Artikel
Radiosurgery (RS) and multisession radiosurgery (msRS) of brain metastases – treatment strategies and special aspects
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Autoren
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Susanne Fichte
- CyberKnife Centrum Mitteldeutschland, im Hauptgebäude des HELIOS Klinikum Erfurt, Erfurt, Deutschland
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Hans-Ulrich Herold
- CyberKnife Centrum Mitteldeutschland, Erfurt, Deutschland
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Gunnar Surber
- CyberKnife Centrum Mitteldeutschland, Erfurt, Deutschland
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Klaus Hamm
- im HELIOS Klinikum Erfurt, Erfurt, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Radiosurgery (RS) is a well-accepted therapeutic option for brain metastases and increasingly used even for multiple metastases. The authors describe the treatment strategies and outcomes of patients treated in our department after implementation of a CyberKnife robotic radiosurgery device, with a special focus on multisession radiosurgery, RS of the resection cavity and repeated radiosurgery.
Methods: From October 2012 to December 2015, 163 patients were treated for brain metastases. Patient data, planning details and imaging were analyzed retrospectively. For follow-ups, contrast-enhanced MRI was fused to the initial imaging. Tumor response was evaluated for each target volume and local control rate was assessed at 3, 6 and 12 months after treatment. Additionally, regional progression (new brain metastases) was documented. Kaplan-Meier estimation was used for statistical analysis of survival and local progression-free survival.
Results: 163 patients underwent radiosurgery for a total of 364 brain metastases (1-9 per session). Multisession RS was used in case of large target volumes and/or neurological deficits in 47 of initial treatments. 23 patients had radiosurgery of resection cavities following neurosurgery. 23, 9 and 2 patients were treated 2, 3 or 4 times, respectively, during the evaluation period. Follow-up was complete for 158 patients. Mean time of follow-up was 12,2 (0,3-45,7) months. Overall survival was 67% and 46% at 6 and 12 months, respectively. Complete imaging was available for 98, 70 and 44 patients at 3, 6 and 12 months. Local control rate was 97,1%, 89,5% and 78,5% at 3, 6 and 12 months. 56 patients had regional progression after a mean time of 7,6 (1-39) months. In 26 patients, repeated radiosurgery was performed up to August 2016.
Conclusion: RS and msRS are safe options for treatment of brain metastases with a good rate of local control. Repeated radiosurgical treatment can be performed in cases of local and distant tumor progression, avoiding or postponing whole-brain radiation. Radiosurgery is also an option for local failure after WBRT.
