Efficacy of 3D-TSE Sequence-based Radiosurgery in Prolonging Time to Distant Intracranial Failure: A Session-wise Analysis in a Histology-Diverse Patient Cohort

Eyub Y Akdemir; Selin Gurdikyan; Muni Rubens; Kevin J Abrams; Charif Sidani; Margaret C Chaneles; Matthew D Hall; Robert H Press; D Jay Wieczorek; Ranjini Tolakanahalli; Alonso N Gutierrez; Omer Gal; Alonso La Rosa; Tugce Kutuk; Michael W McDermott; Yazmin Odia; Minesh P Mehta; Rupesh Kotecha

doi:10.1093/neuonc/noae232

Efficacy of 3D-TSE Sequence-based Radiosurgery in Prolonging Time to Distant Intracranial Failure: A Session-wise Analysis in a Histology-Diverse Patient Cohort

Neuro Oncol. 2024 Nov 2:noae232. doi: 10.1093/neuonc/noae232. Online ahead of print.

Authors

Eyub Y Akdemir¹, Selin Gurdikyan¹, Muni Rubens^{2

3}, Kevin J Abrams⁴, Charif Sidani⁴, Margaret C Chaneles⁴, Matthew D Hall^{1

3}, Robert H Press¹, D Jay Wieczorek^{1

3}, Ranjini Tolakanahalli^{1

3}, Alonso N Gutierrez^{1

3}, Omer Gal¹, Alonso La Rosa¹, Tugce Kutuk¹, Michael W McDermott^{3

5}, Yazmin Odia^{3

6}, Minesh P Mehta^{1

3}, Rupesh Kotecha^{1

3}

Affiliations

¹ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
² Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
³ Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
⁴ Department of Radiology, Baptist Health South Florida, Miami, USA.
⁵ Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA.
⁶ Department of Neuro-Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.

PMID: 39492654
DOI: 10.1093/neuonc/noae232

Abstract

Background: Stereotactic radiosurgery (SRS) for patients with brain metastases (BM) is associated with a risk of distant intracranial failure (DIF). This study evaluates the impact of integrating dedicated 3D-TSE sequences to MPRAGE in BM detection and DIF prolongation in a histology-agnostic patient cohort.

Methods: The study population included adults treated with SRS from February 2019 to January 2024 who underwent MPRAGE alone or dual-sequence with the addition of 3D-TSE starting from February 2020. Median times to DIF were estimated using the Kaplan-Meier method.

Results: The 216 study patients who underwent 332 SRS courses for 1456 BM imaged with MPRAGE and 3D-TSE (primary cohort) were compared to a control cohort (92 patients, 135 SRS courses, 462 BM). In the session-wise analysis, the median time to DIF between the cohorts was significantly prolonged in the primary vs. control cohorts (11.4 vs. 6.8 months, p=0.029), more pronounced in the subgroups with 1-4 metastases (14.7 vs. 8.1 months, p=0.008) and with solitary BM (36.4 vs. 10.9 months, p=0.001). While patients relapsing on immunotherapy or targeted therapy did not significantly benefit from 3D-FSE (7.2 vs. 5.7 months, p=0.280), those who relapsed on chemotherapy or who were off systemic therapy (including synchronous metastases) exhibited a trend towards longer time to DIF with 3D-TSE integration (14.7 vs. 7.9 months, p=0.057).

Conclusions: Implementing 3D-TSE sequences into SRS practice increases BM detection across all patients and translates into clinical relevance by prolonging time to DIF, particularly in those with limited intracranial disease and those not receiving CNS-active agents.

Keywords: 3D fast/turbo spin echo (3D-TSE); Brain metastases; MRI sequence; distant intracranial failure (DIF); stereotactic radiosurgery (SRS).

© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.