- •Dedicated SRS imaging with MPRAGE and SPACE improved detection of brain metastases.
- •This approach was associated with a significant decrease in the incidence of DIF.
- •The benefit of MPRAGE with SPACE was more pronounced for patients undergoing their first SRS course.
- •This represents a practical solution to a commonly encountered problem in clinical practice.
Stereotactic radiosurgery (SRS) is increasingly used for brain metastases (BM) patients, but distant intracranial failure (DIF) remains the principal disadvantage of this focal therapeutic approach. The objective of this study was to determine if dedicated SRS imaging would improve lesion detection and reduce DIF.
Between 02/2020 and 01/2021, SRS patients at a tertiary care institution underwent dedicated treatment planning MRIs of the brain including MPRAGE and SPACE post-contrast sequences. DIF was calculated using the Kaplan–Meier method; comparisons were made to a historical consecutive cohort treated using MPRAGE alone (02/2019–01/2020).
134 patients underwent 171 SRS courses for 821 BM imaged with both MPRAGE and SPACE (primary cohort). MPRAGE sequence evaluation alone detected 679 lesions. With neuroradiologists evaluating SPACE and MPRAGE, an additional 108 lesions were identified (p < 0.001). Upon multidisciplinary review, 34 additional lesions were identified. Compared to the historical cohort (103 patients, 135 SRS courses, 479 BM), the primary cohort had improved median time to DIF (13.5 vs. 5.1 months, p = 0.004). The benefit was even more pronounced for patients treated for their first SRS course (18.4 vs. 6.3 months, p = 0.001). SRS using MPRAGE and SPACE was associated with a 60% reduction in risk of DIF compared to the historical cohort (HR: 0.40; 95% CI: 0.28–0.57, p < 0.001).
Among BM patients treated with SRS, a treatment planning SPACE sequence in addition to MPRAGE substantially improved lesion detection and was associated with a statistically significant and clinically meaningful prolongation in time to DIF, especially for patients undergoing their first SRS course.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Radiotherapy and Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Current approaches to the management of brain metastases.Nat Rev Clin Oncol. 2020; 17: 279-299
- A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy.Neuro Oncol. 2014; 16: 1283-1288
- Recent advances in managing brain metastasis.F1000Res. 2018; 7: 1772
- Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 Brain metastases: A randomized clinical trial.JAMA. 2016; 316: 401
- The dandelion effect: treat the whole lawn or weed selectively?.J Clin Oncol. 2011; 29: 121-124
- Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study.Lancet Oncol. 2014; 15: 387-395
- Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.JAMA. 2006; 295: 2483
- Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone.Int J Radiat Oncol Biol Phys. 2007; 68: 1388-1395
- Integration of systemic therapy and stereotactic radiosurgery for brain metastases.Cancers (Basel). 2021; 13: 3682
- Impact of MRI timing on tumor volume and anatomic displacement for brain metastases undergoing stereotactic radiosurgery.Neurooncol Pract. 2021; 8: 674-683
- Impact of MRI timing on accuracy of stereotactic radiosurgical planning: visualizing the forest from the trees.Int J Radiat Oncol Biol Phys. 2019; 103: 1012-1013
- Brain tumor-enhancement visualization and morphometric assessment: A comparison of MPRAGE, SPACE, and VIBE MRI techniques.AJNR Am J Neuroradiol. 2019; 40: 1140-1148
- Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases.Neuro Oncol. 2020; 22: 757-772
- Magnetic resonance imaging for brain stereotactic radiotherapy : A review of requirements and pitfalls.Strahlenther Onkol. 2020; 196: 444-456
- Comparison of lesion enhancement on spin-echo and gradient-echo images.AJNR Am J Neuroradiol. 1994; 15: 37-44
- Contrast-enhanced 3-dimensional SPACE versus MP-RAGE for the detection of brain metastases: considerations with a 32-channel head coil.Invest Radiol. 2013; 48: 55-60
- Contrast-enhanced MR imaging of metastatic brain tumor at 3 tesla: utility of T(1)-weighted SPACE compared with 2D spin echo and 3D gradient echo sequence.Magn Reson Med Sci. 2008; 7: 13-21
- The complexity of managing large brain metastasis.Int J Radiat Oncol Biol Phys. 2019; 104: 483-484
Shiue K, Barnett GH, Suh JH, Vogelbaum MA, Reddy CA, Weil RJ, et al. Using higher isodose lines for gamma knife treatment of 1 to 3 brain metastases is safe and effective. Neurosurgery. 2014;74:360-4; discussion 4-5; quiz 5-6.
- Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.Lancet Oncol. 2009; 10: 1037-1044
- Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study.J Clin Oncol. 2011; 29: 134-141
- Novel risk stratification score for predicting early distant brain failure and salvage whole-brain radiotherapy after stereotactic radiosurgery for brain metastases.Cancer. 2015; 121: 3836-3843
- A clinical nomogram and recursive partitioning analysis to determine the risk of regional failure after radiosurgery alone for brain metastases.Radiother Oncol. 2014; 111: 52-58
- Increases in the number of brain metastases detected at frame-fixed, thin-slice MRI for gamma knife surgery planning.Neuro Oncol. 2010; 12: 1187-1192
- Time-delayed contrast-enhanced MRI improves detection of brain metastases and apparent treatment volumes.J Neurosurg. 2016; 124: 489-495
- MRI-based radiosurgical planning: implications in imaging timing.Ann Transl Med. 2019; 7: S188-S
- Interval from imaging to treatment delivery in the radiation surgery age: how long is too long?.Int J Radiat Oncol Biol Phys. 2015; 93: 126-132
- The effect of contrast dose, imaging time, and lesion size in the MR detection of intracerebral metastasis.AJNR Am J Neuroradiol. 1995; 16: 373-380
- Comparison of single- and triple-dose contrast material in the MR screening of brain metastases.AJNR Am J Neuroradiol. 1998; 19: 821-828
- The Effect of Slice Thickness on Contours of Brain Metastases for Stereotactic Radiosurgery.Adv Radiat Oncol. 2021; 6: 100708
- Advantages and pitfalls in 3T MR brain imaging: a pictorial review.AJNR Am J Neuroradiol. 2005; 26: 2229-2237
- Usefulness of contrast-enhanced T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions in detection of small brain metastasis at 3T MR imaging: comparison with magnetization-prepared rapid acquisition of gradient echo imaging.AJNR Am J Neuroradiol. 2009; 30: 923-929
- A Dutch phase III randomized multicenter trial: whole brain radiotherapy versus stereotactic radiotherapy for 4–10 brain metastases.Neurooncol Adv. 2021; 3
- Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05.Int J Radiat Oncol Biol Phys. 2000; 47: 291-298
- Treatment for brain metastases: ASCO-SNO-ASTRO guideline.J Clin Oncol. 2022; 40: 492-516
- Frequent use of local therapy underscores need for multidisciplinary care in the management of patients with melanoma brain metastases treated with PD-1 inhibitors.Int J Radiat Oncol Biol Phys. 2019; 105: 1113-1118
Published online: June 01, 2022
Accepted: May 27, 2022
Received in revised form: May 11, 2022
Received: March 14, 2022
© 2022 Elsevier B.V. All rights reserved.