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J Neurooncol. 2016 Jun;128(2):251-7. doi: 10.1007/s11060-016-2103-3. Epub 2016 Mar 10.

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

Author information

1
Department of Radiation Oncology, UT Southwestern Medical Center, 5801 Forest Park Rd, Dallas, TX, 75390-9183, USA.
2
Department of Clinical Sciences and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
3
Department of Neurological Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
4
Department of Radiation Oncology, Inova Dwight and Martha Schar Cancer Institute, 3300 Gallows Road, Falls Church, VA, 22042, USA. choekevin@yahoo.com.

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.

KEYWORDS:

Brain metastasis; MRI; Stereotactic radiosurgery

PMID:
26966096
DOI:
10.1007/s11060-016-2103-3
[Indexed for MEDLINE]

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