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Hirnmetastasen solider Tumoren

  • Harun Badakhshi
Chapter
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Zusammenfassung

Etwa vier von 10 Patienten (w/m) leiden im Verlauf ihrer Krebserkrankung an Hirnmetastasierung. Hirnmetastasen (HM) solider Tumoren gehören innerhalb der onkologischen Anamnesen zu den häufigsten Todesursachen maligner Erkrankungen. Während die Ganzhirnradiotherapie schon seit den 1980ern zum Behandlungsstandard gehört, wurden in den späten 1990ern neue Interventionsoptionen ausgelotet. Stereotaktische Radiochirurgie wurde hinsichtlich ihrer Wirksamkeit und Sicherheit systematisch untersucht und weiter differenziert. Die Trennung von singulären und Oligometastasen von polymetastasierten Fällen war der Beginn einer differenzialtherapeutischen Herangehensweise. Die Erzeugung robuster wissenschaftlicher Evidenz hat die Datenlage zu und damit das Verständnis der ZNS-metastasierten Patienten (w/m) grundsätzlich geändert. Damit wurde ein neuer globaler Standard der Behandlung definiert, in der Patienten (w/m) mit vereinzelten ZNS-Metastasen (bis zu vier Läsionen) einer stereotaktischen Radiochirurgie mit oder ohne GHRT unterzogen werden sollten.

Literatur

  1. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363(9422):1665–1672CrossRefPubMedGoogle Scholar
  2. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. Jama 295(21):2483–2491CrossRefPubMedGoogle Scholar
  3. Aoyama H, Tago M, Shirato H (2015) Japanese Radiation Oncology Study Group I. Stereotactic Radiosurgery With or Without Whole-Brain Radiotherapy for Brain Metastases: Secondary Analysis of the JROSG 99-1 Randomized Clinical Trial. JAMA oncology 1(4):457–464CrossRefPubMedGoogle Scholar
  4. Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M et al (2014) A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. International journal of radiation oncology, biology, physics 88(4):899–906CrossRefPubMedGoogle Scholar
  5. Atalar B, Modlin LA, Choi CY, Adler JR, Gibbs IC, Chang SD et al (2013) Risk of leptomeningeal disease in patients treated with stereotactic radiosurgery targeting the postoperative resection cavity for brain metastases. International journal of radiation oncology, biology, physics 87(4):713–718CrossRefPubMedGoogle Scholar
  6. Bachelot T, Romieu G, Campone M, Dieras V, Cropet C, Dalenc F et al (2013) Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. The Lancet Oncology 14(1):64–71CrossRefPubMedGoogle Scholar
  7. Borgelt B, Gelber R, Larson M, Hendrickson F, Griffin T, Roth R (1981) Ultra-rapid high dose irradiation schedules for the palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. International journal of radiation oncology, biology, physics 7(12):1633–1638CrossRefPubMedGoogle Scholar
  8. Bradley KA, Mehta MP (2004) Management of brain metastases. Seminars in oncology 31(5):693–701CrossRefPubMedGoogle Scholar
  9. Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C et al (2013) Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro-oncology 15(10):1429–1437CrossRefPubMedPubMedCentralGoogle Scholar
  10. Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. The Lancet Oncology 10(11):1037–1044CrossRefPubMedGoogle Scholar
  11. Chao JH, Phillips R, Nickson JJ (1954) Roentgen-ray therapy of cerebral metastases. Cancer 7(4):682–689CrossRefPubMedGoogle Scholar
  12. Choi CY, Chang SD, Gibbs IC, Adler JR, Harsh GRt, Lieberson RE et al (2012) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases: prospective evaluation of target margin on tumor control. International journal of radiation oncology, biology, physics 84(2):336–342CrossRefPubMedGoogle Scholar
  13. Deng L, Liang H, Burnette B, Beckett M, Darga T, Weichselbaum RR et al (2014) Irradiation and anti-PD-L1 treatment synergistically promote antitumor immunity in mice. The Journal of clinical investigation 124(2):687–695CrossRefPubMedPubMedCentralGoogle Scholar
  14. Eriksson PS, Perfilieva E, Bjork-Eriksson T, Alborn AM, Nordborg C, Peterson DA et al (1998) Neurogenesis in the adult human hippocampus. Nature medicine 4(11):1313–1317CrossRefPubMedGoogle Scholar
  15. Gondi V, Hermann BP, Mehta MP, Tome WA (2013) Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors. International journal of radiation oncology, biology, physics 85(2):348–354CrossRefPubMedGoogle Scholar
  16. Gondi V, Pugh SL, Tome WA, Caine C, Corn B, Kanner A et al (2014) Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 32(34):3810–3816CrossRefGoogle Scholar
  17. Houten L, Reilley AA (1980) An investigation of the cause of death from cancer. Journal of surgical oncology 13(2):111–116CrossRefPubMedGoogle Scholar
  18. Kaul D, Angelidis A, Budach V, Ghadjar P, Kufeld M, Badakhshi H (2015) Prognostic indices in stereotactic radiotherapy of brain metastases of non-small cell lung cancer. Radiation oncology 10(1):244CrossRefPubMedPubMedCentralGoogle Scholar
  19. Kocher M, Soffietti R, Abacioglu U, Villa S, Fauchon F, Baumert BG et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases:results of the EORTC 22952-26001 study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 29(2):134–141CrossRefGoogle Scholar
  20. Leth T, von Oettingen G, Lassen-Ramshad YA, Lukacova S, Hoyer M (2015) Survival and prognostic factors in patients treated with stereotactic radiotherapy for brain metastases. Acta oncologica 54(1):107–114CrossRefPubMedGoogle Scholar
  21. Lin NU, Lee EQ, Aoyama H, Barani IJ, Barboriak DP, Baumert BG et al (2015) Response assessment criteria for brain metastases: proposal from the RANO group. The Lancet Oncology 16(6):e270–278CrossRefPubMedGoogle Scholar
  22. Lin X, DeAngelis LM (2015) Treatment of Brain Metastases. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 33(30):3475–3484CrossRefGoogle Scholar
  23. Mehta MP (2015a) Brain metastases: the changing landscape. Oncology 29(4):257–260PubMedGoogle Scholar
  24. Mehta MP (2015b) The controversy surrounding the use of whole-brain radiotherapy in brain metastases patients. Neuro-oncology 17(7):919–923CrossRefPubMedGoogle Scholar
  25. Mehta MP, Ahluwalia MS (2015c) Whole-brain radiotherapy and stereotactic radiosurgery in brain metastases: what is the evidence? American Society of Clinical Oncology educational book/ASCO American Society of Clinical Oncology Meeting: e99–104Google Scholar
  26. Mehta MP, Rodrigus P, Terhaard CH, Rao A, Suh J, Roa W et al (2003) Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 21(13):2529–2536CrossRefGoogle Scholar
  27. Mehta MP, Tsao MN, Whelan TJ, Morris DE, Hayman JA, Flickinger JC et al (2005) The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. International journal of radiation oncology, biology, physics 63(1):37–46CrossRefPubMedGoogle Scholar
  28. Mohammadi AM, Recinos PF, Barnett GH, Weil RJ, Vogelbaum MA, Chao ST et al (2012) Role of Gamma Knife surgery in patients with 5 or more brain metastases. Journal of neurosurgery 117 Suppl:5–12PubMedGoogle Scholar
  29. Monje ML, Mizumatsu S, Fike JR, Palmer TD (2002) Irradiation induces neural precursor-cell dysfunction. Nature medicine 8(9):955–962CrossRefPubMedGoogle Scholar
  30. Muacevic A, Kreth FW, Horstmann GA, Schmid-Elsaesser R, Wowra B, Steiger HJ et al (1999) Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. Journal of neurosurgery 91(1):35–43CrossRefPubMedGoogle Scholar
  31. Myrseth E, Møller P, Pedersen P-H, Lund-Johansen M (2009) Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 64:654–661; discussion 661–663PubMedGoogle Scholar
  32. Nieder C, Grosu AL, Mehta MP (2012) Brain metastases research 1990– 2010: pattern of citation and systematic review of highly cited articles. TheScientificWorldJournal 2012:721598Google Scholar
  33. O'Neill BP, Iturria NJ, Link MJ, Pollock BE, Ballman KV, O'Fallon JR (2003) A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. International journal of radiation oncology, biology, physics 55(5):1169–1176CrossRefPubMedGoogle Scholar
  34. Patchell RA, Tibbs PA, Regine WF, Dempsey RJ, Mohiuddin M, Kryscio RJ et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. Jama 280(17):1485–1489CrossRefPubMedGoogle Scholar
  35. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. The New England journal of medicine 322(8):494–500CrossRefPubMedGoogle Scholar
  36. Pollock BE, Driscoll CLW, Foote RL, Link MJ, Gorman DA, Bauch CD, Mandrekar JN, Krecke KN, Johnson CH (2006) Patient outcomes after vestibular schwannoma management: a prospective comparison of microsurgical resection and stereotactic radiosurgery. Neurosurgery 59:77–85; discussion 77–85CrossRefPubMedGoogle Scholar
  37. Rades D, Huttenlocher S, Gebauer N, Hornung D, Trang NT, Khoa MT et al (2015a) Impact of stereotactic radiosurgery dose on control of cerebral metastases from renal cell carcinoma. Anticancer research 35(6):3571–3574PubMedGoogle Scholar
  38. Rades D, Huttenlocher S, Khoa MT, Thai PV, Hornung D, Schild SE (2015b) Number of cerebral lesions predicts freedom from new brain metastases after radiosurgery alone in lung cancer patients. Oncology letters 10(2):1109–1112PubMedPubMedCentralGoogle Scholar
  39. Rades D, Pluemer A, Veninga T, Hanssens P, Dunst J, Schild SE (2007) Whole-brain radiotherapy versus stereotactic radiosurgery for patients in recursive partitioning analysis classes 1 and 2 with 1 to 3 brain metastases. Cancer 110(10):2285–2292CrossRefPubMedGoogle Scholar
  40. Rades D, Pluemer A, Veninga T, Schild SE (2008) Comparison of different treatment approaches for one to two brain metastases in elderly patients. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al] 184(11):565–571CrossRefGoogle Scholar
  41. Rades D, Schild SE (2012) Do patients with a limited number of brain metastases need whole-brain radiotherapy in addition to radiosurgery? Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft [et al] 188(8):702–706CrossRefGoogle Scholar
  42. Rades D, Schild SE, Lohynska R, Veninga T, Stalpers LJ, Dunst J (2007b) Two radiation regimens and prognostic factors for brain metastases in nonsmall cell lung cancer patients. Cancer 110(5):1077–1082CrossRefPubMedGoogle Scholar
  43. Rades D, Sehmisch L, Huttenlocher S, Blank O, Hornung D, Terheyden P et al (2014) Radiosurgery alone for 1–3 newly-diagnosed brain metastases from melanoma: impact of dose on treatment outcomes. Anticancer research 34(9):5079–5082PubMedGoogle Scholar
  44. Régis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, Zanaret M, Peragut JC (2002) Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97:1091–1100CrossRefPubMedGoogle Scholar
  45. Sahgal A, Aoyama H, Kocher M, Neupane B, Collette S, Tago M et al (2015a) Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. International journal of radiation oncology, biology, physics 91(4):710–717CrossRefPubMedGoogle Scholar
  46. Sahgal A, Larson D, Knisely J (2015b) Stereotactic radiosurgery alone for brain metastases. The Lancet Oncology 16(3):249–250CrossRefPubMedGoogle Scholar
  47. Sanghavi SN, Miranpuri SS, Chappell R, Buatti JM, Sneed PK, Suh JH et al (2001) Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method. International journal of radiation oncology, biology, physics 51(2):426–434CrossRefPubMedGoogle Scholar
  48. Schoggl A, Kitz K, Reddy M, Wolfsberger S, Schneider B, Dieckmann K et al (2000) Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta neurochirurgica 142(6):621–626CrossRefPubMedGoogle Scholar
  49. Soltys SG, Adler JR, Lipani JD, Jackson PS, Choi CY, Puataweepong P et al (2008) Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. International journal of radiation oncology, biology, physics 70(1):187–193CrossRefPubMedGoogle Scholar
  50. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. International journal of radiation oncology, biology, physics 70(2):510–514CrossRefPubMedGoogle Scholar
  51. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. International journal of radiation oncology, biology, physics 77(3):655–661CrossRefPubMedGoogle Scholar
  52. Sperduto PW, Shanley R, Luo X, Andrews D, Werner-Wasik M, Valicenti R et al (2014) Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA). International journal of radiation oncology, biology, physics 90(3):526–531CrossRefPubMedPubMedCentralGoogle Scholar
  53. Sperduto PW, Wang M, Robins HI, Schell MC, Werner-Wasik M, Komaki R et al (2013) A phase 3 trial of whole brain radiation therapy and stereotactic radiosurgery alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: Radiation Therapy Oncology Group 0320, International journal of radiation oncology, biology, physics 85(5):1312–1318CrossRefPubMedPubMedCentralGoogle Scholar
  54. Stokes TB, Niranjan A, Kano H, Choi PA, Kondziolka D, Dade Lunsford L et al (2015) White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery. Journal of neuro-oncology 121(3):583–590CrossRefPubMedGoogle Scholar
  55. Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Vichare A et al (2012) International practice survey on the management of brain metastases: Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control. Clinical oncology 24(6):e81–92CrossRefPubMedGoogle Scholar
  56. Tsao M, Xu W, Sahgal A (2012) A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer 118(9):2486–2493CrossRefPubMedGoogle Scholar
  57. Willett A, Wilkinson JB, Shah C, Mehta MP (2015) Management of solitary and multiple brain metastases from breast cancer. Indian journal of medical and paediatric oncology: official journal of Indian Society of Medical & Paediatric Oncology 36(2):87–93Google Scholar
  58. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J et al (2014a) Stereotactic radiosurgery for patients with brain metastases – authors' reply. The Lancet Oncology 15(7):e248CrossRefPubMedGoogle Scholar
  59. Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J et al (2014b) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. The Lancet Oncology 15(4):387–395CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  • Harun Badakhshi
    • 1
  1. 1.Direktor der Klinik für integrative RadioonkologieKlinikum Ernst von Bergmann, akademisches Krankenhaus der CharitéPotsdamDeutschland

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