Highlights
- •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.
Abstract
Background
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.
Methods
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).
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: June 01, 2022
Accepted:
May 27,
2022
Received in revised form:
May 11,
2022
Received:
March 14,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
