Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2023; 14(10): 400-408
Published online Oct 24, 2023. doi: 10.5306/wjco.v14.i10.400
Treatment of patients with multiple brain metastases by isolated radiosurgery: Toxicity and survival
André Vinícius de Camargo, Marcos Duarte de Mattos, Murilo Kenji Kawasaki, Danilo Nascimento Salviano Gomes, Allisson Bruno Barcelos Borges, Vinicius de Lima Vazquez, Raphael L C Araujo
André Vinícius de Camargo, Marcos Duarte de Mattos, Murilo Kenji Kawasaki, Danilo Nascimento Salviano Gomes, Department of Radiotherapy, Barretos Cancer Hospital, São Paulo, Barretos 14784-400, Brazil
Allisson Bruno Barcelos Borges, Department of Radiation Therapy, Hospital DF Star Rede D´Or, Brasília 70390-140, Brazil
Vinicius de Lima Vazquez, Department of Surgery, Barretos Cancer Hospital, São Paulo, Barretos 14784-400, Brazil
Raphael L C Araujo, Department of Surgery, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
Raphael L C Araujo, IEP, Barretos Cancer Hospital, São Paulo, Barretos 14784-400, Brazil
Author contributions: de Camargo AV, Borges ABB, Vazquez VL, and Araujo RLC contributed to conceptualization; de Camargo AV, de Mattos MD, Kawasaki MK, Gomes DNS, and Borges ABB contributed to data collection; de Camargo AV and Araujo RLC contributed to data analysis; all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Barretos Cancer Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raphael L C Araujo, MD, PhD, Adjunct Professor, Surgical Oncologist, Department of Surgery, Universidade Federal de São Paulo, No. 715 Napoleão de Barros Street, São Paulo 04024-002, Brazil. raphaellcaraujo@gmail.com
Received: June 27, 2023
Peer-review started: June 27, 2023
First decision: August 10, 2023
Revised: September 1, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: October 24, 2023
Processing time: 118 Days and 15.6 Hours
Abstract
BACKGROUND

Radiosurgery for multiple brain metastases has been more reported recently without using whole-brain radiotherapy. Nevertheless, the sparsity of the data still claims more information about toxicity and survival and their association with both dosimetric and geometric aspects of this treatment.

AIM

To assess the toxicity and survival outcome of radiosurgery in patients with multiple (four or more lesions) brain metastases.

METHODS

In a single institution, data were collected retrospectively from patients who underwent radiosurgery to treat brain metastases from diverse primary sites. Patients with 4-21 brain metastases were treated with a single fraction with a dose of 18 Gy or 20 Gy. The clinical variables collected were relevant to toxicity, survival, treatment response, planning, and dosimetric variables. The Spearman’s rank correlation coefficients, Mann-Whitney test, Kruskal-Wallis test, and Log-rank test were used according to the type of variable and outcomes.

RESULTS

From August 2017 to February 2020, 55 patients were evaluated. Headache was the most common complaint (38.2%). The median overall survival (OS) for patients with karnofsky performance status (KPS) > 70 was 8.9 mo, and this was 3.6 mo for those with KPS ≤ 70 (P = 0.047). Patients with treated lesions had a median progression-free survival of 7.6 mo. There were no differences in OS (19.7 vs 9.5 mo) or progression-free survival (10.6 vs 6.3 mo) based on prior irradiation. There was no correlation found between reported toxicities and planning, dosimetric, and geometric variables, implying that no additional significant toxicity risks appear to be added to the treatment of multiple (four or more) lesions.

CONCLUSION

No associations were found between the evaluated toxicities and the planning dosimetric parameters, and no differences in survival rates were detected based on previous treatment status.

Keywords: Radiosurgery, Brain metastases, Radiotherapy, Survival, Toxicity, Cancer

Core Tip: Toxicity and survival outcome of radiosurgery in patients with multiple brain metastases (≥ 4) were evaluated. A total of 55 patients were evaluated; headache was the most common complaint, but no associations were found between the evaluated toxicities and the planning and dosimetric parameters. The median overall survival found was 10 mo and the survival of the group that did not undergo irradiation before radiosurgery was 9.5 mo. The results are equivalent to those found by authors who evaluated patients with up to four lesions. Our data demonstrate the safe use of isolated stereotactic radiosurgery to treat patients with four or more brain metastases.