Progress of stereotactic radiotherapy in the treatment of brain metastatic tumor_West China Medical Journal

Authors：

HE Haixia ,  LI Yan

Departments of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Yan, Email: yy1240@ 163.com

Keywords：

Brain metastasis; Stereotactic radiosurgery; Overall survival; Local control rates; Toxic reaction

DOI：

10.7507/1002-0179.201802052

Video：

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Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.

Citation： HE Haixia, LI Yan. Progress of stereotactic radiotherapy in the treatment of brain metastatic tumor. West China Medical Journal, 2018, 33(4): 442-448. doi: 10.7507/1002-0179.201802052 Copy

1.	Linskey ME, Andrews DW, Asher AL, et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol, 2010, 96(1): 45-68.
2.	Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 2010, 77(3): 655-661.
3.	Rudà R, Franchino F, Soffietti R. Treatment of brain metastasis: current status and future directions. Curr Opin Oncol, 2016, 28(6): 502-510.
4.	Peters S, Bexelius C, Munk V, et al. The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat Rev, 2016, 45: 139-162.
5.	Maria B, Antonella V, Michela R, et al. Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy. Ther Adv Med Oncol, 2016, 8(6): 450-459.
6.	Glitza Oliva I, Tawbi H, Davies MA. Melanoma brain metastases: current areas of investigation and future directions. Cancer J, 2017, 23(1): 68-74.
7.	Mulvenna P, Nankivell M, Barton RA, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet, 2016, 388(155): 2004-2014.
8.	Schuler M, Wu YL, Hirsh V, et al. First-line afatinib versus chemotherapy in patients with non-small cell lung cancer and common epidermal growth factor receptor gene mutations and brain metastases. J Thorac Oncol, 2016, 11(3): 380-390.
9.	Gaudy-Marqueste C, Dussouil AS, Carron R, et al. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer, 2017, 84: 44-54.
10.	孙明亮, 徐建宇, 徐向英. 早期非小细胞肺癌立体定向放疗的相关研究. 实用肿瘤学杂志, 2018(1): 53-56.
11.	Kirkpatrick JP, Soltys SG, Lo SS, et al. The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro Oncol, 2017, 19(suppl_2): ii38-ii49.
12.	Cho E, Rubinstein L, Stevenson P, et al. The use of stereotactic radiosurgery for brain metastases from breast cancer: who benefits most?. Breast Cancer Res Treat, 2015, 149(3): 743-749.
13.	Kocher M, Wittig A, Piroth MD, et al. Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO working group on stereotactic radiotherapy. Strahlenther Onkol, 2014, 190(6):521-532.
14.	Li X, Li Y, Cao Y, et al. Safety and efficacy of fractionated stereotactic radiotherapy and stereotactic radiosurgery for treatment of pituitary adenomas: a systematic review and meta-analysis. J Neurol Sci, 2017, 372: 110-116.
15.	Ishihara T, Yamada K, Harada A, et al. Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer: evaluation of indications and predictors of local control. Strahlenther Onkol, 2016, 192(6): 386-393.
16.	Han J, Girvigian MR, Chen JC, et al. A comparative study of stereotactic radiosurgery, hypofractionated, and fractionated stereotactic radiotherapy in the treatment of skull base meningioma. Am J Clin Oncol, 2014, 37(3): 255-260.
17.	Eaton BR, Lariviere MJ, La Riviere MJ, et al. Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases. J Neurooncol, 2015, 123(1): 103-111.
18.	Sneed PK, Mendez J, Vemer-van den Hoek JG, et al. Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg, 2015, 123(2): 373-386.
19.	Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA, 2006, 295(21): 2483-2491.
20.	Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med, 1990, 322(8): 494-500.
21.	Tsao MN, Rades D, Wirth A, et al. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol, 2012, 2(3): 210-225.
22.	Qin H, Wang C, Jiang Y, et al. Patients with single brain metastasis from non-small cell lung cancer equally benefit from stereotactic radiosurgery and surgery: a systematic review. Med Sci Monit, 2015, 21: 144-152.
23.	Vuong DA, Rades D, Le AN, et al. The cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis in Vietnam from the perspective of patients and families. World Neurosurg, 2012, 77(2): 321-328.
24.	Vuong DA, Rades D, van Eck AT, et al. Comparing the cost-effectiveness of two brain metastasis treatment modalities from a payer's perspective: stereotactic radiosurgery versus surgical resection. Clin Neurol Neurosurg, 2013, 115(3): 276-284.
25.	Prabhu RS, Press RH, Patel KR, et al. Single-fraction stereotactic radiosurgery (SRS) alone versus surgical resection and SRS for large brain metastases: a multi-institutional analysis. Int J Radiat Oncol Biol Phys, 2017, 99(2): 459-467.
26.	Patel KR, Burri SH, Asher AL, et al. Comparing preoperative with postoperative stereotactic radiosurgery for resectable brain metastases: a multi-institutional analysis. Neurosurgery, 2016, 79(2): 279-285.
27.	Mahajan A, Ahmed S, Li J, et al. Postoperative stereotactic radiosurgery versus observation for completely resected brain metastases: results of a prospective randomized study. Int J Radiat Oncol Biol Phys, 2016, 96(2): S2.
28.	Mahajan A, Ahmed S, Mcaleer MF, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol, 2017, 18(8): 1040-1048.
29.	Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC•3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol, 2017, 18(8): 1049-1060.
30.	Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol, 2011, 29(2): 134-141.
31.	Patil CG, Pricola K, Sarmiento JM, et al. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev, 2017, 9(9): CD006121.
32.	Combs SE, Schulz-Ertner D, Thilmann C, et al. Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery. Strahlenther Onkol, 2004, 180(9): 590-596.
33.	Schüttrumpf LH, Niyazi M, Nachbichler SB, et al. Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases. Radiat Oncol, 2014, 9: 105.
34.	Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol, 2009, 10(11): 1037-1044.
35.	Hall MD, Mcgee JL, Mcgee MC, et al. Cost-effectiveness of stereotactic radiosurgery with and without whole-brain radiotherapy for the treatment of newly diagnosed brain metastases. J Neurosurg, 2014, 121(Suppl): 84-90.
36.	Sahgal A, Aoyama H, Kocher M, et al. Phase 3 trials of stereotactic radiosurgery with or without Whole-Brain radiation therapy for 1 to 4 brain metastases: individual patient data Meta-analysis. Int J Radiat Oncol Biol Phys, 2015, 91(4): 710-717.
37.	Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA, 2016, 316(4): 401-409.
38.	Khan M, Lin J, Liao G, et al. Comparison of WBRT alone, SRS alone, and their combination in the treatment of one or more brain metastases: review and meta-analysis. Tumour Biol, 2017, 39(7): 1010428317702903.
39.	Likhacheva A, Pinnix CC, Parikh NR, et al. Predictors of survival in contemporary practice after initial radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys, 2013, 85(3): 656-661.
40.	Noel G, Bollet MA, Noel S, et al. Linac stereotactic radiosurgery: an effective and safe treatment for elderly patients with brain metastases. Int J Radiat Oncol Biol Phys, 2005, 63(5): 1555-1561.
41.	Yomo S, Hayashi M. Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80 years and older. BMC Cancer, 2016, 16(1): 948.
42.	Chen L, Shen C, Redmond KJ, et al. Use of stereotactic radiosurgery in elderly and very elderly patients with brain metastases to limit toxicity associated with whole brain radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 98(4): 939-947.
43.	Yamamoto M, Kawabe T, Sato Y, et al. A case-matched study of stereotactic radiosurgery for patients with multiple brain metastases: comparing treatment results for 1-4 vs ≥ 5 tumors: clinical article. J Neurosurg, 2013, 118(6): 1258-1268.
44.	Serizawa T, Yamamoto M, Sato Y, et al. Gamma knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional prospective study. J Neurosurg, 2010, 113(Suppl): 48-52.
45.	Yamamoto M, Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol, 2014, 15(4): 387-395.
46.	Xue J, Kubicek GJ, Grimm J, et al. Biological implications of whole-brain radiotherapy versus stereotactic radiosurgery of multiple brain metastases. J Neurosurg, 2014, 121(Suppl): 60-68.
47.	Zindler JD, Bruynzeel AME, Eekers DBP, et al. Whole brain radiotherapy versus stereotactic radiosurgery for 4-10 brain metastases: a phase Ⅲ randomised multicentre trial. BMC Cancer, 2017, 17(1): 500.
48.	Kroeze SG, Fritz C, Hoyer M, et al. Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: a systematic review. Cancer Treat Rev, 2017, 53: 25-37.
49.	Lee SM, Lewanski CR, Counsell N, et al. Randomized trial of erlotinib plus whole-brain radiotherapy for NSCLC patients with multiple brain metastases. J Natl Cancer Inst, 2014, 106(7): dju151.
50.	Ahluwalia MS, Chao ST, Parsons MW, et al. Phase II trial of sunitinib as adjuvant therapy after stereotactic radiosurgery in patients with 1-3 newly diagnosed brain metastases. J Neurooncol, 2015, 124(3): 485-491.
51.	Sperduto PW, Wang M, Robins HI, et al. 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. Int J Radiat Oncol Biol Phys, 2013, 85(5): 1312-1318.
52.	刘桂梅, 张新勇, 田翠孟, 等. 全脑放疗时间对 EGFR 突变非小细胞肺癌脑转移患者生存的影响. 中国肺癌杂志, 2016, 19(8): 501-507.
53.	Li MX, He H, Ruan ZH, et al. Central nervous system progression in advanced non-small cell lung cancer patients with EGFR mutations in response to first-line treatment with two EGFR-TKIs, gefitinib and erlotinib: a comparative study. BMC Cancer, 2017, 17(1): 245.
54.	Magnuson WJ, Lester-Coll NH, Wu AJ, et al. Management of brain metastases in tyrosine kinase inhibitor-naïve epidermal growth factor receptor-mutant non-small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol, 2017, 35(10): 1070-1077.
55.	Kurtz G, Zadeh G, Gingras-Hill G, et al. Salvage radiosurgery for brain metastases: prognostic factors to consider in patient selection. Int J Radiat Oncol Biol Phys, 2014, 88(1): 137-142.
56.	Mckay WH, Mctyre ER, Okoukoni C, et al. Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery. J Neurosurg, 2017, 127(1): 148-156.

1. Linskey ME, Andrews DW, Asher AL, et al. The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol, 2010, 96(1): 45-68.
2. Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 2010, 77(3): 655-661.
3. Rudà R, Franchino F, Soffietti R. Treatment of brain metastasis: current status and future directions. Curr Opin Oncol, 2016, 28(6): 502-510.
4. Peters S, Bexelius C, Munk V, et al. The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat Rev, 2016, 45: 139-162.
5. Maria B, Antonella V, Michela R, et al. Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy. Ther Adv Med Oncol, 2016, 8(6): 450-459.
6. Glitza Oliva I, Tawbi H, Davies MA. Melanoma brain metastases: current areas of investigation and future directions. Cancer J, 2017, 23(1): 68-74.
7. Mulvenna P, Nankivell M, Barton RA, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet, 2016, 388(155): 2004-2014.
8. Schuler M, Wu YL, Hirsh V, et al. First-line afatinib versus chemotherapy in patients with non-small cell lung cancer and common epidermal growth factor receptor gene mutations and brain metastases. J Thorac Oncol, 2016, 11(3): 380-390.
9. Gaudy-Marqueste C, Dussouil AS, Carron R, et al. Survival of melanoma patients treated with targeted therapy and immunotherapy after systematic upfront control of brain metastases by radiosurgery. Eur J Cancer, 2017, 84: 44-54.
10. 孙明亮, 徐建宇, 徐向英. 早期非小细胞肺癌立体定向放疗的相关研究. 实用肿瘤学杂志, 2018(1): 53-56.
11. Kirkpatrick JP, Soltys SG, Lo SS, et al. The radiosurgery fractionation quandary: single fraction or hypofractionation? Neuro Oncol, 2017, 19(suppl_2): ii38-ii49.
12. Cho E, Rubinstein L, Stevenson P, et al. The use of stereotactic radiosurgery for brain metastases from breast cancer: who benefits most?. Breast Cancer Res Treat, 2015, 149(3): 743-749.
13. Kocher M, Wittig A, Piroth MD, et al. Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO working group on stereotactic radiotherapy. Strahlenther Onkol, 2014, 190(6):521-532.
14. Li X, Li Y, Cao Y, et al. Safety and efficacy of fractionated stereotactic radiotherapy and stereotactic radiosurgery for treatment of pituitary adenomas: a systematic review and meta-analysis. J Neurol Sci, 2017, 372: 110-116.
15. Ishihara T, Yamada K, Harada A, et al. Hypofractionated stereotactic radiotherapy for brain metastases from lung cancer: evaluation of indications and predictors of local control. Strahlenther Onkol, 2016, 192(6): 386-393.
16. Han J, Girvigian MR, Chen JC, et al. A comparative study of stereotactic radiosurgery, hypofractionated, and fractionated stereotactic radiotherapy in the treatment of skull base meningioma. Am J Clin Oncol, 2014, 37(3): 255-260.
17. Eaton BR, Lariviere MJ, La Riviere MJ, et al. Hypofractionated radiosurgery has a better safety profile than single fraction radiosurgery for large resected brain metastases. J Neurooncol, 2015, 123(1): 103-111.
18. Sneed PK, Mendez J, Vemer-van den Hoek JG, et al. Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg, 2015, 123(2): 373-386.
19. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA, 2006, 295(21): 2483-2491.
20. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med, 1990, 322(8): 494-500.
21. Tsao MN, Rades D, Wirth A, et al. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol, 2012, 2(3): 210-225.
22. Qin H, Wang C, Jiang Y, et al. Patients with single brain metastasis from non-small cell lung cancer equally benefit from stereotactic radiosurgery and surgery: a systematic review. Med Sci Monit, 2015, 21: 144-152.
23. Vuong DA, Rades D, Le AN, et al. The cost-effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of brain metastasis in Vietnam from the perspective of patients and families. World Neurosurg, 2012, 77(2): 321-328.
24. Vuong DA, Rades D, van Eck AT, et al. Comparing the cost-effectiveness of two brain metastasis treatment modalities from a payer's perspective: stereotactic radiosurgery versus surgical resection. Clin Neurol Neurosurg, 2013, 115(3): 276-284.
25. Prabhu RS, Press RH, Patel KR, et al. Single-fraction stereotactic radiosurgery (SRS) alone versus surgical resection and SRS for large brain metastases: a multi-institutional analysis. Int J Radiat Oncol Biol Phys, 2017, 99(2): 459-467.
26. Patel KR, Burri SH, Asher AL, et al. Comparing preoperative with postoperative stereotactic radiosurgery for resectable brain metastases: a multi-institutional analysis. Neurosurgery, 2016, 79(2): 279-285.
27. Mahajan A, Ahmed S, Li J, et al. Postoperative stereotactic radiosurgery versus observation for completely resected brain metastases: results of a prospective randomized study. Int J Radiat Oncol Biol Phys, 2016, 96(2): S2.
28. Mahajan A, Ahmed S, Mcaleer MF, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol, 2017, 18(8): 1040-1048.
29. Brown PD, Ballman KV, Cerhan JH, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC•3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol, 2017, 18(8): 1049-1060.
30. Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol, 2011, 29(2): 134-141.
31. Patil CG, Pricola K, Sarmiento JM, et al. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev, 2017, 9(9): CD006121.
32. Combs SE, Schulz-Ertner D, Thilmann C, et al. Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery. Strahlenther Onkol, 2004, 180(9): 590-596.
33. Schüttrumpf LH, Niyazi M, Nachbichler SB, et al. Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases. Radiat Oncol, 2014, 9: 105.
34. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol, 2009, 10(11): 1037-1044.
35. Hall MD, Mcgee JL, Mcgee MC, et al. Cost-effectiveness of stereotactic radiosurgery with and without whole-brain radiotherapy for the treatment of newly diagnosed brain metastases. J Neurosurg, 2014, 121(Suppl): 84-90.
36. Sahgal A, Aoyama H, Kocher M, et al. Phase 3 trials of stereotactic radiosurgery with or without Whole-Brain radiation therapy for 1 to 4 brain metastases: individual patient data Meta-analysis. Int J Radiat Oncol Biol Phys, 2015, 91(4): 710-717.
37. Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA, 2016, 316(4): 401-409.
38. Khan M, Lin J, Liao G, et al. Comparison of WBRT alone, SRS alone, and their combination in the treatment of one or more brain metastases: review and meta-analysis. Tumour Biol, 2017, 39(7): 1010428317702903.
39. Likhacheva A, Pinnix CC, Parikh NR, et al. Predictors of survival in contemporary practice after initial radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys, 2013, 85(3): 656-661.
40. Noel G, Bollet MA, Noel S, et al. Linac stereotactic radiosurgery: an effective and safe treatment for elderly patients with brain metastases. Int J Radiat Oncol Biol Phys, 2005, 63(5): 1555-1561.
41. Yomo S, Hayashi M. Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80 years and older. BMC Cancer, 2016, 16(1): 948.
42. Chen L, Shen C, Redmond KJ, et al. Use of stereotactic radiosurgery in elderly and very elderly patients with brain metastases to limit toxicity associated with whole brain radiation therapy. Int J Radiat Oncol Biol Phys, 2017, 98(4): 939-947.
43. Yamamoto M, Kawabe T, Sato Y, et al. A case-matched study of stereotactic radiosurgery for patients with multiple brain metastases: comparing treatment results for 1-4 vs ≥ 5 tumors: clinical article. J Neurosurg, 2013, 118(6): 1258-1268.
44. Serizawa T, Yamamoto M, Sato Y, et al. Gamma knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional prospective study. J Neurosurg, 2010, 113(Suppl): 48-52.
45. Yamamoto M, Serizawa T, Shuto T, et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol, 2014, 15(4): 387-395.
46. Xue J, Kubicek GJ, Grimm J, et al. Biological implications of whole-brain radiotherapy versus stereotactic radiosurgery of multiple brain metastases. J Neurosurg, 2014, 121(Suppl): 60-68.
47. Zindler JD, Bruynzeel AME, Eekers DBP, et al. Whole brain radiotherapy versus stereotactic radiosurgery for 4-10 brain metastases: a phase Ⅲ randomised multicentre trial. BMC Cancer, 2017, 17(1): 500.
48. Kroeze SG, Fritz C, Hoyer M, et al. Toxicity of concurrent stereotactic radiotherapy and targeted therapy or immunotherapy: a systematic review. Cancer Treat Rev, 2017, 53: 25-37.
49. Lee SM, Lewanski CR, Counsell N, et al. Randomized trial of erlotinib plus whole-brain radiotherapy for NSCLC patients with multiple brain metastases. J Natl Cancer Inst, 2014, 106(7): dju151.
50. Ahluwalia MS, Chao ST, Parsons MW, et al. Phase II trial of sunitinib as adjuvant therapy after stereotactic radiosurgery in patients with 1-3 newly diagnosed brain metastases. J Neurooncol, 2015, 124(3): 485-491.
51. Sperduto PW, Wang M, Robins HI, et al. 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. Int J Radiat Oncol Biol Phys, 2013, 85(5): 1312-1318.
52. 刘桂梅, 张新勇, 田翠孟, 等. 全脑放疗时间对 EGFR 突变非小细胞肺癌脑转移患者生存的影响. 中国肺癌杂志, 2016, 19(8): 501-507.
53. Li MX, He H, Ruan ZH, et al. Central nervous system progression in advanced non-small cell lung cancer patients with EGFR mutations in response to first-line treatment with two EGFR-TKIs, gefitinib and erlotinib: a comparative study. BMC Cancer, 2017, 17(1): 245.
54. Magnuson WJ, Lester-Coll NH, Wu AJ, et al. Management of brain metastases in tyrosine kinase inhibitor-naïve epidermal growth factor receptor-mutant non-small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol, 2017, 35(10): 1070-1077.
55. Kurtz G, Zadeh G, Gingras-Hill G, et al. Salvage radiosurgery for brain metastases: prognostic factors to consider in patient selection. Int J Radiat Oncol Biol Phys, 2014, 88(1): 137-142.
56. Mckay WH, Mctyre ER, Okoukoni C, et al. Repeat stereotactic radiosurgery as salvage therapy for locally recurrent brain metastases previously treated with radiosurgery. J Neurosurg, 2017, 127(1): 148-156.

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Progress of stereotactic radiotherapy in the treatment of brain metastatic tumor

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