Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05
- PMID: 10802351
- DOI: 10.1016/s0360-3016(99)00507-6
Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05
Abstract
Purpose: To determine the maximum tolerated dose of single fraction radiosurgery in patients with recurrent previously irradiated primary brain tumors and brain metastases.
Methods and materials: Adults with cerebral or cerebellar solitary non-brainstem tumors </= 40 mm in maximum diameter were eligible. Initial radiosurgical doses were 18 Gy for tumors </= 20 mm, 15 Gy for those 21-30 mm, and 12 Gy for those 31-40 mm in maximum diameter. Dose was prescribed to the 50-90% isodose line. Doses were escalated in 3 Gy increments providing the incidence of irreversible grade 3 (severe) or any grade 4 (life threatening) or grade 5 (fatal) Radiation Therapy Oncology Group (RTOG) central nervous system (CNS) toxicity (unacceptable CNS toxicity) was < 20% within 3 months of radiosurgery. Chronic CNS toxicity was also assessed.
Results: Between 1990-1994, 156 analyzable patients were entered, 36% of whom had recurrent primary brain tumors (median prior dose 60 Gy) and 64% recurrent brain metastases (median prior dose 30 Gy). The maximum tolerated doses were 24 Gy, 18 Gy, and 15 Gy for tumors </= 20 mm, 21-30 mm, and 31-40 mm in maximum diameter, respectively. However, for tumors < 20 mm, investigators' reluctance to escalate to 27 Gy, rather than excessive toxicity, determined the maximum tolerated dose. In a multivariate analysis, maximum tumor diameter was one variable associated with a significantly increased risk of grade 3, 4, or 5 neurotoxicity. Tumors 21-40 mm were 7.3 to 16 times more likely to develop grade 3-5 neurotoxicity compared to tumors < 20 mm. Other variables significantly associated with grade 3-5 neurotoxicity were tumor dose and Karnofsky Performance Status. The actuarial incidence of radionecrosis was 5%, 8%, 9%, and 11% at 6, 12, 18, and 24 months following radiosurgery, respectively. Forty-eight percent of patients developed tumor progression within the radiosurgical target volume. A multivariate analysis revealed two variables that were significantly associated with an increased risk of local progression, i.e. progression in the radiosurgical target volume. Patients with primary brain tumors (versus brain metastases) had a 2.85 greater risk of local progression. Those treated on a linear accelerator (versus the Gamma Knife) had a 2.84 greater risk of local progression. Of note, 61 % of Gamma Knife treated patients had recurrent primary brain tumors compared to 30% of patients treated with a linear accelerator.
Conclusions: The maximum tolerated doses of single fraction radiosurgery were defined for this population of patients as 24 Gy, 18 Gy, and 15 Gy for tumors </= 20 mm, 21-30 mm, and 31-40 mm in maximum diameter. Unacceptable CNS toxicity was more likely in patients with larger tumors, whereas local tumor control was most dependent on the type of recurrent tumor and the treatment unit.
Comment in
-
RTOG 90-05: the real conclusion.Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):269-71. doi: 10.1016/s0360-3016(99)00506-4. Int J Radiat Oncol Biol Phys. 2000. PMID: 10802348 No abstract available.
Similar articles
-
Radiosurgery for the treatment of previously irradiated recurrent primary brain tumors and brain metastases: initial report of radiation therapy oncology group protocol (90-05).Int J Radiat Oncol Biol Phys. 1996 Feb 1;34(3):647-54. doi: 10.1016/0360-3016(95)02106-x. Int J Radiat Oncol Biol Phys. 1996. PMID: 8621289 Clinical Trial.
-
Gamma knife radiosurgery for malignant melanoma brain metastases.Cancer J Sci Am. 1998 Mar-Apr;4(2):103-9. Cancer J Sci Am. 1998. PMID: 9532412
-
Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥ 2 cm.J Neurosurg. 2018 Aug;129(2):366-382. doi: 10.3171/2017.3.JNS162532. Epub 2017 Sep 22. J Neurosurg. 2018. PMID: 28937324
-
Radiosurgical dose selection for brain metastasis.Prog Neurol Surg. 2012;25:139-47. doi: 10.1159/000331187. Epub 2012 Jan 6. Prog Neurol Surg. 2012. PMID: 22236675 Review.
-
Primary Gamma Knife Radiosurgery for pineal region tumors: A systematic review and pooled analysis of available literature with histological stratification.J Pineal Res. 2023 Dec;75(4):e12910. doi: 10.1111/jpi.12910. Epub 2023 Sep 13. J Pineal Res. 2023. PMID: 37705383 Review.
Cited by
-
Dosimetric and Clinical Prognostic Factors in Single-Isocenter Linac-Based Stereotactic Radiotherapy for Brain Metastases.Cancers (Basel). 2024 Sep 23;16(18):3243. doi: 10.3390/cancers16183243. Cancers (Basel). 2024. PMID: 39335214 Free PMC article.
-
Preoperative stereotactic radiosurgery for patients with 1-4 brain metastases: A single-arm phase 2 trial outcome analysis (NCT03398694).Neurooncol Pract. 2024 May 8;11(5):593-603. doi: 10.1093/nop/npae043. eCollection 2024 Oct. Neurooncol Pract. 2024. PMID: 39279766
-
Single versus multiple fraction stereotactic radiosurgery for medium-sized brain metastases (4-14 cc in volume): reducing or fractionating the radiosurgery dose?Front Oncol. 2024 Aug 13;14:1333245. doi: 10.3389/fonc.2024.1333245. eCollection 2024. Front Oncol. 2024. PMID: 39193387 Free PMC article.
-
Multifraction stereotactic radiotherapy utilizing inhomogeneous dose distribution for brainstem metastases: a single-center retrospective analysis.J Radiat Res. 2024 Sep 24;65(5):658-666. doi: 10.1093/jrr/rrae057. J Radiat Res. 2024. PMID: 39154372 Free PMC article.
-
Prediction of radiologic outcome-optimized dose plans and post-treatment magnetic resonance images: A proof-of-concept study in breast cancer brain metastases treated with stereotactic radiosurgery.Phys Imaging Radiat Oncol. 2024 Jun 24;31:100602. doi: 10.1016/j.phro.2024.100602. eCollection 2024 Jul. Phys Imaging Radiat Oncol. 2024. PMID: 39040435 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical