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01.01.2008 | Review

Radiosurgery in the treatment of brain metastases: critical review regarding complications

verfasst von: Marcos Vinícius Calfat Maldaun, Paulo Henrique Pires Aguiar, Frederick Lang, Dima Suki, David Wildrick, Raymond Sawaya

Erschienen in: Neurosurgical Review | Ausgabe 1/2008

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Abstract

Stereotactic radiosurgery (SRS) has been described as an effective treatment option for brain metastases. In general, SRS has been indicated for the treatment of lesions smaller than 3 cm in maximum diameter and for lesions considered not surgically treatable, owing to the patient’s clinical status or because the lesion was located in or near eloquent brain areas. In several studies, SRS has been associated with clinical and radiographic improvement of the lesions and has been compared with surgery as the modality of choice for brain metastases. Beyond the high rate of local disease control with SRS, the few complications that have been described occurred mainly in the acute post treatment period. Most publications have addressed the outcome and effectiveness of this treatment modality but have not critically analyzed long-term complications, steroid dependency, or results relating to specific brain locations. It is important to understand the radiobiologic effects of a well-demarcated high dose of radiation on the brain lesion, controlling the tumor growth and not causing significant alteration of the related brain region, especially in an area controlling eloquent function.

Auchter RM, Lamond JP, Alexander E et al (1996) A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35PubMedCrossRef

Bance M, Guha A (2001) Radiation-induced malignant tumors after stereotactic radiosurgery. Otol Neurotol 22:124–125PubMedCrossRef

Bindal AK, Bindal RK, Hess KR et al (1996) Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg 84:748–754PubMed

Boyd TS, Mehta MP (1999) Stereotactic radiosurgery for brain metastases. Oncology (Williston Park) 13:1397–1409

Brown PD, Brown CA, Pollock BE, Gorman DA, Foote RL (2002) Stereotactic radiosurgery for patients with “radioresistant” brain metastases. Neurosurgery 51:656–665; discussion 665–657PubMedCrossRef

Burri SH, Asher A, Shaffrey M (2004) Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 54:1033–1034; author reply 1034–1035PubMedCrossRef

Chang EL, Selek U, Hassenbusch SJ 3rd et al (2005) Outcome variation among “radioresistant” brain metastases treated with stereotactic radiosurgery. Neurosurgery 56:936–945; discussion 936–945PubMed

Chin LS, Lazio BE, Biggins T, Amin P (2000) Acute complications following gamma knife radiosurgery are rare. Surg Neurol 53:498–502; discussion 502PubMedCrossRef

Chitapanarux I, Goss B, Vongtama R et al (2003) Prospective study of stereotactic radiosurgery without whole brain radiotherapy in patients with four or less brain metastases: incidence of intracranial progression and salvage radiotherapy. J Neurooncol 61:143–149PubMedCrossRef

10.

Cho KG, Hoshino T, Pitts LH, Nomura K, Shimosato Y (1988) Proliferative potential of brain metastases. Cancer 62:512–515PubMedCrossRef

11.

Flickinger JC, Schell MC, Larson DA (1990) Estimation of complications for linear accelerator radiosurgery with integrated logistic formula. Int J Radiat Oncol Biol Phys 19(1):143–148PubMed

12.

Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751PubMedCrossRef

13.

Gerosa M, Nicolato A, Foroni R, Tomazzoli L, Bricolo A (2005) Analysis of long-term outcomes and prognostic factors in patients with non-small cell lung cancer brain metastases treated by gamma knife radiosurgery. J Neurosurg 102(Suppl):75–80

14.

Gerosa M, Nicolato A, Foroni R et al (2002) Gamma knife radiosurgery for brain metastases: a primary therapeutic option. J Neurosurg 97:515–524PubMed

15.

Goodman KA, Sneed PK, McDermott MW et al (2001) Relationship between pattern of enhancement and local control of brain metastases after radiosurgery. Int J Radiat Oncol Biol Phys 50:139–146PubMedCrossRef

16.

Hillard VH, Shih LL, Chin S, Moorthy CR, Benzil DL (2003) Safety of multiple stereotactic radiosurgery treatments for multiple brain lesions. J Neurooncol 63:271–278PubMedCrossRef

17.

Hopewell JW, van der Kogel AJ (1999) Pathophysiological mechanisms leading to the development of late radiation-induced damage to the central nervous system. Front Radiat Ther Oncol 33:265–275PubMed

18.

Huber PE, Hawighorst H, Fuss M, van Kaick G, Wannenmacher MF, Debus J (2001) Transient enlargement of contrast uptake on MRI after linear accelerator (linac) stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 49:1339–1349PubMedCrossRef

19.

Jawahar A, Ampil F, Wielbaecher C, Hartman GH, Zhang JH, Nanda A (2004) Management strategies for patients with brain metastases: has radiosurgery made a difference? South Med J 97:254–258PubMedCrossRef

20.

Kamiryo T, Kassell NF, Thai QA, Lopes MB, Lee S, Steiner L (1996) Histological changes in the normal rat brain after gamma irradiation. Acta Neurochir (Wien) 138(4):451–459CrossRef

21.

Karger CP, Munter MW, Heiland S, Peschke P, Debus J, Hartmann GH (2002) Dose–response curves and tolerance doses for late functional changes in the normal rat brain after stereotactic radiosurgery evaluated by magnetic resonance imaging: influence of end points and follow-up time. Radiat Res 157(6):617–625PubMedCrossRef

22.

Kim DG, Chung HT, Gwak HS, Paek SH, Jung HW, Han DH (2000) Gamma knife radiosurgery for brain metastases: prognostic factors for survival and local control. J Neurosurg 93(Suppl 3):23–29PubMed

23.

Kocher M, Treuer H, Vogs J, Hoevels M, Sturm V, Muller RP (2000) Computer simulation of cytotoxic and vascular effects of radiosurgery in solid and necrotic brain metastases. Radiother Oncol 54(2):149–156PubMedCrossRef

24.

Kondziolka D, Lunsford LD, Claassen D, Maitz AH, Flickinger JC (1992) Radiobiology of radiosurgery: part I. The normal rat brain model. Neurosurgery 31(2):271–279PubMedCrossRef

25.

Kondziolka D, Lunsford LD, Witt TC, Flickinger JC (2000) The future of radiosurgery: radiobiology, technology, and applications. Surg Neurol 54:406–414PubMedCrossRef

26.

Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD (2005) Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients’ perspective regarding complications. Am J Clin Oncol 28:173–179PubMedCrossRef

27.

Leksell L (1968) Cerebral radiosurgery. I. Gammathalanotomy in two cases of intractable pain. Acta Chir Scand 134:585–595PubMed

28.

Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316PubMed

29.

Lippitz BE, Kraepelien T, Hautanen K et al (2004) Gamma knife radiosurgery for patients with multiple cerebral metastases. Acta Neurochir Suppl 91:79–87PubMed

30.

Liu Y, Xiao S, Liu M et al (2000) Analysis of related factors in complications of stereotactic radiosurgery in intracranial tumors. Stereotact Funct Neurosurg 75:129–132PubMedCrossRef

31.

Loeffler JS, Shrieve DC (1994) What is appropriate therapy for a patient with a single brain metastasis? Int J Radiat Oncol Biol Phys 29:915–917; discussion 920PubMed

32.

Maor MH, Dubey P, Tucker SL et al (2000) Stereotactic radiosurgery for brain metastases: results and prognostic factors. Int J Cancer 90:157–162PubMedCrossRef

33.

Marcou Y, Lindquist C, Adams C, Retsas S, Plowman PN (2001) What is the optimal therapy of brain metastases? Clin Oncol (R Coll Radiol) 13:105–111

34.

Matsuo T, Shibata S, Yasunaga A et al (1999) Dose optimization and indication of Linac radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 45:931–939PubMedCrossRef

35.

McIver JI, Pollock BE (2004) Radiation-induced tumor after stereotactic radiosurgery and whole brain radiotherapy: case report and literature review. J Neurooncol 66:301–305PubMedCrossRef

36.

Mehta M, Noyes W, Craig B et al (1997) A cost-effectiveness and cost-utility analysis of radiosurgery vs. resection for single-brain metastases. Int J Radiat Oncol Biol Phys 39:445–454PubMedCrossRef

37.

Munter MW, Karger CP, Reith W, Schneider HM, Peschke P, Debus J (1999) Delayed vascular injury after single high-dose irradiation in the rat brain: histologic, immunohisochemical, and angiographic studies. Radiology 212:475–482PubMed

38.

Nieder C, Nestle U, Motaref B, Walter K, Niewald M, Schnabel K (2000) Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes? Int J Radiat Oncol Biol Phys 46:297–302PubMedCrossRef

39.

Noel G, Medioni J, Valery CA et al (2003) Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer. Lung Cancer 41:333–343PubMedCrossRef

40.

Oh B, Pagnini PG, Wang MY, Liu C, Kim PE, Yu C, Apuzzo MLJ (2007) Stereotactic radiosurgery: adjacent tissue injury and response after high-dose single fraction radiation: part I—histology, imaging, and molecular events. Neurosurgery 60(1):31–45PubMedCrossRef

41.

O’Neill BP, Iturria NJ, Link MJ, Pollock BE, Ballman KV, O’Fallon JR (2003) A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 55:1169–1176PubMedCrossRef

42.

Petrovich Z, Yu C, Giannotta SL, O’Day S, Apuzzo ML (2002) Survival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery. J Neurosurg 97:499–506PubMed

43.

Posner JB (1992) Management of brain metastases. Rev Neurol (Paris) 148:477–487

44.

Sansur CA, Chin LS, Ames JW et al (2000) Gamma knife radiosurgery for the treatment of brain metastases. Stereotact Funct Neurosurg 74:37–51PubMedCrossRef

45.

Sawaya R (1999) Surgical treatment of brain metastases. Clin Neurosurg 45:41–47PubMed

46.

Sawaya R, Hammoud M, Schoppa D et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1056PubMedCrossRef

47.

Schoggl A, Kitz K, Reddy M et al (2000) Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir (Wien) 142:621–626CrossRef

48.

Shaw E, Scott C, Souhami L et al (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47:291–298PubMedCrossRef

49.

Sheehan J, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD (2004) The expanding role of neurosurgeons in the management of brain metastases. Surg Neurol 62:32–40; discussion 40–31PubMedCrossRef

50.

Sheehan JP, Sun MH, Kondziolka D, Flickinger J, Lunsford LD (2002) Radiosurgery for non-small cell lung carcinoma metastatic to the brain: long-term outcomes and prognostic factors influencing patient survival time and local tumor control. J Neurosurg 97:1276–1281PubMedCrossRef

51.

Shehata MK, Young B, Reid B et al (2004) Stereotactic radiosurgery of 468 brain metastases < or =2 cm: implications for SRS dose and whole brain radiation therapy. Int J Radiat Oncol Biol Phys 59:87–93PubMedCrossRef

52.

Shinoura N, Yamada R, Okamoto K, Nakamura O, Shitara N (2002) Local recurrence of metastatic brain tumor after stereotactic radiosurgery or surgery plus radiation. J Neurooncol 60:71–77PubMedCrossRef

53.

Simonova G, Liscak R, Novotny J Jr, Novotny J (1999) [Radiosurgery with the Leksell gamma knife in the treatment of solitary brain metastasis—5-year results]. Vnitr Lek 45:284–290PubMed

54.

Simonova G, Liscak R, Novotny J Jr, Novotny J (2000) Solitary brain metastases treated with the Leksell gamma knife: prognostic factors for patients. Radiother Oncol 57:207–213PubMedCrossRef

55.

Siomin VE, Vogelbaum MA, Kanner AA, Lee SY, Suh JH, Barnett GH (2004) Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery. J Neurooncol 67:115–121PubMedCrossRef

56.

Sperduto PW (2003) A review of stereotactic radiosurgery in the management of brain metastases. Technol Cancer Res Treat 2:105–110PubMed

57.

Sturm V, Kober B, Hover KH et al (1987) Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator. Int J Radiat Oncol Biol Phys 13:279–282PubMed

58.

Suh JH, Vogelbaum MA, Barnett GH (2004) Update of stereotactic radiosurgery for brain tumors. Curr Opin Neurol 17:681–686PubMedCrossRef

59.

Suzuki H, Toyoda S, Muramatsu M, Shimizu T, Kojima T, Taki W (2003) Spontaneous haemorrhage into metastatic brain tumours after stereotactic radiosurgery using a linear accelerator. J Neurol Neurosurg Psychiatry 74:908–912PubMedCrossRef

60.

Szeifert GT, Massager N, DeVriendt D et al (2002) Observations of intracranial neoplasms treated with gamma knife radiosurgery. J Neurosurg 97:623–626PubMed

61.

Szeifert GT, Salmon I, Rorive S et al (2005) Does gamma knife surgery stimulate cellular immune response to metastatic brain tumors? A histopathological and immunohistochemical study. J Neurosurg 102(Suppl):180–184

62.

Takahashi M, Narabayashi I, Kuroiwa T, Uesugi Y, Tatsumi T, Inomata T (2003) Stereotactic radiosurgery (SRS) for multiple metastatic brain tumors: effects of the number of target tumors on exposure dose in normal brain tissues. Int J Clin Oncol 8:289–296PubMedCrossRef

63.

Thomson JA, Parsons PG, Sturm RA (1993) In vivo and in vitro expression of octamer binding proteins in human melanoma metastases, brain tissue, and fibroblasts. Pigment Cell Res 6:13–22PubMedCrossRef

64.

Ulm AJ, Friedman WA, Bova FJ, Bradshaw P, Amdur RJ, Mendenhall WM (2004) Linear accelerator radiosurgery in the treatment of brain metastases. Neurosurgery 55:1076–1085PubMedCrossRef

65.

Van der Koegel A (1991) Central nervous system radiation injury in animal models. In: Gutin P, Leibel S, Sheline G (eds) Radiation injury to the nervous system. Raven, New York, pp 91–111

66.

Vecil GG, Suki D, Maldaun MV, Lang FF, Sawaya R (2005) Resection of brain metastases previously treated with stereotactic radiosurgery. J Neurosurg 102:209–215PubMed

67.

Voges J, Treuer H, Sturm V, Buchner C, Lehrke R, Kocher M, Staar S, Kuchta J, Muller RP (1996) Risk analysis of linear accelerator radiosurgery. Int J Radiat Oncol Biol Phys 36(5):1055–1063PubMedCrossRef

68.

Warnick RE, Darakchiev BJ, Breneman JC (2004) Stereotactic radiosurgery for patients with solid brain metastases: current status. J Neurooncol 69:125–137PubMedCrossRef

69.

Wellis G, Nagel R, Vollmar C, Steiger HJ (2003) Direct costs of microsurgical management of radiosurgically amenable intracranial pathology in Germany: an analysis of meningiomas, acoustic neuromas, metastases and arteriovenous malformations of less than 3 cm in diameter. Acta Neurochir (Wien) 145:249–255CrossRef

70.

Weltman E, Salvajoli JV, Brandt RA et al (2001) Radiosurgery for brain metastases: who may not benefit? Int J Radiat Oncol Biol Phys 51:1320–1327PubMedCrossRef

71.

Weltman E, Salvajoli JV, Brandt RA et al (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161PubMedCrossRef

72.

Yung WKA, Kunschner LJ, Sawaya R, Chang EL, Fuller GN (2002) Intracranial metastases. In: Levin VA (ed) Cancer in the nervous system, 2nd edn. Oxford University Press, Oxford, UK, pp 321–340

Titel: Radiosurgery in the treatment of brain metastases: critical review regarding complications
verfasst von: Marcos Vinícius Calfat Maldaun
Paulo Henrique Pires Aguiar
Frederick Lang
Dima Suki
David Wildrick
Raymond Sawaya
Publikationsdatum: 01.01.2008
Verlag: Springer-Verlag
Erschienen in: Neurosurgical Review / Ausgabe 1/2008
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-007-0110-8

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