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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.