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Multi-institutional study of ‘Sandwich treatment’ for motor area large brain metastases (LBM) with diameter over 3 cm Cover

Multi-institutional study of ‘Sandwich treatment’ for motor area large brain metastases (LBM) with diameter over 3 cm

Open Access
|Jan 2024

Figures & Tables

FIGURE 1.

The mean tumor and peri-tumor edema volume changes. (A) The mean tumor volume decreased dramatically from 20.1 cm3 (range: 17.2–29.7 cm3) at the time of ‘Sandwich treatment’ to 12.3 cm3 (range: 7.7–22.4 cm3) 3 months later (P < 0.001); (B) The mean peri-tumor edema volume at first-stage SRS and second-stage SRS of ‘Sandwich treatment’ was 12.6 cm3 (range: 4.9–19.6 cm3) and 5.2 cm3 (range: 1.2–13.2 cm3) (P < 0.001).2-SSRS = two-staged stereotactic radiosurgery
The mean tumor and peri-tumor edema volume changes. (A) The mean tumor volume decreased dramatically from 20.1 cm3 (range: 17.2–29.7 cm3) at the time of ‘Sandwich treatment’ to 12.3 cm3 (range: 7.7–22.4 cm3) 3 months later (P < 0.001); (B) The mean peri-tumor edema volume at first-stage SRS and second-stage SRS of ‘Sandwich treatment’ was 12.6 cm3 (range: 4.9–19.6 cm3) and 5.2 cm3 (range: 1.2–13.2 cm3) (P < 0.001).2-SSRS = two-staged stereotactic radiosurgery

FIGURE 2.

A typical case with LBM located in motor area that received ‘Sandwich treatment’. (A) The lesion had severe peri-tumor edema and invading towards the frontal lobe; (B) 3 months after ‘Sandwich treatment’, peri-tumor edema and tumor volume significantly reduced.
A typical case with LBM located in motor area that received ‘Sandwich treatment’. (A) The lesion had severe peri-tumor edema and invading towards the frontal lobe; (B) 3 months after ‘Sandwich treatment’, peri-tumor edema and tumor volume significantly reduced.

FIGURE 3.

Patients’ median MMT and BI score. (A) MMT score at the beginning and the end of ‘Sandwich treatment’ (P < 0.001); (B) BI score before ‘Sandwich treatment’ and at 3 months later (P < 0.001).BI score = Barthel Index score; MMT score = manual muscle testing score; 2-SSRS = two-staged stereotactic radiosurgery
Patients’ median MMT and BI score. (A) MMT score at the beginning and the end of ‘Sandwich treatment’ (P < 0.001); (B) BI score before ‘Sandwich treatment’ and at 3 months later (P < 0.001).BI score = Barthel Index score; MMT score = manual muscle testing score; 2-SSRS = two-staged stereotactic radiosurgery

FIGURE 4.

Kaplan - Meier curve of the patient’s (A) Overall survival (OS) and (B) tumor local control (TLC) rate.
Kaplan - Meier curve of the patient’s (A) Overall survival (OS) and (B) tumor local control (TLC) rate.

Risk factors of TLC for LBM in motor area after ‘Sandwich treatment’

Univariate analysisMultivariate analysis

HR ratio95%CIP-valueHR ratio95%CIP-value
Age0.978(0.598–1.686)0.697
  >=62
  <62
Sex1.678(0.913–2.174)0.781
  Male
  Female
Primary tumor
  Lung/Breast0.459(0.359–0.898)< 0.010.539(0.339–0.812)0.007
  Lung/GL tract0.913(0.478–1.316)< 0.010.784(0.498–0.987)0.006
  Breast/Gl tract1.987(0.878–1.974)0.411
KPS score2.113(1.159–6.733)0.139
  >= 60
  <60
Total tumor volume0.719(0.419–1.598)0.211
  >=20.1cm3
  <20.1cm3
Peri-tumor edema volume1.589(0.973–2.894)0.566
  >=12.6cm3
  <12.6cm3
Dose at first-stage SRS1.325(0.53–1.734)0.989
  >= 13.0 Gy
  < 13.0 Gy
Dose at second-stage SRS0.845(0.356–1.250)0.593
  >= 12.5 Gy
  < 12.5 Gy

Comparison between ‘Sandwich treatment’ and other reports of 2-SSRS strategy for BM

AuthorYearCase numberMedian diameter/volume of BMTotal dose2-SSRS interval6 Months OS/median OS6 Months TLC/median TLCRadiation necrosis
Yomo et al.920122717.8 cm327 Gy3−4 weeks8.8 months89.8%11.1%
Yomo and Hayashi2920145816.4 cm328 Gy3−4 weeks63%85.0%8.6%
Angelov et al.10201854Diameter>=2cm30 Gy34 days65%88.0%11.0%
Dohm et al.8201833LBM29 Gy30 days65%96.8%6.06%
Hori et al.3120201814 cm3N/AN/A14.6 months91.0%N/A
Ito et al.32202017810 cm326 Gy7−38 days6.6 months93.2%6.20%
Damron et al.302022248.1 cm330 Gy32 days9.1months80%N/A
Cho et al.332022142Median 7.4 cm327−28 Gy32 days14 months88−90%17%
Present study20235120.1 cm325.5 Gy7 days91.8%, 14 months93.4%13.11%

Patient characteristics

CharacteristicValueRange
Age(median, years)6234–81
Sex
  Female36
  Male25
Primary tumor
  Lung39
  Breast13
  Gastric-intestinal tract9
KPS (median)6050 –80
Dose at first-stage SRS (median, Gy)13.011–15
Dose at second-stage SRS (median, Gy)12.511–14
Total tumor volume (mean, cm3)20.117.2–29.7
Peri-tumor edema volume (mean, cm3)12.64.9–19.6
Follow-up time (median, months)18.36.3–47.9
DOI: https://doi.org/10.2478/raon-2024-0002 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 145 - 152
Submitted on: Jul 3, 2023
Accepted on: Sep 23, 2023
Published on: Jan 6, 2024
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2024 Zheng Wang, Haining Chen, Qun Chen, Yucun Zhu, Min Li, Jia Zhou, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.