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Open Access Highly Accessed Study protocol

Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway

Giuseppe Minniti12*, Vincenzo Esposito2, Enrico Clarke1, Claudia Scaringi1, Alessandro Bozzao3, Teresa Falco1, Vitaliana De Sanctis1, Maurizio Maurizi Enrici4, Maurizio Valeriani1, Mattia Falchetto Osti1 and Riccardo Maurizi Enrici1

Author Affiliations

1 Radiation Oncology Unit, Sant’ Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy

2 IRCCS Neuromed, 86077 Pozzilli, IS, Italy

3 Neuroradiology Unit, Sant’ Andrea Hospital, University Sapienza, 00189 Rome, Italy

4 Ophthalmology Unit, S. Andrea Hospital, University Sapienza, 00189 Rome, Italy

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Radiation Oncology 2014, 9:110  doi:10.1186/1748-717X-9-110

Published: 8 May 2014

Abstract

Background

To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway.

Patients and methods

We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses.

Results

At a median follow-up of 13 months (range, 2–36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6–27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up.

Conclusions

Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.

Keywords:
Stereotactic radiosurgery; Skull base metastases; Hypofractionated stereotactic radiosurgery; Radiation-induced optic neuropathy