Valdés-Martínez F, Onofre-Castillo J, Valero-Castillo R, De la Peña-Hinojosa C, Córdova-Chávez NA, Santana-Vela IA

Language: Spanish
References: 18
Page: 137-145
PDF size: 693.42 Kb.

ABSTRACT

Background: Stereotactic radiotherapy is a non-invasive procedure in which doses of radiation are administered to cerebral lesions in an ablative attempt. Magnetic resonance plays an important role in evaluating therapeutic response and complications.
Objective: The objective of this study is to analyze brain metastases by magnetic resonance, evaluating the changes that occur following treatment with stereotactic radiotherapy to determine whether image characteristics are related to the treatment success rate.
Material and methods: A study of cases and controls in 20 metastases was conducted, of patients subjected to stereotactic radiotherapy, who had baseline magnetic resonance and post-treatment control. The variables analyzed were: volume of lesion, detection of lesion, perilesional edema, and mass effect.
Results: no magnetic resonance image characteristics were observed that could be associated with a poor response to treatment; however, metastases originating in a melanoma were associated with poor response to treatment. Size larger than 1 cm³ was associated with good response to treatment, and the origin of metastases in primary tumors of the lung.
Conclusions: Among the lesions analyzed only the size larger than 1 cm³ as a variable assessed by image was associated with a good response to treatment, and with the pulmonary origin of metastasis. Melanoma as the origin of metastasis was associated with poor response to treatment. Due to the limited number of patients, these results should be considered preliminary.

REFERENCES

1. Gavrilovic IT, Posner JB. Brain metastases: Epidemiol and pathophysiology. J Neurooncol 2005;75:5–14.

2. Barnholtz-Sloan JS, Sloan AE, Davis FG et al. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol 2004;22:2865–72.

3. Schouten LJ, Rutten J, Huveneers HA et al. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 2002;94:2698 –705.

4. Amer MH, Al-Sarraf M, Baker LH et al. Malignant melanoma and central nervous system metastases: Incidence, diagnosis, treatment and survival. Cancer 1978;42:660–8.

5. Pirzkall A, Debus J, Lohr F, Fuss M, Rhein B, Engenhart- Cabillic R Wannenmacher M. Radiosurgery alone or in combination with wholebrain radiotherapy for brain metastases. J Clin Oncol 1998;16:3563-9.

6. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys 1999;45:427-34.

7. Sanghavi SN, Miranpuri SS, Chappell R, Buatti JM, Sneed PK, Suh JH, Regine WF, Weltman E, King VJ, Goetsch SJ, Breneman JC, Sperduto PW, Scott C, Mabanta S, Mehta MP: Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method. Int J Radiat Oncol Biol Phys. 2001, 51:426-34.

8. Sneed PK, Suh JH, Goetsch SJ, Sanghavi SN, Chappell R, Buatti JM, Regine WF, Weltman E, King VJ, Breneman JC, Sperduto PW, Mehta MP. A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 2002;53:519-26.

9. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004;363:1665-72.

10. Manon R, O’Neill A, Knisely J, Werner-Wasik M, Lazarus HM, Wagner H, Gilbert M, Mehta M. Eastern Cooperative Oncology Group. Phase II trial of radiosurgery for one to three newly diagnosed brain metastases from renal cell carcinoma, melanoma, and sarcoma: an Eastern Cooperative Oncology Group study (E 6397). J Clin Oncol 2005;23:8870- 6.

11. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 2006;295:2483-91.

12. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Hassel MB, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011;29:134-41.

13. Kalkanis SN, Kondziolka D, Gaspar LE, Burri SH, Asher AL, Cobbs CS, Ammirati M, Robinson PD, Andrews DW, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Linskey ME. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2010;96:33-43.

14. Flickinger JC, Lunsford LD, Kondziolka D, Maitz AH, Epstein AH, Simons SR, Wu A: Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformations. Int J Radiat Oncol Biol Phys 1992, 23:19-26.

15. Voges J, Treuer H, Sturm V, Büchner C, Lehrke R, Kocher M, Staar S, Kuchta J, Müller RP. Risk analysis of linear accelerator radiosurgery. Int J Radiat Oncol Biol Phys 1996;36:1055-63.

16. Shaw E, Scott C, Souhami L, Dinapoli R, Kline R, Loeffler J, Farnan N. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000;47:291-8.

17. Petrovich Z, Yu C, Giannotta SL, O’Day S, Apuzzo ML. Survival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery. J Neurosurg 2002;97(5 Suppl):499-506.

18. Blonigen BJ, Steinmetz RD, Levin L, Lamba MA, Warnick RE, Breneman JC: Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 2010;77:996-1001.