A Second course of stereotactic image-guided robotic radiosurgery for patients with cerebral metastasis.

A Second course of stereotactic image-guided robotic radiosurgery for patients with cerebral metastasis.

World Neurosurg. 2018 Dec 12;:

Authors: Jiang X, Wang H, Song Y, Wang X, Li F, Dong Y, Wang J, Chen H, Yuan Z

Abstract
OBJECTIVES: The purpose of this research was to study the outcome of brain metastases in a cohort of patients undergoing a second course of stereotactic image-guided robotic radiosurgery, and to identify predictors corelated with survival.
METHODS: A total of 63 patients with primary malignancies underwent a second course of Cyberknife radiosurgery for intracranial progression, including recurrence and new metastases after initial stereotactic radiosurgery (SRS). Overall survival (OS) and control rate were calculated by Kaplan-Meier. A Cox proportional hazards model was used to analyze predictive factors for survival.
RESULTS: With a median follow-up duration of 12 months following second SRS, the median OS of the second course of radiosurgery were 18 months. On multivariate analysis, sum of total plan target volume (tPTV) (HR 2.112, 95%CI 1.069-4.173) and minimum dose (HR 1.990, 95%CI 1.017-3.892) were associated with OS significantly. Median intracranial progression free survival (IPFS) was 23 months. 6-month and 12-month local control rates of the targets were 97.0% and 94.4%, respectively. Univariate analysis revealed that only tumor number significantly influenced IPFS (P=0.012). 9 (14.2%) patients developed brain necrosis. Median time to brain necrosis in regions where brain necrosis occurred after single course of SRS was not reached, compared to16 months for those treated with repeat SRS (P=0.041).
CONCLUSIONS: A second course of Cyberknife radiosurgery appears to be an effective salvage option for brain progression following initial SRS. The tPTV shows prediction for OS. Tumor volume of initial SRS may influence selection of the potential population that may benefit from salvage radiosurgery.

PMID: 30553069 [PubMed - as supplied by publisher]

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