Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Characteristics
2.2. Radiosurgery Technique
2.3. Patient Follow-Up
2.4. Study Endpoints
2.5. Statistical Analysis
3. Results
3.1. Overall Survival
3.2. Tumor Control and Adverse Radiation Effects
4. Discussion
4.1. Fractionated Whole-Brain Radiation Therapy (WBTR) and Surgery
4.2. The Role of Stereotactic Radiosurgery
4.3. SRS and Systemic HPB Cancer Therapies
4.4. Neurological Response
4.5. Adverse Radiation Effects
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Value |
---|---|
Total No. of pts. | 19 |
Sex | |
Male | 13 (68%) |
Female | 6 (32%) |
Age at initial primary cancer diagnosis (years) | 65 ± 11 (61 [45–80]) |
Age at initial brain metastasis diagnosis (years) | 66 ± 11 (61 [45–83]) |
Time from primary cancer diagnosis to brain metastasis (months) | 16 [0–130] |
Age at SRS | 67 ± 11 (61 [48–83]) |
KPS score at SRS | 80 [50–90] |
Primary histopathology | |
Only adenocarcinoma | 13 (68%) |
Only SCC | 1 (5%) |
Both adenocarcinoma and SCC | 1 (5%) |
Data unavailable | 4 (21%) |
No. of pts. with concurrent systemic therapy | 8 (42%) |
Cytotoxic chemotherapy (No. of pts.) | 4 (50%) |
Immunotherapy (No. of pts.) | 3 (38%) |
Targeted therapy (No. of pts.) | 1 (13%) |
Prior radiotherapy (RT) characteristics | |
Type (No. of pts.) | |
None | 17 (89%) |
WBRT | 2 (11%) |
No. of pts. with prior surgical resection | 8 (42%) |
No. of pts. with active primary disease | 11 (58%) |
Characteristics | Value |
---|---|
Metastasis characteristics | |
Total no. of HPB metastasis | 76 |
No. of HPB metastasis per pt. | 4 ± 4 (3 [1–16]) |
SRS characteristics | |
Margin dose (Gy) | 17 ± 2 (18 [15–20]) |
Max dose (Gy) | 31 ± 7 (32 [18.8–40.1]) |
Isodose (%) | 58 ± 13 (50 [45–80]) |
Cumulative tumor volume of HPB brain metastases (cm3) per pt. | 12 ± 11 (8.1 [1.0–44.2]) |
Cumulative V12 (cm3) per pt. | 18 ± 14 (13.1 [2.2–46.8]) |
Characteristics | Value |
---|---|
Median survival (months) | 8 (1–79) |
Local tumor progression characteristics | |
Progression (No. of pts.) at last follow-up | 4 (21.1%) |
Time between initial SRS and local tumor progression (months) | 8.5 (2–15) |
Management of local tumor progression (No. of pts.) | |
SRS | 4 (100%) |
Distant tumor progression characteristics | |
Progression (# of pts.) at last follow-up | 4 (21.1%) |
Time between initial SRS and distant tumor progression (months) | 6.5 (2–17) |
Management of distant tumor progression (No. of pts.) | |
SRS | 4 (100%) |
No. of pts. with ARE | 0 (0%) |
Median overall survival (months) from SRS | 8 (1–33) |
Median overall survival (months) from brain metastases diagnosis | 8 (1–79) |
Cause of death | |
Systemic disease | 18 (100.0%) |
Author/Year | Primary Disease | Management Strategies | # Patients | Time from Primary dx to Brain Mets dx | OS from Brain Mets dx. Median |
---|---|---|---|---|---|
Nam et al. 2019 [11] | HCC | Resection: 25 WBRT: 37 SRS: 9 | 86 | 20 mo. (0–144.1) | 1.6 mo. |
Han et al. 2013 [14] | HCC | Surgery: 10 WBRT: 12 SRS: 13 | 33 | 18.3 mo. (0.5–75) | 2.6 mo. (1.3–3.9) |
Choi et al. 2009 [15] | HCC | Surgery: 11 WBRT: 16 SRS: 10 Steroids: 25 | 62 | 18.2 mo. | 1.7 mo. |
Jordan et al. 2018 [13] | PCC | Surgery: 4 WBRT: 13 SRS: 3 | 25 | 17 mo. (0–79) | 1.5 mo. |
Frega et al. 2018 [12] | CCC | Surgery: 4 WBRT: 5 | 6 | 13.6 mo. (7.3–52.8) | 3.7 mo. (0.9–17.8) |
Dodoo et al. 2023 [16] | CCC | Surgery: 1 WBRT: 6 SRS: 2 | 21 | 14.4 mo. | 4.2 mo. (0.2–33.8) |
D’Andrea et al. 2020 [17] | CCC | Surgery: 4 WBRT: 5 SRS: 4 | 9 | 16.7 mo. (0.7–66.7) | 3.8 mo. (0.1–16.9) |
Present study | HCC, PCC, CCC | Surgery: 8 WBRT: 2 SRS: 19 | Total: 19 HCC: 9 PCC: 7 CCC: 2 | 16 mo. (0–130) | 8 mo. (1–79) |
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Wei, Z.; Srinivasan, P.; Patel, R.; Bednarz, G.; Flickinger, J.C.; Hadjipanayis, C.G.; Niranjan, A.; Lunsford, L.D. Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers. Cancers 2024, 16, 1665. https://doi.org/10.3390/cancers16091665
Wei Z, Srinivasan P, Patel R, Bednarz G, Flickinger JC, Hadjipanayis CG, Niranjan A, Lunsford LD. Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers. Cancers. 2024; 16(9):1665. https://doi.org/10.3390/cancers16091665
Chicago/Turabian StyleWei, Zhishuo, Priyanka Srinivasan, Ritam Patel, Greg Bednarz, John C. Flickinger, Constantinos G. Hadjipanayis, Ajay Niranjan, and L. Dade Lunsford. 2024. "Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers" Cancers 16, no. 9: 1665. https://doi.org/10.3390/cancers16091665