Clinical Researches About Stereotactic Radiosurgery Of Multiple Brain Metastases

Application of 3D-BRAVO in Detecting multiple Brain Metastases Background and purposeBrain metastasis is one of the most common intracranial tumor. With the improvement of the systemic treatment and imaging technology, the detection rate of brain metastasis increased. More than half of the patients with brain metastasis are multiple brain metastases, and multiple brain metastases generally progress rapidly, and the prognosis is poor.The number and location of lesions are very important for the management and prognosis evaluation of patients with brain metastasis. Current management of multiple brain metastases include whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), surgery, medications. In recent years, the SRS is more and more applied in the management of multiple brain metastases.Thus it is more important to accurately determine the number and size of lesions by imaging examination. At present, the routine imaging examination of patients with suspected brain metastases is MR plain sequence and contrast enhanced 2 dimensional T1 weighted sequence, and the application of contrast enhanced three-dimensional volume(3D-BRAVO) scan is relatively seldom. But the contrast enhanced 3D-BRAVO sequence using thin-slice and volume scan can significantly reduce the missed diagnosis and improve the detection rate of lesions. This study was to compare the sensitivity of enhanced 3D-BRAVO and conventional 2D-T1WI sequence in diagnosis of multiple brain metastases, and to evaluate the value of contrast enhanced 3-dimensional brain volume imaging (3D-BRAVO) sequence.MethodsSelect 45 BM and suspected BM patients to undergo MR plan scan and contrast enhanced scan(2D-T1WI and 3D-BRAVO). Then according to the imaging of the 3D-BRAVO, filter 35 multiple BM patients. The number and size of the lesions in two contrast enhanced sequences were analyzed.Results(1) Number:35 cases were diagnosed as multiple brain metastases, according to 3D-BRAVO contrast enhanced sequence. In 35 cases, there were 175 lesions in 3D-BRAVO contrast enhanced sequence, and 115 lesions in 2D contrast enhanced T1WI sequence. On the basis of 3D-BRAVO contrast enhanced scan, the sensitivity of 2D contrast enhanced T1WI scan is 64.57%, and the missed diagnosis rate is 35.43%. The paired t-test analysis shows that a significantly greater number of lesions was detected using 3D-BRAVO contrast enhanced scan.(2) Size:measure the 113 lesions both found by 3D-BRAVO contrast enhanced scan and 2D contrast enhanced T1 WI scan. The average size is about 12.06±9.29mm on 2D contrast enhanced T1WI scan and is about 12.96±9.75mm on 3D-BRAVO contrast enhanced scan. There is a significant difference on size between 3D-BRAVO contrast enhanced scan and 2D contrast enhanced T1WI scan.ConclusionsContrast-enhanced 3D-BRAVO can effectually detect tiny brain metastasis. Taking enhanced 3D-BRAVO for replacement of normal enhanced T1WI sequence can improve the detection rate of lesions in multiple brain metastases.Evaluation of Stereotactic Radiosurgery for 238 patients with multiple brain metastasesBackground and purposeBrain metastases develop in 20% to 40% of patients with cancer. Approximately over 50% of patients present with multiple metastases. Brain metastases are a significant cause of morbidity and mortality in cancer patients. Patients with multiple brain metastases have more poor prognosis. Radiotherapy for multiple brain metastases includes the whole brain radiotherapy, stereotactic radiosurgery(SRS) and the combination of the both strategies. In the last decade, the use of SRS has become more common in clinical practice worldwide. The aim of this study is to evaluate the efficacy of SRS as a treatment of multiple brain metastases, and assesses factors of prognostic significance for tumor control and overall survival.MethodsWe retrospectively analyzed 238 patients with multiple brain metastases underwent stereotactic radiosurgery from August 2011 to December 2014.191 patients were treated by SRS alone,22 patients were treated by SRS combined with whole brain radiotherapy(WBRT), and 25 patients were salvaged by SRS after the WBRT failure. We use Kaplan-Meier method to compute the overall survival. The univariate analysis was used by the mean of The Log rank method. Multivariate analysis with COX regression models was used to estimate the significant prognostic factors.ResultsThe median overall survival(OS) was 13(2-54) months after SRS. The follow-up rate was 98.7% in the group. The 6 months local control rate for all of the patients after SRS was 88.3%. The median OS for SRS alone group, combined group, salvaged group were 14,10,10 months respectively(χ2=6.818, P=0.033). The 1 year and 2 year survival rate were 53.9%,12.3%. The univariate analysis estimate that treatment method, extracranial disease, KPS score and RPA classification were significant prognostic factors for survival rate. Multivariate analysis revealed significant factors for OS to be extracranial disease, KPS score and RPA.ConclusionA definitive benefit of SRS is observed in the treatment of multiple brain metastases. There is no significant difference of survival between SRS alon & and SRS combined with WBRT. SRS can also as sole the treatment for multiple brain metastases. Multivariate analysis revealed that extracranial disease and KPS score were significant factors for OS. The RPA classification was the independent prognostic factor for survival.ObjectiveTo evaluate the therapeutic efficacy and its affecting factors of multiple brain metastases treatment with Gamma Knife radiosurgery alone.MethodsWe retrospectively analyzed 191 patients with multiple brain metastases underwent stereotactic radiosurgery alone from August 2011 to December 2014. The mean number of brain metastases was 6.1 (range 2～26), the mean total tumor volume was 5.8 cm3 (range 0.03～26.5cm3), median marginal dose was 20.5 Gy.105 cases (55.0%) with 24 lesions,54 cases (28.3%)with 5～10 lesions,32 cases (16.7%)with≥11 lesions.The univariate analysis was used by the mean of The Log rank method. Multivariate analysis with COX regression models was used to estimate the significant prognostic factors.ResultsThe median overall survival(OS) was 14 months after SRS. The 6 months local control rate for all of the patients after GKRS was 88.1%. The median survival time of 2～4 group,5～10 group,≥11 group were 14,13 and 13 months respectively (P=0.683), The overall 1 year survival rate,2 year survival rates were 53.9%,12.3% respectively, univariate and multivariate analysis showed that the prognostic factors affecting overall survival rate:extracranial disease control, KPS score and RPA clssification.ConclusionThis study revealed that SRS alone is an effective and safe minimally invasive option for selected patients with multiple brain metastases. No significant difference of survival and side-effects were detected in 2-4 group,5～10 group,≥11 group. SRS might be a suitable alternative for patients with up to ten brain metastases. Multivariate analysis showed that KPS score, extracranial disease control and RPA classification is the prognostic factors of survival.