, Buckner JC, Galanis E, Roberge D. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. The Lancet Oncology. 2017;18(8):1049-1060. https://doi.org/10.1016/S1470-2045(17)30441-2
Vetlova ER, Banov SM, Golanov AV, Pronin IN, Antipina NA, Galkin MV. Results of hypofractionated stereotactic radiotherapy for resected and intact large brain metastases. Burdenko’s Journal of Neurosurgery. 2023;87(6):67-75. (In Russ.). https://doi.org/10.17116/neiro20238706167
Soliman H, Ruschin M, Angelov L, Brown PD, Chiang VLS, Kirkpatrick JP, Lo SS, Mahajan A, Oh KS, Sheehan JP, Soltys SG, Sahgal A. Consensus Contouring Guidelines for Postoperative Completely Resected Cavity Stereotactic Radiosurgery for Brain Metastases. International Journal of Radiation Oncology — Biology — Physics. 2018;100(2):436-442. https://doi.org/10.1016/j.ijrobp.2017.09.047
Foreman PM, Jackson BE, Singh KP, Romeo AK, Guthrie BL, Fisher WS, Riley KO, Markert JM, Willey CD, Bredel M, Fiveash JB. Postoperative radiosurgery for the treatment of metastatic brain tumor: Evaluation of local failure and leptomeningeal disease. Journal of Clinical Neuroscience. 2018;49:48-55. https://doi.org/10.1016/j.jocn.2017.12.009
Marcrom SR, Foreman PM, Colvin TB, McDonald AM, Kirkland RS, Popple RA, Riley KO, Markert JM, Willey CD, Bredel M, Fiveash JB. Focal Management of Large Brain Metastases and Risk of Leptomeningeal Disease. Advances in Radiation Oncology. 2019;5(1):34-42. https://doi.org/10.1016/j.adro.2019.07.016
Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M, Norton HJ, Fraser RW. A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. International Journal of Radiation Oncology — Biology — Physics. 2014;88(4):899-906. https://doi.org/10.1016/j.ijrobp.2013.12.013
Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280(17):1485-1489. https://doi.org/10.1001/jama.280.17.1485
Udovicich C, Ng SP, Tange D, Bailey N, Haghighi N. From postoperative to preoperative: a case series of hypofractionated and single-fraction neoadjuvant stereotactic radiosurgery for brain metastases. Operative Neurosurgery. 2022;22(4):208-214. https://doi.org/10.1227/ONS.0000000000000101
Li YD, Coxon AT, Huang J, Abraham CD, Dowling JL, Leuthardt EC, Dunn GP, Kim AH, Dacey RG, Zipfel GJ, Evans J, Filiput EA, Chicoine MR. Neoadjuvant stereotactic radiosurgery for brain metastases: a new paradigm. Neurosurgical Focus. 2022;53(5):E8. https://doi.org/10.3171/2022.8.FOCUS22367
Nguyen TK, Sahgal A, Detsky J, Atenafu EG, Myrehaug S, Tseng CL, Husain Z, Heyn C, Maralani P, Ruschin M, Perry J, Soliman H. Predictors of leptomeningeal disease following hypofractionated stereotactic radiotherapy for intact and resected brain metastases. Neuro-Oncology. 2020;22(1):84-93. https://doi.org/10.1093/neuonc/noz144
Faruqi S, Ruschin M, Soliman H, Myrehaug S, Zeng KL, Husain Z, Atenafu E, Tseng CL, Das S, Perry J, Maralani P, Heyn C, Mainprize T, Sahgal A. Adverse Radiation Effect After Hypofractionated Stereotactic Radiosurgery in 5 Daily Fractions for Surgical Cavities and Intact Brain Metastases. International Journal of Radiation Oncology — Biology — Physics. 2020;106(4):772-779. https://doi.org/10.1016/j.ijrobp.2019.12.002
Prabhu RS, Miller KR, Asher AL, Heinzerling JH, Moeller BJ, Lankford SP, McCammon RJ, Fasola CE, Patel KR, Press RH, Sumrall AL, Ward MC, Burri SH. Preoperative stereotactic radiosurgery before planned resection of brain metastases: updated analysis of efficacy and toxicity of a novel treatment paradigm. Journal of Neurosurgery. 2018;131(5):1387-1394. https://doi.org/10.3171/2018.7.JNS181293
Patel KR, Nedzi L, Lau S, Barnett SL, Mickey BE, Moore W, Bindal S, Wardak Z, Dan T, Timmerman R, Patel TR. Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases. World Neurosurgery. 2018;120:e480-e487. https://doi.org/10.1016/j.wneu.2018.08.107
Patel KR, Burri SH, Asher AL, Crocker IR, Fraser RW, Zhang C, Chen Z, Kandula S, Zhong J, Press RH, Olson JJ, Oyesiku NM, Wait SD, Curran WJ, Shu HK, Prabhu RS. Comparing Preoperative With Postoperative Stereotactic Radiosurgery for Resectable Brain Metastases: A Multi-institutional Analysis. Neurosurgery. 2016;79(2):279-285. https://doi.org/10.1227/NEU.0000000000001096
Patel KR, Burri SH, Boselli D, Symanowski JT, Asher AL, Sumrall A, Fraser RW, Press RH, Zhong J, Cassidy RJ, Olson JJ, Curran WJ, Shu HG, Crocker IR, Prabhu RS. Comparing pre-operative stereotactic radiosurgery (SRS) to post-operative whole brain radiation therapy (WBRT) for resectable brain metastases: a multi-institutional analysis. Journal of Neuro-Oncology. 2017;131(3):611-618. https://doi.org/10.1007/s11060-016-2334-3
Vetlova E, Golbin DA, Golanov AV, Potapov AA, Banov SM, Antipina N, Kostjuchenko VV, Usachev DY, Belyaev AY, Goryaynov S. Preoperative Stereotactic Radiosurgery of Brain Metastases: Preliminary Results. Cureus. 2017;9(12):e1987. https://doi.org/10.7759/cureus.1987
Murphy E, Yang K, Suh J, Yu J, Schilero C, Mohammadi A, Stevens G, Angelov L, Vogelbaum M, Barnett G, Ahluwalia M, Neyman G, Chao S. Trls-05. Early results from a prospective phase i/ii dose escalation study of neoadjuvant radiosurgery for brain metastases. Neuro-Oncology Advances. 2019;1(suppl 1):i9. https://doi.org/10.1093/noajnl/vdz014.038
Nieder C, Andratschke NH, Geinitz H, Grosu AL. Diagnosis-specific graded prognostic assessment score is valid in patients with brain metastases treated in routine clinical practice in two European countries. Medical Science Monitor. 2012;18(7):CR450-455. https://doi.org/10.12659/MSM.883213

Close metadata