• World Neurosurg · Mar 2020

    Stereotactic Radiosurgery to greater than 10 brain metastases: Evidence to support the role of radiosurgery for ideal hippocampal sparing in the treatment of multiple brain metastases.

    • Matthew S Susko, Michael A Garcia, Lijun Ma, Jean L Nakamura, David R Raleigh, Shannon Fogh, Philip Theodosopoulos, Michael McDermott, Penny K Sneed, and Steve E Braunstein.
    • Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA.
    • World Neurosurg. 2020 Mar 1; 135: e174-e180.

    BackgroundBrain metastases are a common occurrence, with literature supporting the treatment of a limited number of brain metastases with stereotactic radiosurgery (SRS), as opposed to whole brain radiotherapy (WBRT). Less well understood is the role of SRS in patients with ≥10 brain metastases.MethodsPatients treated with SRS to ≥10 brain metastases without concurrent WBRT between March 1999 and December 2016 were reviewed. Analysis was performed for overall survival, treated lesion freedom from progression (FFP), freedom from new metastases (FFNMs), and adverse radiation effect. Hippocampal volumes were retrospectively generated in patients treated with up-front SRS for evaluation of dose volume metrics.ResultsA total of 143 patients were identified with 75 patients having up-front SRS and 68 patients being treated as salvage therapy after prior WBRT. The median number of lesions per patient was 13 (interquartile range [IQR], 11-17). Median total volume of treatment was 4.1 cm3 (IQR, 2.0-9.9 cm3). The median 12-month FFP for up-front and salvage treatment was 96.8% (95% confidence interval [CI], 95.5-98.1) and 83.6% (95% CI, 79.9-87.5), respectively (P < 0.001). Twelve-month FFNMs for up-front and salvage SRS was 18.8% (95% CI, 10.9-32.3) versus 19.2% (95% CI, 9.7-37.8), respectively (P = 0.90). The mean hippocampal dose was 150 cGy (IQR, 100-202 cGy).ConclusionsExcellent rates of local control can be achieved when treating patients with >10 intracranial metastases either in the up-front or salvage setting. Hippocampal sparing is readily achievable with expected high rates of new metastatic lesions in treated patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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