Page 47 - ARNM-2-1

Advances in Radiotherapy &

Nuclear Medicine

SHORT COMMUNICATION
Gamma knife radiosurgery following whole-brain

radiation

1
Natasha Mathur , Badal Juneja , Alan Turtz , Howard Warren Goldman ,
3
2
3
2
2
Qianyi Xu , Dave Mulvihill , and Gregory J. Kubicek *
2
1 Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
2 Department of Radiation Oncology, MD Anderson-Cooper Cancer Center, Camden, New Jersey,
United States of America
3 Department of Neurological Surgery, Cooper University Hospital, One Cooper Plaza, Camden,
New Jersey, United States of America
Abstract
In this study, we aimed to determine outcomes for patients requiring salvage
stereotactic radiosurgery (SRS) who have progression of brain metastatic disease
after initial treatment with whole-brain radiation (WBRT). This is a retrospective
analysis of a prospective database of 112 patients who were treated with salvage SRS
after experiencing failure following WBRT treatment with salvage SRS. Collectively,
the patients had a median overall survival of 7 months after salvage SRS. Patients
who had more than two brain metastases had a significantly shorter median survival
but were not subjected to increased risk for distant brain failure. We also found that
a short intervening time between WBRT and central nervous system (CNS) failure
did not seem to worsen the nervous system control or reduce patient survival. Small
cell lung cancer (SCLC) was associated with decreased overall survival and CNS
*Corresponding author: control. In conclusion, SRS use following WBRT is safe and effective in the majority of
Gregory J. Kubicek patients. Patients with rapid failure after WBRT can be successfully salvaged with SRS.
(Greg.kubicek @gjk55@miami.edu)
The findings also shed light on the overall poor outcomes, coupled with low median
Citation: Mathur N, Juneja B, survival and high rates of CNS failure, in patients suffering multiple metastases
Turtz A, et al. Gamma knife
radiosurgery following whole-brain stemming from SCLC.
radiation. Adv Radiother Nucl Med.
2024;2(1):2231.
https://doi.org/10.36922/arnm.2231 Keywords: Stereotactic radiosurgery; Radiation therapy; Salvage; Central nervous system
Received: November 11, 2023
Accepted: March 11, 2024
Published Online: March 28, 2024 1. Introduction
Copyright: © 2024 Author(s). Cancer metastasis to the brain is a common pathological event. It has been estimated
This is an Open-Access article that there are 98,000 to 170,000 cases of cancer metastasis to the brain per year in the
distributed under the terms of the
Creative Commons Attribution United States alone. Therapies for this clinical challenge include whole-brain radiation
License, permitting distribution, therapy (WBRT) and stereotactic radiosurgery (SRS). Declining cognition, decreased
1
and reproduction in any medium, quality of life, and reduced blood counts are some of the notable negative impacts of
provided the original work is
properly cited. employing WBRT, which is, however, superior to SRS in terms of reduced likelihood of
inducing subsequent CNS failure. 2-5
Publisher’s Note: AccScience
Publishing remains neutral with Although WBRT can reduce subsequent brain failure as compared to SRS, CNS failure
regard to jurisdictional claims in 4-6
published maps and institutional would still develop in patients after undergoing WBRT. Several studies have shown
7,8
affiliations. that the rate of distant brain metastases after WBRT is around 25% to 50%, which can

Volume 2 Issue 1 (2024) 1 https://doi.org/10.36922/arnm.2231