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Erschienen in: memo - Magazine of European Medical Oncology 1/2015

01.04.2015 | review

Radiotherapy for brain metastases: are we getting better?

verfasst von: MD Dr. Leor Zach, MD Dr. Alisa Talianski, MBBS, MA, MRCP Dr. Yaakov Richard Lawrence

Erschienen in: memo - Magazine of European Medical Oncology | Ausgabe 1/2015

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Abstract

Brain metastases are the most common malignant adult CNS tumor. The blood brain barrier (BBB) prevents many drugs from achieving therapeutic concentrations in the central nervous system (CNS), leaving the brain as a potential sanctuary site of disease and underscoring the importance of radiotherapy. Neurons, glial cells and vascular endothelium are prone to radiation-induced damage. Efforts have been made to reduce radiation-induced toxicity and increase efficacy (Stereotactic radio-surgery - SRS, advanced radiation-techniques that allow decreasing the dose to the hippocampi, while intensifying the radiation dose to large brain metastases or administering neuroprotective or radiation sensitizing agents during whole brain radiotherapy -WBRT in order to increase the therapeutic ratio). Surgery, radiotherapy and new pharmacological agents may become advantages for specific patient subgroups or in specific disease stages. Choosing how to treat brain metastases, must take into consideration patients and disease parameters (the primary tumor, age and performance status, systemic and brain tumor burden), and the potential risks and benefits of a treatment tool emphasising QOL considerations. Which modality to apply and when, is often a matter of local practice and treatment availability since level I evidence is lacking. The technology behind WBRT, FSR and SRS has substantially advanced over the previous decade, however only formal clinical trials will allow a definite answer to the question - are we getting better?

Literatur
  1. Tsao MN, Lloyd N, Wong RKS, Chow E, Rakovitch E, Laperriere N, Xu W, Sahgal A. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases (review). Cochrane Database Syst Rev. 2012;(4):CD003869.
  2. Tsao M, Xu W, Sahgal A. A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer. 2012;118(9):2486–93.View ArticlePubMed
  3. Davis FG, Dolecek TA, McCarthy BJ, Villano JL. Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data Neuro Oncol. 2012;14(9):1171–7.View ArticlePubMed CentralPubMed
  4. Barani IJ, Larson DA, Berger MS. Future directions in treatment of brain metastases. Surg Neurol Int. 2013;4(Suppl 4):S220–30.PubMed CentralPubMed
  5. Lin NU. Targeted therapies in brain metastases Curr Treat Options Neurol. 2014;16(1):276.View ArticlePubMed CentralPubMed
  6. Kondziolka D, Kalkanis SN, Mehta MP, Ahluwalia M, Loeffler JS. It is time to reevaluate the management of patients with brain metastases Neurosurgery. 2014;75:1–9.View ArticlePubMed
  7. Peled N, Zach L, liran O, Illouze M, Bunn PA Jr, Hirsch FR. Effective crizotinib schedule for brain metastases in ALK rearrangement metastatic non small-cell lung cancer. J Thorac Oncol. 2013;8(12):112–3.View Article
  8. Okwan-Duodu D, Pollack BP, Lawson D, Khan MK. Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma. Am J Clin Oncol. 2014 Jan 18 [Epub ahead of print].
  9. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363:1665–72.View ArticlePubMed
  10. Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases (review). Cochrane Database Syst Rev. 2012;(9):CD006121.
  11. Zach L, Guez D, Last D, Daniels D, Grober Y, Nissim O, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Cohen ZR, Mardor Y. Delayed contrast extravasation MRI for depicting tumor and non-tumoral tissues in primary and metastatic brain tumors PLoS One. 2012;7(12):e52008.View ArticlePubMed CentralPubMed
  12. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, Mc Kenna MG, Byhardt R. Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37(4):745–51.View ArticlePubMed
  13. Dyer MA, Arvold ND, Chen YH, Pinnell NE, Mitin T, Lee EQ, Hodi SF, Ibrahim N, Weiss SE, Kelly PJ, Floyd SR, Mahadevan A, Alexander BM. The role of whole brain radiation therapy in the management of melanoma brain metastases. Radiat Oncol. 2014;9:143.View ArticlePubMed CentralPubMed
  14. Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, Van den Berge D, Collette S, Collette L, Mueller RP. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 Study. J Clin Oncol. 2010;29:134–41.View ArticlePubMed CentralPubMed
  15. Li J, Benzen SM, Li J, Renschler M, Mehta MP. Relationship between neurocognitive function and quality of life after WBRT in patients with brain metastases. Int J Radiat Oncol Biol Phys. 2008;71(1):64–70.View ArticlePubMed
  16. Kirkpatrick JP, Yin FF, Sampson JH. Radiotherapy and radiosurgery for tumors of the central nervous system. Surg Oncol Clin N Am. 2013;22:445–61.View ArticlePubMed
  17. Crossen JR, Garwood D, Glatstein E, Neuwelt EA. Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy. J Clin Oncol. 1994;12(3):627–42.PubMed
  18. Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S, Inomata T, Kuneida E, Hayakawa K, Nakagawa K, Kobashi G, Shirato H. Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys. 2007;68(5):1388–95.View ArticlePubMed
  19. Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C, Choucair A, Fox S, Suh JH, Roberge D, Kavadi V, Bentzen SM, Mehta MP, Watkins-Bruner D. Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol. 2013;15(10):1429–37.View ArticlePubMed CentralPubMed
  20. Mehta MP, Rodrigus P, Terhaard CHJ, Rao A, Suh J, Wilson R, Souhami L, Bezjak A, et al. Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol. 2003;21(13):2529–36.View ArticlePubMed
  21. Rane N, Quaghebeur G. CNS effects following the treatment of malignancy. Clin Radiol. 2012;67:61–8.View ArticlePubMed
  22. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kriscio RJ, Markesbery WR, Macdonald JS, Young B. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494–500.View ArticlePubMed
  23. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ, Markesbery WR, Foon KA, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA. 1998;280:1485–9.View ArticlePubMed
  24. Hodgson DC, Charpentier AM, Cigsar C, Atenafu EG, Ng A, Bahl G, Zadeh G, Miguel JS, Menard C. A multi-institutional study of factors influencing the use of stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys. 2013;85(2):335–40.View ArticlePubMed
  25. Harth S, Abo-Madyan Y, Zheng L, Siebenlist K, Herskind C, Wenz A, Frank F, Giordano A. Estimation of intracranial failure risk following hippocampal-sparing whole brain radiotherapy. Radiother Oncol. 2013;109:152–8.View ArticlePubMed
  26. Wan JF, Zhang SJ, Wang L, Zhao KL. Implications for preserving neural stem cells in whole brain radiotherapy and prophylactic cranial irradiation: a review of 2270 metastases in 488 patients. J Radiat Res. 2013;54:285–91.View ArticlePubMed CentralPubMed
  27. Ghia A, Tome WA, Thomas S. Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys. 2007;68:971–7.View ArticlePubMed
  28. Gondi V, Tome WA, Marsh J. Estimated of perihippocampal disease progression after hippocampal avoidance during whole-brain radiotherapy: safety profile for RTOG 0933. Radiother Oncol. 2010;95:327–31.View ArticlePubMed CentralPubMed
  29. Gondi V, Hermann BP, Mehta MP, Tomé WA. Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors. Int J Radiat Oncol Biol Phys. 2013;85(2):348–54.View ArticlePubMed
  30. Chera BS, Amdur RJ, Patel P, Mendenhall WM. A radiation oncologist's guide to contouring the hippocampus. Am J Clin Oncol. 2009;32:20–2.View ArticlePubMed
  31. Gutiérrez AN, Westerly DC, Tomé WA, Jaradat HA, Mackie TR, Bentzen SM, Khuntia D, Mehta MP. Whole brain radiation therapy with hippocampal avoidance and simultaneously integrated brain metastases boost: a planning study. Int J Radiat Oncol Biol Phys. 2007;69(2):589–97.View ArticlePubMed CentralPubMed
  32. Memory preservation with conformal avoidance of the hippocampus during whole-brain radiotherapy (WBRT) for patients with brain metastases: primary endpoint results of RTOG 0933 ASTRO abstract 2013.
  33. Prokic V, Wiedenmann N, Fels F, Schmucker M, Nieder C, Grosu AL. Whole brain irradiation with hippocampal sparing and dose escalation on multiple brain metastases: a planning study on treatment concepts. Int J Radiat Oncol Biol Phys. 2013;85(1):264–70.View ArticlePubMed
  34. Chang WS, Kim HY, Chang JW, Park YG, Chang JH. Analysis of radio-surgical results in patients with brain metastases according to the number of brain lesions: is stereotactic radiosurgery effective for multiple brain metastases? J Neurosurg. 2010;113(Suppl):73–8.PubMed
  35. Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, Sperduto PW, Vogelbaum MA, Radawski RD, Wang JZ, Gillin MT, Mohideen N, Hahn CA, Chang EL. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline. Prac Radiat Oncol. 2012;2:210–25.View Article
Metadaten
Titel
Radiotherapy for brain metastases: are we getting better?
verfasst von
MD Dr. Leor Zach
MD Dr. Alisa Talianski
MBBS, MA, MRCP Dr. Yaakov Richard Lawrence
Publikationsdatum
01.04.2015
Verlag
Springer Vienna
Erschienen in
memo - Magazine of European Medical Oncology / Ausgabe 1/2015
Print ISSN: 1865-5041
Elektronische ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-014-0181-5

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