Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T13:25:06.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-operative stereotactic radiosurgery of brain metastases: A single-center retrospective review of clinical outcomes

Published online by Cambridge University Press:  27 May 2019

Zachary T. Smith ,
Syed U. Ashruf ,
Charles Mylander ,
Kerry J. Thompson ,
Charles Geraghty ,
Brian Hasson ,
Timothy G. Burke  and
Luqman K. Dad Open the ORCID record for Luqman K. Dad [Opens in a new window]
Zachary T. Smith
Affiliation:
Department of Radiation Oncology
Syed U. Ashruf
Affiliation:
Annapolis Radiology Associates
Charles Mylander
Affiliation:
The Rebecca Fortney Breast Center
Kerry J. Thompson
Affiliation:
Annapolis Radiology Associates
Charles Geraghty
Affiliation:
Department of Radiation Oncology
Brian Hasson
Affiliation:
Department of Radiation Oncology
Timothy G. Burke
Affiliation:
Department of Neurosurgery, Anne Arundel Medical Center, Annapolis, MD, USA
Luqman K. Dad*
Affiliation:
Department of Radiation Oncology
*
Author for correspondence: Dr. Luqman K. Dad, Anne Arundel Medical Center, 2002 Medical Parkway Suite 235, Annapolis, MD 21401, USA. Tel: 443-481-5800. Fax: 443-481-5808. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

We sought to retrospectively report our outcomes using post-operative stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) in place of whole-brain radiation therapy (WBRT) following resection of brain metastases from our hospital-based community practice.

Materials and Methods:

A retrospective review of 23 patients who underwent post-operative SRS at our single institution from 2013 to 2017 was undertaken. Patient records, treatment plans and diagnostic images were reviewed. Local failure, distant intracranial failure and overall survival were studied. Categorical variables were analyzed using Fisher’s exact tests. Continuous variables were analyzed using Mann–Whitney tests. The Kaplan–Meier method was used to estimate survival times.

Results:

16 (70%) were single-fraction SRS, whereas the remaining 7 patients received a five-fraction treatment course. The median single-fraction dose was 16 Gy (range, 16–18). The median total dose for fractionated treatments was 25 Gy (range, 25–35). Overall survival at 6 and 12 months was 95 and 67%, respectively. Comparison of SRS versus SRT local control rates at 6 and 12 months revealed control rates of 92 and 78% versus 29 and 14%, respectively. Every patient with dural/pial involvement at the time of surgery had distant intracranial failure at the 12-month follow-up.

Findings:

Single-fraction frameless SRS proved to be an effective modality with excellent local control rates. However, the five-fraction SRT course was associated with an increased rate of local recurrence. Dural/pial involvement may portend a high risk for distant intracranial disease; therefore, it may be prudent to consider alternative approaches in these cases.

Keywords

brain metastasespost-operativeradiationtherapystereotactic radiosurgery
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 2 , June 2020 , pp. 127 - 131
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Attributing Department Department of Radiation Oncology, DeCesaris Cancer Institute, Anne Arundel Medical Center, 2001 Medical Pkwy, Annapolis, MD 21401

References

Andrews, DW, Scott, CB, Sperduto, PW, et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 radomised trial. Lancet. 2004; 363: 1665–1672.CrossRefGoogle ScholarPubMed
Patchell, RA, Tibbs, PA, Regine, WF, et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. J Am Med Assoc. 1998; 280: 1485–1489.CrossRefGoogle ScholarPubMed
Chow, E, Davis, L, Holden, L, Tsao, M, Danjoux, C.Prospective assessment of patient-rated symptoms following whole-brain radiotherapy for brain metastases. J Pain Symptom Manage. 2005; 30: 18–23.CrossRefGoogle ScholarPubMed
Kondziolka, D, Niranjan, A, Flickinger, JC, Lunsford, LD. Radiosurgery with or without whole-brain radiotherapy for brain metastases: the patients’ perspective regarding complications. Am J Clin Oncol. 2005; 28: 173–179.CrossRefGoogle ScholarPubMed
Kocher, M, Soffietti, R, Abacioglu, U, et al. Adjuvent whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EROTC 22953-26001 study. J Clin Oncol. 2011; 29: 134–141.CrossRefGoogle Scholar
Chang, EL, Wefel, JS, Hess, KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiotherapy plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009; 10: 1037–1044.CrossRefGoogle ScholarPubMed
Brown, PD, Jaeckle, K, Ballman, KV, et al. 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. J Am Med Assoc. 2016; 316(4): 401–409.CrossRefGoogle ScholarPubMed
Sun, A, Bae, K, Gore, EM, et al. Phase III trial of prophylactic cranial irradiation compared with observation in patients with locally advanced non-small-cell lung cancer: neurocognitive and quality-of-life analysis. J Clin Oncol. 2011; 29(3): 279–286.CrossRefGoogle ScholarPubMed
Nayak, L, Lee, EQ, Wen, PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012; 14: 48–54.CrossRefGoogle ScholarPubMed
Barnholtz-Sloan, JS, Sloan, AE, Davis, FG, Vigneau, FD, Lai, P, Sawaya, RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004; 22: 2865–2872.CrossRefGoogle Scholar
Soltys, SG, Adler, JR, Lipani, JD, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys. 2008; 70: 187–193.CrossRefGoogle ScholarPubMed
Kelly, PJ, Lin, YB, Yu, AY, et al. Stereotactic irradiation of the postoperative resection cavity for brain metastasis: a frameless linear accelerator-based case series and review of the technique. Int J Radiat Oncol Bio Phys. 2012; 82: 95–101.CrossRefGoogle ScholarPubMed
Choi, CY, Chang, SD, Gibbs, IC, et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases: prospective evaluation of target margin on tumor control. Int J Radiat Oncol Bio Phys. 2012; 84: 336–342.CrossRefGoogle ScholarPubMed
Hartford, AC, Paravati, AJ, Spire, WJ, et al. Postoperative stereotactic radiosurgery without whole-brain radiation therapy for brain metastases: potential role of preoperative tumor size. Int J Radiat Oncol Bio Phys. 2013; 85: 650–655.CrossRefGoogle ScholarPubMed
Brennan, C, Yang, TJ, Hilden, P, et al. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys. 2014; 88: 130–136.CrossRefGoogle ScholarPubMed
Lamba, N, Muskens, IS, DiRisio, AC, et al. Stereotactic radiosurgery verse whole-brain radiotherapy after intracranial metastasis resection: a systematic review and meta-analysis. Radiat Oncol. 2017; 12: 106.CrossRefGoogle Scholar
Iorio-Morin, C, Masson-Côté, L, Ezahr, Y, Blanchard, J, Ebacher, A, Mathieu, D.Early gamma knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control. J Neurosurg. 2014; 121 (suppl), 69–74.CrossRefGoogle ScholarPubMed
Smith, TR, Lall, RR, Lall, RR, et al. Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study. J Neurosurg. 2014; 121: 839–845.CrossRefGoogle ScholarPubMed
Mahajan, A, Ahmed, S, McAleer, MF, et al. Prospective randomized trial of post-operative stereotactic radiosurgery versus observation for completely resected brain metastases. Lancet Oncol. 2017; 18(8): 1040–1048.CrossRefGoogle Scholar
Shaw, E, Kline, R, Gillin, M, et al. Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys. 1993; 27: 1231–1239.CrossRefGoogle ScholarPubMed
Patchell, RA, Tibbs, PA, Walsh, JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990; 322: 494–500.CrossRefGoogle ScholarPubMed
Deangelis, LM, Delattre, JY, Posner, JB. Radiation-induced dementia in patients cured of brain metastases. Neurology. 1989; 39: 789–796.CrossRefGoogle ScholarPubMed
Nieder, C, Schwerdtfeger, K, Steudel, WI, Schnabel, K.Patterns of relapse and late toxicity after resection and whole-brain radiotherapy for solitary brain metastases. Strahlenther Onkol. 1998; 174: 275–278.CrossRefGoogle ScholarPubMed
Meyers, CA, Smith, JA, Bezjak, A, et al. Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized trial phase III trial. J Clin Oncol. 2004; 22: 157–165.CrossRefGoogle ScholarPubMed
Soliman, H, Ruschin, M, Angelov, L, et al. Consensus contouring guidelines for postoperative completely resected cavity stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Bio Phys. 2018; 100: 436–442.CrossRefGoogle ScholarPubMed
Wang, CC, Floyd, SR, Chang, CH, et al. Cyberknife Hypofractionated Stereotactic Radiosurgery (HSRS) of resection cavity after excision of larger cerebral metastasis: efficacy and safety of an 800 cGy x3 daily fractions regimen. J Neurooncol. 2012; 106: 601–610.CrossRefGoogle Scholar
Steinmann, D, Maertens, B, Janssen, S, et al. Hypofractionated stereotactic radiotherapy (hfSRT) after tumour resection of a single brain metastasis: report of a single-centre individualized treatment approach. J Cancer Res Clin Oncol. 2012; 138: 1523–1529.CrossRefGoogle ScholarPubMed
Minniti, G, Scaringi, C, Paolini, S, et al. Single-fraction verse multifraction (3 × 9 Gy) stereotactic radiosurgery for large (>2 cm) brain metastases: a comparative analysis of local control and risk of radiation-induced brain necrosis. Int J Radiat Oncol Bio Phys. 2016; 95: 1142–1148.CrossRefGoogle Scholar
Zhong, J, Ferris, MJ, Switchenko, J, et al. Postoperative stereotactic radiosurgery for resected brain metastases: a comparison of outcomes for large resection cavities. Pract Radiat Oncol. 2017; 7(6): e419–e425.CrossRefGoogle ScholarPubMed