Brain metastasis tumor SRS after in-place recurrence again the effect of SRS treatment

Stereotactic radiosurgery (SRS) has reached a consensus on the effectiveness of the treatment of brain metastasis tumors, but there is no unified understanding of how to save brain metastasis tumors after SRS recurrence.
several studies have concluded that SRS treatment can be used again, but the effectiveness and safety of reSRS therapy are highly controversial.
Loi, of the Radiotherapy Department at the University of Florence in Italy, systematically assessed and metasta the effects of re-SRS therapy on re-in-place re-relapsed brain metastasis tumors after SRS, and discussed the relevant factors.
results were published online in September 2020 in Critical Reviews in Oncology.
methods, the researchers retrieved documents from the PubMed, Scopus, and Cochrane Library databases reporting that the brain metastasis tumor line SRS relapsed in place and then the SRS again.
included in the standard: original literature published in English, treatment results reviewed by peers, the study of patients with cerebral metastasis tumor SRS in-place recurrence, the treatment method is SRS again.
results of the study included local recurrence rates of tumors at 6 and 12 months, medium survival time, and the rate of radioactive necrotasia.
exclude literature that does not provide the main findings, duplicate literature, and case reports.
included a total of 11 retrospective studies that met the criteria, including 335 patients (389 brain metastasis tumors).
patients were 22-88 years old, with a middle age of 59, and 55% of patients had KPS > 70 points.
types of metastatic tumors are mainly lung cancer (35%), lymphoma (24%) and breast cancer (22%).
30% of patients had complete brain radiotherapy (WBRT) before the second SRS.
two SRS intervals between 6 and 19 months, with a mid 13 months.
the second SRS, the tumor volume was 1-40cm3, the medium was 12cm3, the radiotherapy dose was 15.5-26.5Gy, the medium was 19Gy, and the biologically effective dose was 50.4Gy.
follow-up time was 1-124 months, with a medium of 12 months.
results showed that the proportion of local recurrence of tumors in place for 6 and 12 months after SRS was 7% (95% CI, 4%-12%) and 24% (95% CI, 19%-30%) respectively.
survival time is 14 months (95% CI, 8.8-22.0).
13% (95% CI, 8%-19%) of radioactive necrotasia after SRS re-emerged, and the occurrence of radioactive necrotasia occurred 3-8 months after SRS, with a medium of 4 months.
subgroup analysis showed that the risk of radioactive necrotization was higher in patients with a medium age of ≥13%:7%) (p-0.004) and higher in the WBRT group (19%:7%) (p-0.004).
Conclusions Finally, the authors conclude that brain metastasis tumors in-place recurrence patients after SRS, SRS is an effective treatment, the effect of treatment is no less than surgery.
radioactive necrosis is a major complication of the re-SRS, but more research is needed to analyze the factors that influence the incidence of radioactive necrosis.
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