Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS)

Christopher Abraham, Adam Garsa, Shahed N. Badiyan, Robert Drzymala, Deshan Yang, Todd DeWees, Christina Tsien, Joshua L. Dowling, Keith M. Rich, Michael R. Chicoine, Albert H. Kim, Eric C. Leuthardt, Cliff Robinson

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Objective: To identify potentially actionable dosimetric predictors of local control (LC) for non-small cell lung cancer (NSCLC) brain metastases treated with single-fraction stereotactic radiosurgery (SRS). Methods and materials: Patients with NSCLC brain metastases treated with single-fraction SRS were identified. Eligible patients had at least 1 follow-up magnetic resonance imaging scan and were without prior metastasectomy or SRS to the same lesion. LC and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate (UVA) and multivariate analysis (MVA). Receiver operating characteristic (ROC) analysis was used to identify optimal cut points for dose-volume histogram metrics relative to LC. Results: A total of 612 NSCLC brain metastasis were identified in 299 patients with single-fraction SRS between 1999 and 2014. Median follow-up was 10 months. Median OS from time of SRS was 11 months. Overall LC was 75% and 66% at 1 and 2 years, respectively. On UVA, increasing dose by any measure was associated with improved LC. On MVA, volume receiving at least 32 Gy (V32; hazard ratio [HR], 0.069; P <.000), along with higher prescription isodose (HR, 0.953; P =.031) and lower volume (HR, 1.359; P <.000), were independent predictors of improved LC. ROC analysis demonstrated a V32 of 24% to be most predictive for LC. For the entire cohort, 1-year LC for V32 ≥24% was 89% versus 67% for V32 <24% (P =.000). Stratifying by volume, lesions ≤2 cm (n = 323) had a 1-year LC of 95% versus 82% (P =.005) for V32 above and below 24%, respectively. For lesions 2.1 to 3 cm (n = 211), 1-year LC was 79% versus 59% (P =.003) for V32 above and below 24%, respectively. Total tumor volume alone was predictive for OS. Conclusions: Volume, prescription isodose line, and V32 are independent predictors of LC. V32 represents an actionable SRS treatment planning parameter for NSCLC brain metastases.

Original languageEnglish (US)
Pages (from-to)146-153
Number of pages8
JournalAdvances in Radiation Oncology
Volume3
Issue number2
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

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ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Abraham, C., Garsa, A., Badiyan, S. N., Drzymala, R., Yang, D., DeWees, T., Tsien, C., Dowling, J. L., Rich, K. M., Chicoine, M. R., Kim, A. H., Leuthardt, E. C., & Robinson, C. (2018). Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS). Advances in Radiation Oncology, 3(2), 146-153. https://doi.org/10.1016/j.adro.2017.11.003