Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis

Efficacy and safety of an 800 cGy × 3 daily fractions regimen

Che Chuan Wang, Scott R. Floyd, Chin Hong Chang, Peter C. Warnke, Chung Ching Chio, Ekkehard M. Kasper, Anand Mahadevan, Eric T. Wong, Clark C. Chen

Research output: Contribution to journalReview article

42 Citations (Scopus)

Abstract

Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife® HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (<3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8% of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80%. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9%, including radiation necrosis (n = 1, 2.9%), prolonged steroiduse (n = 1, 2.9%), and new-onset seizures (n = 1, 2.9%). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife® HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.

Original languageEnglish (US)
Pages (from-to)601-610
Number of pages10
JournalJournal of neuro-oncology
Volume106
Issue number3
DOIs
StatePublished - Feb 1 2012

Fingerprint

Radiosurgery
Neoplasm Metastasis
Safety
Morbidity
Radiation
Brachytherapy
Melanoma
Histology
Colon
Seizures
Breast
Necrosis
Therapeutics
Kidney
Recurrence
Lung
Survival
Neoplasms

Keywords

  • Brain metastasis
  • Hypo-fractionation
  • Resection cavity
  • Stereotactic radiosurgery

Cite this

Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis : Efficacy and safety of an 800 cGy × 3 daily fractions regimen. / Wang, Che Chuan; Floyd, Scott R.; Chang, Chin Hong; Warnke, Peter C.; Chio, Chung Ching; Kasper, Ekkehard M.; Mahadevan, Anand; Wong, Eric T.; Chen, Clark C.

In: Journal of neuro-oncology, Vol. 106, No. 3, 01.02.2012, p. 601-610.

Research output: Contribution to journalReview article

Wang, Che Chuan ; Floyd, Scott R. ; Chang, Chin Hong ; Warnke, Peter C. ; Chio, Chung Ching ; Kasper, Ekkehard M. ; Mahadevan, Anand ; Wong, Eric T. ; Chen, Clark C. / Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis : Efficacy and safety of an 800 cGy × 3 daily fractions regimen. In: Journal of neuro-oncology. 2012 ; Vol. 106, No. 3. pp. 601-610.
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abstract = "Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife{\circledR} HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (<3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8{\%} of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80{\%}. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9{\%}, including radiation necrosis (n = 1, 2.9{\%}), prolonged steroiduse (n = 1, 2.9{\%}), and new-onset seizures (n = 1, 2.9{\%}). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife{\circledR} HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.",
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AU - Floyd, Scott R.

AU - Chang, Chin Hong

AU - Warnke, Peter C.

AU - Chio, Chung Ching

AU - Kasper, Ekkehard M.

AU - Mahadevan, Anand

AU - Wong, Eric T.

AU - Chen, Clark C.

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AB - Development of hypofractionated stereotactic radiosurgery (HSRS) has expanded the size of lesion that can be safely treated by focused radiation in a limited number of treatment sessions. However, clinical data regarding the efficacy and morbidity of HSRS in the treatment of cerebral metastasis is lacking. Here, we review our experience with CyberKnife® HSRS for this indication. From 2005 to 2010, we identified 37 patients with large (<3 cm in diameter) cerebral metastases resection cavity that was treated with HSRS. This constituted approximately 8% of all treated resection cavities. We reviewed dose regimens, local control, distal control, and treatment associated morbidities. Primary sites for the metastatic lesions included: lung (n = 10), melanoma (n = 12), breast (n = 9), kidney (n = 4), and colon (n = 2). All patients underwent resection of the cerebral metastasis and received 800 cGy × 3 daily fractions to the resection cavity. Of the 37 patients treated, one-year follow-up data was available for 35 patients. The median survival was 5.5 months. Actuarial local control rate at 6 months was 80%. Local failures did not correlate with prior WBRT, or tumor histology. Distant recurrence occurred in 7 of the 35 patients. Morbidities associated with HSRS totaled 9%, including radiation necrosis (n = 1, 2.9%), prolonged steroiduse (n = 1, 2.9%), and new-onset seizures (n = 1, 2.9%). This study demonstrates the safety and efficacy of an 800 cGy × 3 daily fractions CyberKnife® HSRS regimen for irradiation of large resection cavity. The efficacy compares favorably to historical data derived from patients undergoing WBRT, SRS, or brachytherapy.

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