A comprehensive review of MR imaging changes following radiosurgery to 500 brain metastases

T. R. Patel, B. J. McHugh, W. L. Bi, F. J. Minja, J. P S Knisely, Veronica L. Chiang

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Abstract

BACKGROUND AND PURPOSE: Stereotactic radiosurgery is known to control 85%-95% of intracranial metastatic lesions during a median survival of 6-8 months. However, with the advent of newer systemic cancer therapies, survival is improving; this change mandates a longitudinal quantitative analysis of the radiographic response of brain metastases to radiosurgery. MATERIALS AND METHODS: MR imaging of 516 metastases in 120 patients treated with GK-SRS from June 2006 to December 2009 was retrospectively reviewed. Lesion volume at initial treatment and each follow-up was calculated by using the following formula: length x width x height / 2. Volume changes were correlated with patient demographics, histopathology, and radiation treatment variables. RESULTS: Thirty-two percent of lesions increased in volume following radiosurgery. Clinically, this translated into 54% of patients having ≥1 of their lesions increase in size. This increase begins at 6 weeks and can last beyond 15 months' post-SRS. Male sex (P = .002), mean voxel dose <37 Gy (P = .009), and initial treatment volume >500 mm 3 (P < .001) are associated with posttreatment increases in tumor size. Median survival following radiosurgery was 9.5 months for patients with all lesions exhibiting stable/decreased volumes, >18.4 months for patients with all lesions exhibiting increased volumes, and 16.4 months for patients with mixed lesional responses. CONCLUSIONS: Most metastatic lesions are stable or smaller in size during the first 36 months post-SRS. However, a transient increase in volume is seen in approximately one-third of lesions. Sex, treatment dose, initial lesion size, and histopathology all correlate with variations in lesion volume post-SRS. The longer the patient survives, the more likely an increase in lesion size will be seen on follow-up imaging.

Original languageEnglish (US)
Pages (from-to)1885-1892
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume32
Issue number10
DOIs
StatePublished - Nov 2011

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Radiosurgery
Neoplasm Metastasis
Brain
Survival
Therapeutics
Demography
Radiation
Neoplasms

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

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A comprehensive review of MR imaging changes following radiosurgery to 500 brain metastases. / Patel, T. R.; McHugh, B. J.; Bi, W. L.; Minja, F. J.; Knisely, J. P S; Chiang, Veronica L.

In: American Journal of Neuroradiology, Vol. 32, No. 10, 11.2011, p. 1885-1892.

Research output: Contribution to journalArticle

Patel, T. R. ; McHugh, B. J. ; Bi, W. L. ; Minja, F. J. ; Knisely, J. P S ; Chiang, Veronica L. / A comprehensive review of MR imaging changes following radiosurgery to 500 brain metastases. In: American Journal of Neuroradiology. 2011 ; Vol. 32, No. 10. pp. 1885-1892.
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abstract = "BACKGROUND AND PURPOSE: Stereotactic radiosurgery is known to control 85{\%}-95{\%} of intracranial metastatic lesions during a median survival of 6-8 months. However, with the advent of newer systemic cancer therapies, survival is improving; this change mandates a longitudinal quantitative analysis of the radiographic response of brain metastases to radiosurgery. MATERIALS AND METHODS: MR imaging of 516 metastases in 120 patients treated with GK-SRS from June 2006 to December 2009 was retrospectively reviewed. Lesion volume at initial treatment and each follow-up was calculated by using the following formula: length x width x height / 2. Volume changes were correlated with patient demographics, histopathology, and radiation treatment variables. RESULTS: Thirty-two percent of lesions increased in volume following radiosurgery. Clinically, this translated into 54{\%} of patients having ≥1 of their lesions increase in size. This increase begins at 6 weeks and can last beyond 15 months' post-SRS. Male sex (P = .002), mean voxel dose <37 Gy (P = .009), and initial treatment volume >500 mm 3 (P < .001) are associated with posttreatment increases in tumor size. Median survival following radiosurgery was 9.5 months for patients with all lesions exhibiting stable/decreased volumes, >18.4 months for patients with all lesions exhibiting increased volumes, and 16.4 months for patients with mixed lesional responses. CONCLUSIONS: Most metastatic lesions are stable or smaller in size during the first 36 months post-SRS. However, a transient increase in volume is seen in approximately one-third of lesions. Sex, treatment dose, initial lesion size, and histopathology all correlate with variations in lesion volume post-SRS. The longer the patient survives, the more likely an increase in lesion size will be seen on follow-up imaging.",
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