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Cancers
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The Challenge of the Treatment: Radiotherapy of Brain Metastases
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The Challenge of the Treatment: Radiotherapy of Brain Metastases

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 3022

Special Issue Editor

Dr. Rami El Shafie

E-Mail Website1 Website2
Guest Editor
Radiotherapy and Radiation Oncology, University Medical Center Göttingen (UMG), Göttingen, Germany
Interests: thoracic radiation oncology; neuro radiation oncology; eHealth; brain metastases; precision radiation oncology; stereotactic radiotherapy

Special Issue Information

Dear Colleagues,

Brain metastases (BM) occur in every fifth patient with a solid malignancy and the incidence is rising due to improved cranial imaging and longer overall survival. BM are treated in an interdisciplinary fashion, involving neurosurgeons, radiation oncologists and medical oncologists. Select cases of singular BM can be candidates for resection, usually followed by adjuvant therapy. Cases unsuitable for resection or those with more than one lesion receive radiotherapy, either in the form of stereotactic radiosurgery (SRS) for limited lesions or whole-brain radiotherapy (WBRT) for multiple lesions. Technical advances in radiotherapy account for an increasing use of SRS over WBRT with the benefit of better preserving neurocognition and quality of life. Furthermore, advances in the realm of targeted therapies with improved intracerebral efficacy have raised the discussion of omitting local therapy altogether in select cases. Those developments necessitate a general re-evaluation of the established dogma in the treatment of BM and the assessment of novel approaches that account for all available treatment options in an individualized fashion.

Dr. Rami El Shafie
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • brain metastases
  • radiotherapy
  • stereotactic radiosurgery
  • whole-brain radiotherapy
  • adjuvant therapy

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Published Papers (2 papers)

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Research

12 pages, 945 KiB  
Article
Initial Age and Performans Status: Predicators for Re-Irradiation Ability in Patients with Relapsed Brain Metastasis after Initial Stereotactic Radiotherapy
by Isabelle Chambrelant, Laure Kuntz, Clara Le Fèvre, Delphine Jarnet, Julian Jacob and Georges Noël
Cancers 2024, 16(14), 2602; https://doi.org/10.3390/cancers16142602 - 21 Jul 2024
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Abstract
Background: Brain metastases (BMs) frequently occur in cancer patients, and stereotactic radiation therapy (SRT) is a preferred treatment option. In this retrospective study, we analyzed patients treated by SRT for a single BM during their first SRT session and we compared two subgroups: [...] Read more.
Background: Brain metastases (BMs) frequently occur in cancer patients, and stereotactic radiation therapy (SRT) is a preferred treatment option. In this retrospective study, we analyzed patients treated by SRT for a single BM during their first SRT session and we compared two subgroups: “Cohort 1” with patients did not undergo cerebral re-irradiation and “Cohort 2” with patients received at least one subsequent SRT session for cerebral recurrence. Methods: We included patients who received SRT for a single BM between January 2010 and June 2020. Cohort 1 comprised 152 patients, and Cohort 2 had 46 patients. Results: Cohort 2 exhibited younger patients with higher Karnofsky performance status (KPS). Median overall survival was considerably longer in Cohort 2 (21.8 months) compared to Cohort 1 (6.1 months). Local and cerebral recurrence rates were significantly higher in Cohort 2 (p < 0.001), attributed to patient selection and longer survival. The combined score of age and KPS proved to be a predictive factor for survival, with patients under 65 years of age and KPS > 80 showing the best survival rates in the overall population. Conclusion: This retrospective study highlights that the combined score of age and KPS can predict better survival, especially for patients under 65 years with a KPS score above 80. Further research involving larger and more diverse populations is essential to validate and expand upon these findings. Full article
(This article belongs to the Special Issue The Challenge of the Treatment: Radiotherapy of Brain Metastases)
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16 pages, 1382 KiB  
Article
Repeated Stereotactic Radiotherapy for Local Brain Metastases Failure or Distant Brain Recurrent: A Retrospective Study of 184 Patients
by Laure Kuntz, Clara Le Fèvre, Delphine Jarnet, Audrey Keller, Philippe Meyer, Christophe Mazzara, Hélène Cebula, Georges Noel and Delphine Antoni
Cancers 2023, 15(20), 4948; https://doi.org/10.3390/cancers15204948 - 11 Oct 2023
Cited by 1 | Viewed by 1743
Abstract
Background: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of [...] Read more.
Background: The main advantages of stereotactic radiotherapy (SRT) are to delay whole-brain radiotherapy (WBRT) and to deliver ablative doses. Despite this efficacy, the risk of distant brain metastases (BM) one year after SRT ranges from 26% to 77% and 20 to 40% of patients required salvage treatment. The role and consequences of reirradiation remain unclear, particularly in terms of survival. The objective was to study overall survival (OS) and neurological death-free survival (NDFS) and to specify the prognostic factors of long-term survival. Methods: we retrospectively reviewed the data of patients treated between 2010 and 2020 with at least two courses of SRT without previous WBRT. Results: In total, 184 patients were treated for 915 BMs with two-to-six SRT sessions. Additional SRT sessions were provided for local (5.6%) or distant (94.4%) BM recurrence. The median number of BMs treated per SRT was one with a median of four BMs in total. The mean time between the two SRT sessions was 8.9 months (95%CI 7.7–10.1) and there was no significant difference in the delay between the two sessions. The 6-, 12- and 24-month NDFS rates were 97%, 82% and 52%, respectively. The 6-, 12- and 24-month OS rates were 91%, 70% and 38%, respectively. OS was statistically related to the number of SRT sessions (HR = 0.48; p < 0.01), recursive partitioning analysis (HR = 1.84; p = 0.01), salvage WBRT (HR = 0.48; p = 0.01) and brain metastasis velocity (high: HR = 13.83; p < 0.01; intermediate: HR = 4.93; p < 0.01). Conclusions: Lung cancer and melanoma were associated with a lower NDFS compared to breast cancer. A low KPS, a low number of SRT sessions, synchronous extracerebral metastases, synchronous BMs, extracerebral progression at SRT1, a high BMV grade, no WBRT and local recurrence were also associated with a lower NDFS. A high KPS at SRT1 and low BMV grade are prognostic factors for better OS, regardless of the number of BM recurrence events. Full article
(This article belongs to the Special Issue The Challenge of the Treatment: Radiotherapy of Brain Metastases)
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