Fractionated stereotactic radiation therapy for brain metastases: A systematic review with tumour control probability modelling

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Abstract

Objective: Fractionated stereotactic radiotherapy (FSRT) is a relatively new option for the treatment of brain metastases. We performed a quantitative systematic review to determine if local control (LC) following is affected by FSRT dosing regimen. Methods: We reviewed articles describing LC following FSRT for brain metastases. LC data from each study were extracted from actuarial survival curves and aggregated to form a single data set. LC curves were generated using the Kaplan-Meier method. Log-rank testing and Cox proportional hazards modelling were utilized to test for associations between the biologically effective dose (BED) and LC. Tumour control probability modelling was performed to illustrate the relationship between the BED and the likelihood of LC after FSRT. Results: 10 studies (720 metastases) met inclusion criteria. Prescription doses ranged from 18 to 42 Gy, delivered in 3-12 fractions (BED range: 29-100Gy10). 1- and 2-year actuarial LC rates were 80% and 69%, respectively. Increasing BED was associated with improved LC (HR50.77 per increase of 10Gy10, p50.009). Tumour control probability models demonstrated that the BEDs of 40, 50 and 60Gy10 yield predicted 1-year LC rates of 73%, 78% and 84%, respectively. The BEDs of 40, 50 and 60 Gy10 yield 2-year LC rates of 62%, 69% and 81%, respectively. Conclusion: FSRT provides high rates of LC for patients with brain metastases. We found evidence for a dose- response relationship that should be explored in prospective trials. Advances in knowledge: This review identified a dose- response relationship for LC in patients treated with FSRT for brain metastases.

Original languageEnglish (US)
Article number20160666
JournalBritish Journal of Radiology
Volume90
Issue number1070
DOIs
StatePublished - 2017

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Radiotherapy
Neoplasm Metastasis
Brain
Neoplasms
Prescriptions
Survival
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{b5bc53d2b94b49e3b8a8d2adfb6e9e4a,
title = "Fractionated stereotactic radiation therapy for brain metastases: A systematic review with tumour control probability modelling",
abstract = "Objective: Fractionated stereotactic radiotherapy (FSRT) is a relatively new option for the treatment of brain metastases. We performed a quantitative systematic review to determine if local control (LC) following is affected by FSRT dosing regimen. Methods: We reviewed articles describing LC following FSRT for brain metastases. LC data from each study were extracted from actuarial survival curves and aggregated to form a single data set. LC curves were generated using the Kaplan-Meier method. Log-rank testing and Cox proportional hazards modelling were utilized to test for associations between the biologically effective dose (BED) and LC. Tumour control probability modelling was performed to illustrate the relationship between the BED and the likelihood of LC after FSRT. Results: 10 studies (720 metastases) met inclusion criteria. Prescription doses ranged from 18 to 42 Gy, delivered in 3-12 fractions (BED range: 29-100Gy10). 1- and 2-year actuarial LC rates were 80{\%} and 69{\%}, respectively. Increasing BED was associated with improved LC (HR50.77 per increase of 10Gy10, p50.009). Tumour control probability models demonstrated that the BEDs of 40, 50 and 60Gy10 yield predicted 1-year LC rates of 73{\%}, 78{\%} and 84{\%}, respectively. The BEDs of 40, 50 and 60 Gy10 yield 2-year LC rates of 62{\%}, 69{\%} and 81{\%}, respectively. Conclusion: FSRT provides high rates of LC for patients with brain metastases. We found evidence for a dose- response relationship that should be explored in prospective trials. Advances in knowledge: This review identified a dose- response relationship for LC in patients treated with FSRT for brain metastases.",
author = "Sujith Baliga and Garg, {Madhur K.} and Fox, {Jana L.} and Shalom Kalnicki and LaSala, {Patrick A.} and Welch, {Mary R.} and Tome, {Wolfgang A.} and Nitin Ohri",
year = "2017",
doi = "10.1259/bjr.20160666",
language = "English (US)",
volume = "90",
journal = "British Journal of Radiology",
issn = "0007-1285",
publisher = "British Institute of Radiology",
number = "1070",

}

TY - JOUR

T1 - Fractionated stereotactic radiation therapy for brain metastases

T2 - A systematic review with tumour control probability modelling

AU - Baliga, Sujith

AU - Garg, Madhur K.

AU - Fox, Jana L.

AU - Kalnicki, Shalom

AU - LaSala, Patrick A.

AU - Welch, Mary R.

AU - Tome, Wolfgang A.

AU - Ohri, Nitin

PY - 2017

Y1 - 2017

N2 - Objective: Fractionated stereotactic radiotherapy (FSRT) is a relatively new option for the treatment of brain metastases. We performed a quantitative systematic review to determine if local control (LC) following is affected by FSRT dosing regimen. Methods: We reviewed articles describing LC following FSRT for brain metastases. LC data from each study were extracted from actuarial survival curves and aggregated to form a single data set. LC curves were generated using the Kaplan-Meier method. Log-rank testing and Cox proportional hazards modelling were utilized to test for associations between the biologically effective dose (BED) and LC. Tumour control probability modelling was performed to illustrate the relationship between the BED and the likelihood of LC after FSRT. Results: 10 studies (720 metastases) met inclusion criteria. Prescription doses ranged from 18 to 42 Gy, delivered in 3-12 fractions (BED range: 29-100Gy10). 1- and 2-year actuarial LC rates were 80% and 69%, respectively. Increasing BED was associated with improved LC (HR50.77 per increase of 10Gy10, p50.009). Tumour control probability models demonstrated that the BEDs of 40, 50 and 60Gy10 yield predicted 1-year LC rates of 73%, 78% and 84%, respectively. The BEDs of 40, 50 and 60 Gy10 yield 2-year LC rates of 62%, 69% and 81%, respectively. Conclusion: FSRT provides high rates of LC for patients with brain metastases. We found evidence for a dose- response relationship that should be explored in prospective trials. Advances in knowledge: This review identified a dose- response relationship for LC in patients treated with FSRT for brain metastases.

AB - Objective: Fractionated stereotactic radiotherapy (FSRT) is a relatively new option for the treatment of brain metastases. We performed a quantitative systematic review to determine if local control (LC) following is affected by FSRT dosing regimen. Methods: We reviewed articles describing LC following FSRT for brain metastases. LC data from each study were extracted from actuarial survival curves and aggregated to form a single data set. LC curves were generated using the Kaplan-Meier method. Log-rank testing and Cox proportional hazards modelling were utilized to test for associations between the biologically effective dose (BED) and LC. Tumour control probability modelling was performed to illustrate the relationship between the BED and the likelihood of LC after FSRT. Results: 10 studies (720 metastases) met inclusion criteria. Prescription doses ranged from 18 to 42 Gy, delivered in 3-12 fractions (BED range: 29-100Gy10). 1- and 2-year actuarial LC rates were 80% and 69%, respectively. Increasing BED was associated with improved LC (HR50.77 per increase of 10Gy10, p50.009). Tumour control probability models demonstrated that the BEDs of 40, 50 and 60Gy10 yield predicted 1-year LC rates of 73%, 78% and 84%, respectively. The BEDs of 40, 50 and 60 Gy10 yield 2-year LC rates of 62%, 69% and 81%, respectively. Conclusion: FSRT provides high rates of LC for patients with brain metastases. We found evidence for a dose- response relationship that should be explored in prospective trials. Advances in knowledge: This review identified a dose- response relationship for LC in patients treated with FSRT for brain metastases.

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U2 - 10.1259/bjr.20160666

DO - 10.1259/bjr.20160666

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VL - 90

JO - British Journal of Radiology

JF - British Journal of Radiology

SN - 0007-1285

IS - 1070

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