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Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases
Purpose To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development. Methods A single institution retros...
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| Published in: | Journal of neuro-oncology 2022-12, Vol.160 (3), p.591-599 |
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| creator | McKenzie, Grant Gaskins, Jeremy Rattani, Abbas Oliver, Alexandria Southall, William Nakamura, Fumihiko Yusuf, Mehran Mistry, Akshitkumar Williams, Brian Woo, Shiao |
| description | Purpose
To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development.
Methods
A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED
2.5
). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC).
Results
The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT (
p
= 0.01). A larger maximum BED
2.5
was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy;
p
= 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions (
p
|
| doi_str_mv | 10.1007/s11060-022-04178-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2755000886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2755000886</sourcerecordid><originalsourceid>FETCH-LOGICAL-c342t-35addc2b250c79d0490118c0e61bf0dae00d0ecc80f70dc100eedba740615c4b3</originalsourceid><addsrcrecordid>eNp9kMtKxDAUhoMoOo6-gAspuI6eJG3TLkW8gSCIgruQJqdjZdrUJCPM25uZetkJhxyS_Bf4CDlhcM4A5EVgDEqgwDmFnMmK8h0yY4UUVAopdskMWClpUeevB-QwhHcAyKVg--RAlILVss5npHvStnNh5Rfo11nrtYmdG_TmyPRgs9GFSKNHHXscYvaGvfP-TS8ws_iJSzdun1vns26IyZz1uNSD63XWeN0N6Rp1SIPhiOy1ehnw-HvPycvN9fPVHX14vL2_unygRuQ8UlFoaw1veAFG1hbyGhirDGDJmhasRgALaEwFrQRrEghE22iZQ8kKkzdiTs6m3NG7jxWGqN7dyg-pUnFZFAlCVZVJxSeV8S4Ej60afddrv1YM1IaumuiqRFdt6SqeTKff0aumR_tr-cGZBGIShPQ1JKR_3f_EfgEEpYfw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2755000886</pqid></control><display><type>article</type><title>Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases</title><source>Springer Nature</source><creator>McKenzie, Grant ; Gaskins, Jeremy ; Rattani, Abbas ; Oliver, Alexandria ; Southall, William ; Nakamura, Fumihiko ; Yusuf, Mehran ; Mistry, Akshitkumar ; Williams, Brian ; Woo, Shiao</creator><creatorcontrib>McKenzie, Grant ; Gaskins, Jeremy ; Rattani, Abbas ; Oliver, Alexandria ; Southall, William ; Nakamura, Fumihiko ; Yusuf, Mehran ; Mistry, Akshitkumar ; Williams, Brian ; Woo, Shiao</creatorcontrib><description>Purpose
To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development.
Methods
A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED
2.5
). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC).
Results
The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT (
p
= 0.01). A larger maximum BED
2.5
was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy;
p
= 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions (
p
< 0.001).
Conclusion
We found an increased incidence of post-treatment HA for intact MBM receiving a larger maximum BED
2.5,
which was significantly higher for single fraction treatments within our cohort. The presence of lesion HA, either pre- or post-treatment, was indicative of inferior LC. Further investigations of optimal dose and fractionation schedules for treatment of MBM in the era of immunotherapy are warranted.</description><identifier>ISSN: 0167-594X</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-022-04178-2</identifier><identifier>PMID: 36319794</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Brain cancer ; Case Study ; Dosimetry ; Hemorrhage ; Immunotherapy ; Lesions ; Medicine ; Medicine & Public Health ; Melanoma ; Metastases ; Metastasis ; Neuroimaging ; Neurology ; Oncology ; Radiation therapy ; Radiosurgery ; Statistical analysis</subject><ispartof>Journal of neuro-oncology, 2022-12, Vol.160 (3), p.591-599</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c342t-35addc2b250c79d0490118c0e61bf0dae00d0ecc80f70dc100eedba740615c4b3</citedby><cites>FETCH-LOGICAL-c342t-35addc2b250c79d0490118c0e61bf0dae00d0ecc80f70dc100eedba740615c4b3</cites><orcidid>0000-0002-6737-3966</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36319794$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McKenzie, Grant</creatorcontrib><creatorcontrib>Gaskins, Jeremy</creatorcontrib><creatorcontrib>Rattani, Abbas</creatorcontrib><creatorcontrib>Oliver, Alexandria</creatorcontrib><creatorcontrib>Southall, William</creatorcontrib><creatorcontrib>Nakamura, Fumihiko</creatorcontrib><creatorcontrib>Yusuf, Mehran</creatorcontrib><creatorcontrib>Mistry, Akshitkumar</creatorcontrib><creatorcontrib>Williams, Brian</creatorcontrib><creatorcontrib>Woo, Shiao</creatorcontrib><title>Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases</title><title>Journal of neuro-oncology</title><addtitle>J Neurooncol</addtitle><addtitle>J Neurooncol</addtitle><description>Purpose
To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development.
Methods
A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED
2.5
). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC).
Results
The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT (
p
= 0.01). A larger maximum BED
2.5
was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy;
p
= 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions (
p
< 0.001).
Conclusion
We found an increased incidence of post-treatment HA for intact MBM receiving a larger maximum BED
2.5,
which was significantly higher for single fraction treatments within our cohort. The presence of lesion HA, either pre- or post-treatment, was indicative of inferior LC. Further investigations of optimal dose and fractionation schedules for treatment of MBM in the era of immunotherapy are warranted.</description><subject>Brain cancer</subject><subject>Case Study</subject><subject>Dosimetry</subject><subject>Hemorrhage</subject><subject>Immunotherapy</subject><subject>Lesions</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Neuroimaging</subject><subject>Neurology</subject><subject>Oncology</subject><subject>Radiation therapy</subject><subject>Radiosurgery</subject><subject>Statistical analysis</subject><issn>0167-594X</issn><issn>1573-7373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kMtKxDAUhoMoOo6-gAspuI6eJG3TLkW8gSCIgruQJqdjZdrUJCPM25uZetkJhxyS_Bf4CDlhcM4A5EVgDEqgwDmFnMmK8h0yY4UUVAopdskMWClpUeevB-QwhHcAyKVg--RAlILVss5npHvStnNh5Rfo11nrtYmdG_TmyPRgs9GFSKNHHXscYvaGvfP-TS8ws_iJSzdun1vns26IyZz1uNSD63XWeN0N6Rp1SIPhiOy1ehnw-HvPycvN9fPVHX14vL2_unygRuQ8UlFoaw1veAFG1hbyGhirDGDJmhasRgALaEwFrQRrEghE22iZQ8kKkzdiTs6m3NG7jxWGqN7dyg-pUnFZFAlCVZVJxSeV8S4Ej60afddrv1YM1IaumuiqRFdt6SqeTKff0aumR_tr-cGZBGIShPQ1JKR_3f_EfgEEpYfw</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>McKenzie, Grant</creator><creator>Gaskins, Jeremy</creator><creator>Rattani, Abbas</creator><creator>Oliver, Alexandria</creator><creator>Southall, William</creator><creator>Nakamura, Fumihiko</creator><creator>Yusuf, Mehran</creator><creator>Mistry, Akshitkumar</creator><creator>Williams, Brian</creator><creator>Woo, Shiao</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0002-6737-3966</orcidid></search><sort><creationdate>20221201</creationdate><title>Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases</title><author>McKenzie, Grant ; Gaskins, Jeremy ; Rattani, Abbas ; Oliver, Alexandria ; Southall, William ; Nakamura, Fumihiko ; Yusuf, Mehran ; Mistry, Akshitkumar ; Williams, Brian ; Woo, Shiao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c342t-35addc2b250c79d0490118c0e61bf0dae00d0ecc80f70dc100eedba740615c4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Brain cancer</topic><topic>Case Study</topic><topic>Dosimetry</topic><topic>Hemorrhage</topic><topic>Immunotherapy</topic><topic>Lesions</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Neuroimaging</topic><topic>Neurology</topic><topic>Oncology</topic><topic>Radiation therapy</topic><topic>Radiosurgery</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McKenzie, Grant</creatorcontrib><creatorcontrib>Gaskins, Jeremy</creatorcontrib><creatorcontrib>Rattani, Abbas</creatorcontrib><creatorcontrib>Oliver, Alexandria</creatorcontrib><creatorcontrib>Southall, William</creatorcontrib><creatorcontrib>Nakamura, Fumihiko</creatorcontrib><creatorcontrib>Yusuf, Mehran</creatorcontrib><creatorcontrib>Mistry, Akshitkumar</creatorcontrib><creatorcontrib>Williams, Brian</creatorcontrib><creatorcontrib>Woo, Shiao</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McKenzie, Grant</au><au>Gaskins, Jeremy</au><au>Rattani, Abbas</au><au>Oliver, Alexandria</au><au>Southall, William</au><au>Nakamura, Fumihiko</au><au>Yusuf, Mehran</au><au>Mistry, Akshitkumar</au><au>Williams, Brian</au><au>Woo, Shiao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases</atitle><jtitle>Journal of neuro-oncology</jtitle><stitle>J Neurooncol</stitle><addtitle>J Neurooncol</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>160</volume><issue>3</issue><spage>591</spage><epage>599</epage><pages>591-599</pages><issn>0167-594X</issn><eissn>1573-7373</eissn><abstract>Purpose
To assess, for intact melanoma brain metastases (MBM), whether single-fraction stereotactic radiosurgery (SRS) versus fractionated stereotactic radiotherapy (fSRT) is associated with a differential risk of post-treatment lesion hemorrhage (HA) development.
Methods
A single institution retrospective database review identified consecutive patients with previously unresected MBM treated with robotic SRS/fSRT between 2013 and 2021. The presence of lesion HA was determined by multi-disciplinary imaging review. Dosimetric variables were reported as biologically effective doses using an α/β ratio of 2.5 (BED
2.5
). Statistical analysis was performed using mixed effect logistic regression for post-treatment HA and Cox frailty modeling for local control (LC).
Results
The cohort included 48 patients with 226 intact MBM treated with SRS/fSRT. Of lesions without prior HA, 63 of 133 lesions (47.4%) receiving SRS demonstrated evidence of post-treatment HA versus 2 of 24 lesions (8.3%) treated with fSRT (
p
= 0.01). A larger maximum BED
2.5
was observed in lesions developing HA compared to no HA (238.3 Gy vs. 211.4 Gy;
p
= 0.022). 12-month LC was 65.7% (95% CI 37.2–87.3%) and 77.5% (95% CI 58.5–91.2%) for lesions demonstrating pre-treatment and post-treatment HA, respectively, with no local failure events observed within 12 months for non-hemorrhagic lesions (
p
< 0.001).
Conclusion
We found an increased incidence of post-treatment HA for intact MBM receiving a larger maximum BED
2.5,
which was significantly higher for single fraction treatments within our cohort. The presence of lesion HA, either pre- or post-treatment, was indicative of inferior LC. Further investigations of optimal dose and fractionation schedules for treatment of MBM in the era of immunotherapy are warranted.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36319794</pmid><doi>10.1007/s11060-022-04178-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6737-3966</orcidid></addata></record> |
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| source | Springer Nature |
| subjects | Brain cancer Case Study Dosimetry Hemorrhage Immunotherapy Lesions Medicine Medicine & Public Health Melanoma Metastases Metastasis Neuroimaging Neurology Oncology Radiation therapy Radiosurgery Statistical analysis |
| title | Radiosurgery fractionation and post-treatment hemorrhage development for intact melanoma brain metastases |
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