Skip to main content

Advertisement

Table 4 Comparative series

From: Local control after radiosurgery for brain metastases: predictive factors and implications for clinical decision

Author, year Patients/ Lesions Treatment options Dose Local Control (LC) Predictive factors Complication (%)
Noel G, [5] 92/ 145 SRS alone: 34 (37%) WBRT: 30Gy/10 or 40Gy/20 6-months: 93% 1-y: 86% high maximal dose delivered at the isocentre of the GTV 8 - radiation necrosis (5.5%)
   SRS + WBRT: 22 (24%) SRS alone: 14Gy* SRS alone:   1 - seizure
   WBRT + salvage SRS: 36 (39%) SRS plus WBRT: 10Gy* 6-m: 90% 1-y: 78%   
    * On 70% isodose line SRS + WBRT: 6-m/1-y: 90%   
WBRT + SRS:
6-m: 92% 1-y: 86% (NS)
Noel G, [6] 54/ 97 WBRT + salvage SRS WBRT: 30-40Gy 1-y: 91.3% 2-y: 84% no prognostic factors for local control no major complications
   SRS  
minimun dose: 14.4Gy (12.3-19.3) 2 - transient headaches secondary to edema
maximum dose: 20.9 Gy (17.3-38.8) 2 - temporary grade 2 alopecia
Vogelbaum, [12] 202/ 375 SRS alone: 48 (24%) ≤20 mm: 24Gy median: dose to the tumor margin 6 - proven radiation necrosis
  SRS + WBRT: 37 (18%) 21-30 mm: 18Gy 24Gy: NR** 18Gy: 11,57 m 15Gy: 11,83 m   
WBRT + salvage SRS: 117 (58%) 31-40 mm: 15Gy 1-y 24Gy: 85%** 18Gy: 49% 15Gy: 45%
* At tumor margin (50% isodose line), independent if previous WBRT or not ** for 24 Gy compared with 18 or 15 Gy
Shehata, [13] 160/ 468 SRS alone: 228 mets (49%) planned WBRT: 6.75– 50.4 Gy (median 40.5 Gy) Overall LC addition of WBRT trend toward greater complications (RTOG Grade 3 or 4) for SRS doses >20 × ≤20 Gy (p = 0.078)
SRS + planned WBRT: 240 mets (51%) SRS: 7-30Gy at the 40–95% isodose (median 60%) SRS alone: 87% SRS + WBRT: 97% If planned WBRT - dose
  maximal dose:10.7-50 Gy (median 30 Gy) 1-y tumor volume
SRS alone: 77% SRS + WBRT: 96% **
SRS < 20 Gy + WBRT: 91%
SRS ≥ 20 Gy + WBRT: 99%**
If 20Gy: 99% >20Gy: 96% (NS)
Schomas, [14] 80/ 126 SRS alone: 11 (14%) WBRT: 25–46 Gy in 2–3 Gy 1-y: 88.6% minimum target dose 3 patients (5%)
SRS + planned WBRT: 69 (86%) SRS: 18 Gy (10–21) SRS + WBRT: 88.8% 2 - edema
SRS alone: 87.5% (NS) 1 - radiation necrosis (confirmed by resection)
Per dose ** ≤ 12Gy: 66.7% 2- within SRS field
12.1-18Gy: 93.8%   1- outside field (previous WBRT)
>18Gy: 93.3%
2-y: 77.2%
Chao, [15] 111/ NA WBRT + salvage SRS WBRT: 37.5 Gy (30–50) 1-y: 68% tumor size dose 2 - radiation necrosis (5,5 months and 1.5 year after SRS)
SRS: 2-y: 59% 1 - seizure
≤20 mm: 24Gy 21-30 mm: 18Gy
31-40 mm: 15Gy
>40 mm: 12Gy
Chang, [16] 135/ 153 SRS alone: 71 (52,6%) WBRT: 30Gy (22.5-40Gy) 1-y: 69% tumor volume cone diameter edema with mass effect (14%)
SRS + WBRT: 30 (22,2%) SRS ≤1 × > 1 cm: 86 × 56%**   Pathologically proven necrosis (1,3%)
WBRT + salvage SRS: 32 (23,7%) Minimum peripheral dose: 20-24Gy 2-y: 46%   Hemorrhage (4,6%)
≤1 × > 1 cm: 78 × 24%**
Our series, 2015 100/216 SRS alone: 121 (56%) WBRT: 30 Gy (median) 1-y: dose at the PTV margin 8 – asymptomatic radiation necrosis
WBRT + salvage SRS: 95 (44%) SRS alone: 20 Gy (median) SRS alone: 78.4%   2 – symptomatic radiation necrosis
WBRT + salvage SRS: 16 Gy (median) WBRT + SRS: 57.9%**
Per dose**:
≤15 Gy: 39.6%
16-20Gy: 71.7%
≥21 Gy: 92.3
  1. Legends: * isodose prescription; ** statistically significant; NS: not significant; NA: not available.