scholarly journals Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience

2016 ◽  
Vol 41 (4) ◽  
pp. E11 ◽  
Author(s):  
Mir Amaan Ali ◽  
Kate T. Carroll ◽  
Robert C. Rennert ◽  
Thomas Hamelin ◽  
Leon Chang ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Metastases ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Corticosteroid Treatment ◽  
Significant Heterogeneity ◽  
Effective Treatment Option ◽  
Ablation Efficiency ◽  
Collective Experience ◽  
Risk Of Disease

OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1). With a median follow-up duration of 141 days (range 64–794 days), 9 of the SLA-treated BMs progressed despite treatment (35%). All cases of progression occurred in BMs in which < 80% ablation was achieved, whereas no disease progression was observed in BMs in which ≥ 80% ablation was achieved. Five BMs were treated with SLA, followed 1 month later by adjuvant SRS (5 Gy daily × 5 days). No disease progression was observed in these patients despite ablation efficiency of < 80%, suggesting that adjuvant hypofractionated SRS enhances the efficacy of SLA. Of the 23 SLA-treated patients, 3 suffered transient hemiparesis (13%), 1 developed hydrocephalus requiring temporary ventricular drainage (4%), and 1 patient who underwent SLA of a 28.9-cm3 lesion suffered a neurological deficit requiring an emergency hemicraniectomy (4%). Although there is significant heterogeneity in corticosteroid treatment post-SLA, most patients underwent a 2-week taper. CONCLUSIONS Stereotactic laser ablation is an effective treatment option for BMs in which SRS fails. Ablation of ≥ 80% of BMs is associated with decreased risk of disease progression. The efficacy of SLA in this setting may be augmented by adjuvant hypofractionated SRS.

Addition of upfront whole-brain radiotherapy to surgery or stereotactic radiosurgery versus surgery or stereotactic radiosurgery alone for treatment of brain metastases: A systematic review and meta-analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2016-2016
Author(s):  
Yu Yang Soon ◽  
Ivan Weng Keong Tham ◽  
Keith Hsiu Chin Lim ◽  
Wee Yao Koh ◽  
Jiade Jay Lu
Keyword(s):  
Brain Metastases ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
Neurological Toxicity ◽  
Brain Radiotherapy ◽  
Intracranial Disease ◽  
One Year

2016 Background: The benefits of adding upfront whole-brain radiotherapy (WBRT) to surgery or stereotactic radiosurgery (SRS) when compared to surgery or SRS alone for treatment of brain metastases are unclear. We performed a systematic review and meta-analysis of published randomized controlled trials (RCT) to determine the efficacy and safety of additional upfront WBRT. Methods: We searched MEDLINE, EMBASE, CENTRAL from date of inception and annual meeting proceedings of ASCO and ASTRO from 1999 to September 2011 for RCTs comparing surgery or SRS plus WBRT with surgery or SRS alone for treatment of brain metastases. The primary outcome was overall survival (OS). Secondary outcomes include progression free survival (PFS), local and distant intracranial disease progression, neurocognitive function (NF), quality of life (Qol) and neurological toxicity. Hazard ratios (HR), confidence intervals (CI), p values (p) were estimated with random effects models using Revman 5.1. Results: We found five RCTs including 663 patients with one to four brain metastases. Adding upfront WBRT decreased the one-year incidence of any intracranial disease progression from 73-76% to 22 - 47% but did not improve OS (HR 1.11, 95%CI 0.83 - 1.48, p = 0.47) and PFS (HR 0.76, 95%CI 0.53 - 1.10, p = 0.14). Subgroup analyses showed that the effects on overall survival are similar regardless of types of focal therapy used, number of brain metastases, dose and sequence of WBRT. The effects of upfront WBRT on NF, Qol and neurological toxicity were variable. Conclusions: Adding upfront WBRT to surgery or SRS significantly decreased any intracranial disease progression at one year but did not improve overall and progression free survival and produced variable effects on neurocognitive function, quality of life and neurological toxicity when compared with surgery or SRS alone. Future research should focus on developing more effective approaches to characterize and ameliorate the potential neurological toxicity of WBRT.

Stereotactic Laser Ablation as Treatment of Brain Metastases Recurring after Stereotactic Radiosurgery: A Systematic Literature Review

2019 ◽  
Vol 128 ◽  
pp. 134-142 ◽  
Author(s):  
Ali A. Alattar ◽  
Jiri Bartek ◽  
Veronica L. Chiang ◽  
Alireza M. Mohammadi ◽  
Gene H. Barnett ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Literature Review ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Systematic Literature Review

scholarly journals RADI-34. USE OF LOW-DOSE STEREOTACTIC RADIOSURGERY FOR ADVANCED BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i28-i28
Author(s):  
Daniel Yang ◽  
James Yu ◽  
Veronica Chiang
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Low Dose ◽  
Treatment Time ◽  
Standard Dose ◽  
Braf V600e ◽  
Tumor Control ◽  
Poor Performance Status

Abstract BACKGROUND: Gamma knife stereotactic radiosurgery (GKSRS) is commonly used to treat brain metastases. However, treatment time significantly increases as a function of increasing dose and number of lesions treated. In patients with large number of brain metastases, advanced disease, and poor performance status, low-dose GKSRS may be better tolerated and allows for safer re-treatment with radiotherapy should tumors recur. METHODS: We queried our institutional GKSRS database and identified patients treated with low-dose GKSRS for brain metastases as defined by a prescription of 12–15 Gy margin dose. Overall survival was measured from time of initial low-dose GKSRS to death or study exit. A composite endpoint of time to additional GKSRS, whole brain radiotherapy (WBRT), craniotomy, or death was used to examine disease progression. RESULTS: We identified 30 patients treated with low-dose GKSRS at a single institution between 2008 to 2018. A total of 428 brain metastases were treated, with a median of 12 (IQR=4–20) brain metastases per patient. Thirteen patients received immunotherapy concurrent with low-dose GKSRS, and 23 patients received mutation-targeted therapy or immunotherapy. Median overall survival was 238 (IQR 91–580) days, and median composite time to disease progression was 121 (IQR = 33–371) days. The two longest survivors in our cohort are alive at over three years. One had testicular cancer, and the other had melanoma. The metastatic melanoma patient had a BRAF V600E tumor and received mutation-targeted systemic therapy. He received standard-dose GKSRS and WBRT prior to low-dose GKSRS, as well as immunotherapy prior to and concurrent with low-dose GKSRS. CONCLUSIONS: A heterogenous population with large number of brain metastases was treated with low-dose GKSRS, with acceptable but varied results in terms of survival and tumor control. Further study with larger cohorts is warranted to optimize selection criteria and timing of low-dose GKSRS with other radiotherapy and systemic agent.

scholarly journals SURG-27. STEREOTACTIC LASER ABLATION (SLA) AS TREATMENT FOR BRAIN METASTASES THAT RECUR AFTER STEREOTACTIC RADIOSURGERY: A MULTI-INSTITUTIONAL EXPERIENCE

2016 ◽  
Vol 18 (suppl_6) ◽  
pp. vi196-vi196
Author(s):  
Clark Chen ◽  
Mir Amaan ◽  
Robert Rennert ◽  
Kate Carroll ◽  
Mayur Sharma ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Institutional Experience

scholarly journals Case Report: Clinical Experience With Avelumab in Patients With Metastatic Merkel Cell Carcinoma and Brain Metastases Treated in Europe

2021 ◽  
Vol 11 ◽  
Author(s):  
Kate Fife ◽  
Pauline Tétu ◽  
Jessica Prabhakaran ◽  
Celeste Lebbé ◽  
Giovanni Grignani
Keyword(s):  
Brain Metastasis ◽  
Partial Response ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Complete Response ◽  
Merkel Cell ◽  
Patient Case ◽  
Recist 1.1

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer that can metastasize rapidly. In patients with metastatic MCC (mMCC), brain metastases are uncommon but are associated with poor prognosis; furthermore, there is limited published literature regarding treatment of these patients, and no specific regimens are currently recommended by guidelines. Avelumab, an anti–programmed death ligand 1 monoclonal antibody, was the first approved treatment for patients with mMCC. Here, we present 4 cases of patients with mMCC and brain metastases treated with avelumab. Patient age ranged from 48 to 70 years, and all patients received avelumab as second-line therapy following disease progression with platinum-based chemotherapy. Patient cases 1 and 2 received avelumab alone and experienced rapid disease progression according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). In patient case 3, avelumab alone resulted in a prolonged complete response by RECIST 1.1 of 1 brain metastasis and partial response by RECIST 1.1 of a second brain metastasis. After 11 months of avelumab treatment, the patient received concurrent stereotactic radiosurgery that resulted in complete response of the second metastasis. Patient case 4 achieved a partial response by RECIST 1.1 with avelumab plus stereotactic radiosurgery. These results suggest that avelumab followed by radiotherapy or with concurrent radiotherapy may be an effective treatment option for patients with mMCC and brain metastases.

scholarly journals Intracranial Response of Brain Metastases to Osimertinib With or Without Upfront Stereotactic Radiosurgery in TKI-Naïve Nonsmall Cell Lung Cancer Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Michael Chuwei Jin ◽  
Elisa K Liu ◽  
Charles W Macaulay ◽  
Amanda Gian ◽  
Siyu Shi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Disease Progression ◽  
Stereotactic Radiosurgery ◽  
Cell Lung Cancer ◽  
Brain Mri ◽  
Nonsmall Cell Lung Cancer ◽  
Nsclc Patients ◽  
Serial Brain

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is an accepted standard of care for the treatment of brain metastases. However, the benefit of upfront SRS in combination with osimertinib, which has excellent intracranial penetrance, for patients with EGFR-mutant nonsmall cell lung cancer (NSCLC) is unknown. Improved understanding of brain metastasis dynamics in patients treated with osimertinib without intracranial radiotherapy (icRT) could provide insight into the additive benefit of upfront SRS. METHODS This retrospective cohort study included TKI-naïve NSCLC patients with brain metastases treated with osimertinib between 2017 and 2019 at Stanford University. Mutation status was determined by next generation sequencing (NGS), digital droplet polymerase chain reaction (PCR), or EGFR sequencing. Serial brain magnetic resonance imaging (MRIs) were interrogated for intracranial progression and metastasis response. RESULTS A total of 32 patients with 204 brain metastases were identified. A total of 16 patients received osimertinib with upfront icRT (15 SRS) while 16 received osimertinib alone. EGFR mutations were identified, with 17 patients receiving targeted NGS. Initial sizes of measurable brain metastases were similar in patients treated with icRT compared to those receiving osimertinib alone (median 4.5 mm vs 5.0 mm, P = .3813). Number of measurable brain metastases were similar (median 3.5 vs 5.5, P = .2322). A total of 11 (34.4%) patients experienced disease progression on osimertinib (8 [25%] intracranial, 7 [21.9%] extracranial). Changes in brain metastasis size of patients receiving osimertinib alone were assembled based on serial brain MRI. Although changes in metastasis size were not evident in the first MRI after starting osimertinib (Pscan1 = 0.4928), subsequent scans demonstrated increased stratification (Pscan2 = 0.0043 and Pscan3 = 0.0131). CONCLUSION TKI-naïve NSCLC patients receiving osimertinib demonstrate good intracranial response. Understanding the dynamics of metastasis growth could help identify patients at risk for disease progression and those most likely to benefit from icRT.

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