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Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery

  • Clinical Study
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Abstract

The number of brain metastases identified on diagnostic magnetic resonance imaging (MRI) is a key factor in consideration of stereotactic radiosurgery (SRS). However, additional lesions are often detected on high-resolution SRS-planning MRI. We investigated pre-treatment clinical characteristics that are associated with finding additional metastases at SRS. Patients treated with SRS for brain metastases between the years of 2009–2014 comprised the study cohort. All patients underwent frame-fixed, 1 mm thick MRI on the day of SRS. Patient, tumor, and treatment characteristics were analyzed for an association with increase in number of metastases identified on SRS-planning MRI. 289 consecutive SRS cases were analyzed. 725 metastases were identified on pre-treatment MRI and 1062 metastases were identified on SRS-planning MRI. An increase in the number of metastases occurred in 34 % of the cases. On univariate analysis, more than four metastases and the diameter of the largest lesion were significantly associated with an increase in number of metastases on SRS-planning MRI. When stratified by the diameter of the largest lesion into <2, 2–3, or ≥3 cm, additional metastases were identified in 37, 29, and 18 %, respectively. While this increase in the number of metastases is largely due to the difference in imaging technique, the number and size of the metastases were also associated with finding additional lesions. These clinical factors may be considered when determining treatment options for brain metastases.

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Acknowledgments

We would like to thank members of the Department of Radiation Oncology and Department of Neurosurgery at UT Southwestern Medical Center for their helpful critiques of this manuscript.

Funding

AA was supported by NCI 1F30CA168264.

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Authors and Affiliations

  1. Department of Radiation Oncology, UT Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX, 75390-9183, USA

    Zabi Wardak, Alexander Augustyn, Ramzi E. Abdulrahman, Lucien A. Nedzi & Robert D. Timmerman

  2. Department of Clinical Sciences and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA

    Hong Zhu

  3. Department of Neurological Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA

    Bruce E. Mickey, Louis A. Whitworth, Christopher J. Madden & Samuel L. Barnett

  4. Department of Radiation Oncology, Inova Dwight and Martha Schar Cancer Institute, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Kevin S. Choe

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  1. Zabi Wardak
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  2. Alexander Augustyn
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  3. Hong Zhu
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  4. Bruce E. Mickey
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Correspondence to Kevin S. Choe.

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Wardak, Z., Augustyn, A., Zhu, H. et al. Pre-treatment factors associated with detecting additional brain metastases at stereotactic radiosurgery. J Neurooncol 128, 251–257 (2016). https://doi.org/10.1007/s11060-016-2103-3

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  • DOI: https://doi.org/10.1007/s11060-016-2103-3

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