Complications after stereotactic radiosurgery for brain metastases: Incidences, correlating factors, treatments and outcomes

Hitoshi Aiyama, Masaaki Yamamoto, Takuya Kawabe, Shinya Watanabe, Takao Koiso, Yasunori Sato, Yoshinori Higuchi, Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura, Hidetoshi Kasuya, Bierta E. Barfod

Research output: Contribution to journalArticle

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Abstract

Background and purpose: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. Materials and methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998–2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. Results: The overall median survival time after SRS was 7.8 (95% CI; 7.4–8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9–211.4 (median; 24.0, IQR; 12.0–64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381–0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646–4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028–2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245–5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318–0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. Conclusion: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.

Original languageEnglish
Pages (from-to)364-369
Number of pages6
JournalRadiotherapy and Oncology
Volume129
Issue number2
DOIs
Publication statusPublished - 2018 Nov 1

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Radiosurgery
Neoplasm Metastasis
Incidence
Brain
Databases
Research Ethics Committees
Lost to Follow-Up
Tumor Burden
Neoplasms
Cohort Studies
Retrospective Studies
Survival

Keywords

  • Brain metastases
  • Complication
  • Gamma knife
  • Radiosurgery

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Complications after stereotactic radiosurgery for brain metastases : Incidences, correlating factors, treatments and outcomes. / Aiyama, Hitoshi; Yamamoto, Masaaki; Kawabe, Takuya; Watanabe, Shinya; Koiso, Takao; Sato, Yasunori; Higuchi, Yoshinori; Ishikawa, Eiichi; Yamamoto, Tetsuya; Matsumura, Akira; Kasuya, Hidetoshi; Barfod, Bierta E.

In: Radiotherapy and Oncology, Vol. 129, No. 2, 01.11.2018, p. 364-369.

Research output: Contribution to journalArticle

Aiyama, H, Yamamoto, M, Kawabe, T, Watanabe, S, Koiso, T, Sato, Y, Higuchi, Y, Ishikawa, E, Yamamoto, T, Matsumura, A, Kasuya, H & Barfod, BE 2018, 'Complications after stereotactic radiosurgery for brain metastases: Incidences, correlating factors, treatments and outcomes', Radiotherapy and Oncology, vol. 129, no. 2, pp. 364-369. https://doi.org/10.1016/j.radonc.2018.08.018
Aiyama, Hitoshi ; Yamamoto, Masaaki ; Kawabe, Takuya ; Watanabe, Shinya ; Koiso, Takao ; Sato, Yasunori ; Higuchi, Yoshinori ; Ishikawa, Eiichi ; Yamamoto, Tetsuya ; Matsumura, Akira ; Kasuya, Hidetoshi ; Barfod, Bierta E. / Complications after stereotactic radiosurgery for brain metastases : Incidences, correlating factors, treatments and outcomes. In: Radiotherapy and Oncology. 2018 ; Vol. 129, No. 2. pp. 364-369.
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abstract = "Background and purpose: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. Materials and methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998–2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. Results: The overall median survival time after SRS was 7.8 (95{\%} CI; 7.4–8.1) months. Post-SRS complications occurred in 86 patients (2.9{\%}) 1.9–211.4 (median; 24.0, IQR; 12.0–64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4{\%}, 2.2{\%}, 2.4{\%}, 2.6{\%} and 2.9{\%} at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95{\%} CI; 0.381–0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95{\%} CI; 1.646–4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95{\%} CI; 1.028–2.514, p = 0.0374), KPS ≥80{\%} (Adjusted HR; 2.715, 95{\%} CI; 1.245–5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95{\%} CI; 0.318–0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. Conclusion: The post-SRS complication incidence is acceptably low (2.9{\%}). Meticulous long-term follow-up after SRS is crucial for all patients.",
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T1 - Complications after stereotactic radiosurgery for brain metastases

T2 - Incidences, correlating factors, treatments and outcomes

AU - Aiyama, Hitoshi

AU - Yamamoto, Masaaki

AU - Kawabe, Takuya

AU - Watanabe, Shinya

AU - Koiso, Takao

AU - Sato, Yasunori

AU - Higuchi, Yoshinori

AU - Ishikawa, Eiichi

AU - Yamamoto, Tetsuya

AU - Matsumura, Akira

AU - Kasuya, Hidetoshi

AU - Barfod, Bierta E.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background and purpose: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. Materials and methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998–2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. Results: The overall median survival time after SRS was 7.8 (95% CI; 7.4–8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9–211.4 (median; 24.0, IQR; 12.0–64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381–0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646–4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028–2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245–5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318–0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. Conclusion: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.

AB - Background and purpose: Complications after stereotactic radiosurgery (SRS) for brain metastases (BMs) were analyzed in detail using our database including nearly 3000 BM patients. Materials and methods: This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 3271 consecutive patients who underwent gamma knife SRS for BMs during the 1998–2016 period. Excluding four patients lost to follow-up, 112 with three-staged treatment and 189 with post-operative irradiation, 2966 who underwent a single-session of SRS only as radical irradiation were studied. Results: The overall median survival time after SRS was 7.8 (95% CI; 7.4–8.1) months. Post-SRS complications occurred in 86 patients (2.9%) 1.9–211.4 (median; 24.0, IQR; 12.0–64.6) months after treatment. RTOG neurotoxicity grades were 2, 3 and 4 in 58, 25 and 3 patients, respectively. Cumulative incidences determined with a competing risk analysis were 1.4%, 2.2%, 2.4%, 2.6% and 2.9% at the 12th, 24th, 36th, 48th and 60th post-SRS month, respectively. Among various pre-SRS clinical factors and radiosurgical parameters, multivariable analyses demonstrated solitary tumor (Adjusted HR; 0.584, 95% CI; 0.381–0.894, p = 0.0133), controlled primary cancer (Adjusted HR; 2.595, 95% CI; 1.646–4.091, p < 0.0001), no extra-cerebral metastases (Adjusted HR; 1.608, 95% CI; 1.028–2.514, p = 0.0374), KPS ≥80% (Adjusted HR; 2.715, 95% CI; 1.245–5.924, p = 0.0121) and largest tumor volume ≥3.3 cc (Adjusted HR; 0.516, 95% CI; 0.318–0.836, p = 0.0072) to be independently significant predictors of a higher incidence of complications. Conclusion: The post-SRS complication incidence is acceptably low (2.9%). Meticulous long-term follow-up after SRS is crucial for all patients.

KW - Brain metastases

KW - Complication

KW - Gamma knife

KW - Radiosurgery

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