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. 2016;4(2):89-96.

Local control of brain metastases after stereotactic radiosurgery: the impact of whole brain radiotherapy and treatment paradigm

Ryan T Hughes  1 , Paul J Black  1 , Brandi R Page  1 , John T Lucas Jr  1 , Shadi A Qasem  2 , Kounosuke Watabe  3 , Jimmy Ruiz  4 , Adrian W Laxton  5 , Stephen B Tatter  5 , Waldemar Debinski  6 , Michael D Chan  1
Affiliations

Local control of brain metastases after stereotactic radiosurgery: the impact of whole brain radiotherapy and treatment paradigm

Ryan T Hughes et al. J Radiosurg SBRT. 2016.

Abstract

Purpose: We investigate clinical, pathologic, and treatment paradigm-related factors affecting local control of brain metastases after stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT).

Methods and materials: Patients with brain metastases treated with SRS alone, before or after WBRT were considered to determine predictors of local failure (LF), time to failure and survival.

Results: Among 137 patients, 411 brain metastases were analyzed. 23% of patients received SRS alone, 51% received WBRT prior to SRS, and 26% received SRS followed by WBRT. LF occurred in 125 metastases: 63% after SRS alone, 20% after WBRT then SRS, and 22% after SRS then WBRT. Median time to local failure was significantly less after SRS alone compared to WBRT then SRS (12.1 v. 22.7 months, p=0.003). Tumor volume was significantly associated with LF (HR:5.2, p<0.001, 95% CI:3.4-7.8).

Conclusions: WBRT+SRS results in reduced LF. Local control was not significantly different after SRS as salvage therapy versus upfront SRS.

Keywords: brain metastasis; local failure; salvage therapy; stereotactic radiosurgery; treatment paradigm; whole brain radiotherapy.

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Conflict of interest statement

Authors’ disclosure of potential conflicts of interest The authors reported no conflict of interest.

Figures

Figure 1
Figure 1
Time to local failure by treatment paradigm. Blue: SRS alone, Yellow: WBRT then SRS, Red: SRS then WBRT
Figure 2
Figure 2
Time to local failure by indication for SRS. Blue: SRS alone, Yellow: WBRT local failure salvage, Red: WBRT distant failure salvage, Green: Other.
See this image and copyright information in PMC

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