Treatment and prophylaxis for brain metastases from non-small cell lung cancer: whole brain radiation treatment versus stereotactic radiosurgery.

Content Provider	Semantic Scholar
Author	Ferrarese, Fabio Baggio, Vittorio Zorat, Pier Luigi Fiore, Davide
Copyright Year	2006
Abstract	Brain metastases are the most feared complication in the systemic progression of neoplastic disease, and the most frequent brain ‘tumors’, with an incidence 10 times higher than primary lesions. Autoptic studies have shown that the neoplasms with the highest incidence of brain metastases, in order of decreasing frequency, are the lung, breast, kidney and colon [1]. Lung neoplasms are the most common cause of cancerrelated death. There are expected to be more than 165 000 new cases of primary lung cancer in the USA in 2006, and in 25–40% of these patients the disease will progress and involve the brain. Moreover, their longer survival thanks to better treatment in the early and advanced stages will probably also affect the frequency of brain metastases. Already at diagnosis, 10% of non-small cell lung cancer (NSCLC) cases have brain involvement, 6–9% of radically-treated NSCLC recur only in the brain and, as mentioned earlier, 25–40% of patients develop metachronous brain metastases. The prognosis is extremely dismal: patients given supportive therapy alone have a life expectancy of approximately 1 month [2]. After radiotherapy, patients survive approximately 5 months and 10% of patients are still alive after about a year. The treatment options for patients with brain metastases from NSCLC are illustrated in Table 1. Factors influencing the choice of treatment include age, Karnofsky performance score, any extracranial metastases at diagnosis, and the number, site and size of the metastases. A review of the databases on 1200 patients recruited between 1979 and 1993 and enrolled in three consecutive RTOG trials [3] enabled patients to be classified on the basis of three variables that proved statistically significant: PS, age and local control of the primary tumor. Using this classification enables a comparison of the outcome and efficacy of new therapies in homogeneous groups (Table 2). Whole brain radiation therapy (WBRT) has always been considered the treatment of choice for brain metastases because it prolongs the mean survival rate from 1 to 6 months [4]. The rationale for WBRT lies in that radiotherapy affords a good local control, eliminates any micrometastases, reduces the risk of recurrent brain metastases, improves overall survival and quality of life, and can prevent death due to brain compression syndrome [5]. WBRT is also a widespread, easily implemented, non-invasive technique. The treatment is generally hypofractionated, administering 30 Gy in 10 fractions [6]. The drawbacks of WBRT are that its effect on large lesions is limited, the local control rate is less than 50%, 25–50% of patients fail to respond to the RTE and late toxicity can be severe in any long-term survivors [7]. Among the new treatment options, apart from surgery, the last 20 years have seen the introduction of stereotactic radiosurgery (SRS) in clinical practice [6]. SRS enables a highlyfocused distribution of large doses in single fractions. The first case of c-Knife (GK-SRS) treatment of a brain metastasis was reported in 1975. What makes the metastasis an ideal target for this type of treatment is its spherical shape, clear distinction from the adjacent tissue on imaging and dimensions no more than 3 cm. The advantages of SRS over surgery include a brief or no hospital stay, scarce invasiveness, low complication rate (4%), and low cost. In addition, the dose drops rapidly beyond the target volume, inducing minimal changes in the surrounding brain tissue. The availability of modified linear accelerators for performing radiosurgery, sometimes integrated with the Table 1. Therapeutic options
Starting Page	91
Ending Page	106
Page Count	16
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/annonc/17/suppl_2/10.1093/annonc/mdj929/2/mdj929.pdf?Expires=1491449481&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=O~neB3mNkrWnmgPsmfJHl0kPr0DGR-MVFQ3vvw9b8IUwIcPXzaixHzK4l6GiluNKq2Xw~Jiao-52CIaRTfh4QOVNRV~W~fsfKTxqjEfKjZh0rgCmNu3WRH5OLz5M~EGxESTZmjSFLw15vL7Ruz~KIyR7Bg4MZXwM9I2Zwcf3jCXXqrEYEzC9GkluYNOBjVNOhqdy3mGLfdP4AWfAwXXsUZuYZZaeXCJaLYbleCo89n-hc~EhDUqjsqjKCaUHzVfhiFfzF0kUg0zIr6EVec5UJI-hiUd~uf1BvatBj0TACubWHkoUN3Ig4UGUEpQujtPBzZ1A-cWJCrfHm04Puk8i7g__
PubMed reference number	16608990v1
Volume Number	17
Journal	Annals of oncology : official journal of the European Society for Medical Oncology
Language	English
Access Restriction	Open
Subject Keyword	Administration procedure Adverse reaction to drug Cessation of life Classification Compression Dimensions Karnofsky Performance Status Life Expectancy Lung Neoplasms Metastatic malignant neoplasm to brain Neoplasm Metastasis Non-Small Cell Lung Carcinoma Overall Survival Patients Radiation Therapy Oncology Group Radiosurgery Radiotherapy Systems, Linear Accelerator Recent Thymic Emigrant Renal Tissue SRS-A Receptors Small cell carcinoma of lung Structure of parenchyma of lung Sudden infant death syndrome Survivors Therapeutic procedure Whole-Brain Radiotherapy pediatric intracranial germ cell brain tumor primary tumor stereotactic imaging
Content Type	Text
Resource Type	Article