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Gutschenritter, T.* ; Venur, V.A.* ; Combs, S.E. ; Vellayappan, B.* ; Patel, A.P.* ; Foote, M.* ; Redmond, K.J.* ; Wang, T.J.C.* ; Sahgal, A.* ; Chao, S.T.* ; Suh, J.H.* ; Chang, E.L.* ; Ellenbogen, R.G.* ; Lo, S.S.*

The judicious use of stereotactic radiosurgery and hypofractionated stereotactic radiotherapy in the management of large brain metastases.

Cancers 13:70 (2021)
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Brain metastases are the most common intracranial malignant tumor in adults and are a cause of significant morbidity and mortality for cancer patients. Large brain metastases, defined as tumors with a maximum dimension >2 cm, present a unique clinical challenge for the delivery of stereotactic radiosurgery (SRS) as patients often present with neurologic symptoms that require expeditious treatment that must also be balanced against the potential consequences of surgery and radiation therapy—namely, leptomeningeal disease (LMD) and radionecrosis (RN). Hypofractionated stereotactic radiotherapy (HSRT) and pre-operative SRS have emerged as novel treatment techniques to help improve local control rates and reduce rates of RN and LMD for this patient population commonly managed with post-operative SRS. Recent literature suggests that pre-operative SRS can potentially half the risk of LMD compared to post-operative SRS and that HSRT can improve risk of RN to less than 10% while improving local control when meeting the appropriate goals for biologically effective dose (BED) and dose-volume constraints. We recommend a 3-or 5-fraction regimen in lieu of SRS delivering 15 Gy or less for large metastases or resection cavities. We provide a table comparing the BED of commonly used SRS and HSRT regimens, and provide an algorithm to help guide the management of these challenging clinical scenarios.
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Publication type Article: Journal article
Document type Review
Keywords Hypofractionated Stereotactic Radiotherapy ; Large Brain Metas-tases ; Local Control ; Radionecrosis ; Stereotactic Radiosurgery; Postoperative Resection Cavity; Surgical Resection; Local-control; Leptomeningeal Carcinomatosis; Single Metastases; Radiation-therapy; Risk; Volume; Surgery; Cancer
Language english
Publication Year 2021
Prepublished in Year 2020
HGF-reported in Year 2020
ISSN (print) / ISBN 2072-6694
Journal Cancers
Quellenangaben Volume: 13, Issue: 1, Pages: , Article Number: 70 Supplement: ,
Publisher MDPI
Publishing Place St Alban-anlage 66, Ch-4052 Basel, Switzerland
Reviewing status Peer reviewed
Institute(s) Institute of Radiation Medicine (IRM)
POF-Topic(s) 30203 - Molecular Targets and Therapies
Research field(s) Radiation Sciences
PSP Element(s) G-501300-001
DOI 10.3390/cancers13010070
WOS ID WOS:000605791000001
Scopus ID 85098583929
PubMed ID 33383817
Erfassungsdatum 2021-02-06
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