Artikel
Hypofractionated stereotactic radiosurgery (hSRS) for the treatment of brain metastases
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Autoren
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Sergej Telentschak
- Uniklinik Köln, Allgemeine Neurochirurgie, Köln, Deutschland
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Daniel Rueß
- Uniklinik Köln, Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
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Stefan Grau
- Uniklinik Köln, Allgemeine Neurochirurgie, Köln, Deutschland
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Roland Goldbrunner
- Uniklinik Köln, Allgemeine Neurochirurgie, Köln, Deutschland
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Karolina Jablonska
- Uniklinik Köln, Strahlentherapie, Köln, Deutschland
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Harald Treuer
- Uniklinik Köln, Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
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Martin Kocher
- Uniklinik Köln, Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
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Maximilian I. Ruge
- Uniklinik Köln, Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: The introduction of hypofractionated stereotactic radiosurgery (hSRS) has extended indications beyond the well-established single fraction stereotactic radiosurgery (SRS) to tumor size >3 cm and/or tumors localized in eloquent brain areas (i.e. brainstem, basal ganglia, central sulcus area). Especially patients harboring brain metastases (BM) with those features show a very poor prognosis.However, clinical data regarding the oncological efficacy and potential side effects applying hSRS using Cyberknife® for the treatment of those BM are limited. Here we report about our previous experience.
Methods: For this single centre retrospective analysis we included all patients who underwent Cyberknife® hSRS from 2014 to 2017. Following a prospective protocol we applied a median surface dose of 27 Gy in 3 fractions (median isodose level 65%). Patient data was analyzed in terms of progression free survival (PFS), local control (LC) by follow up MRI, overall survival (OS) using Kaplan-Meier and treatment related early and late complications (rated by using the Common Terminology Criteria for Adverse Events, CTCAE, v4.03).
Results: We identified 34 patients with 75 BM (median diameter 2.0 cm; range 0.4 - 4.3 cm). Main indications for Cyberknife® hSRS were large tumor size (i.e. ≥3 cm supra- and ≥2 cm infratentorially, n=18, 53%) and eloquent localization (n=14, 41%). Median MRI follow-up (FU) was 6 months (range 3–16) with data available from 20 patients with 52 tumors. PFS was 44%, 37% and 11% and OS was 69%, 49% and 23% after 3, 6 and 12 months, respectively.
The LC rates of the 52 brain metastases with available imaging follow up were 96%, 92% and 71% at 3, 6 and 12 months. Adverse events grade 1-3 according to CTCAE were overall observed in 21% (n=7/34). Early complications at the time of treatment were present in one case (2%).
Conclusion: hSRS using Cyberknife for the treatment of cerebral metastases is feasible and reasonably tolerated with few early treatment related complications. While local control rates are promising, PFS and OS are poor in context of the heterogeneous prognosis of cancer patients with large or eloquently localized brain metastases.
