B rain metastases are a significant source of illness and death among cancer patients 8 and will eventually develop in about 20%-40% of patients with a primary extracranial neoplasm. 9 The intent of current optimal case management remains mostly palliative. Resection has been shown to improve neurological symptoms, improve functional independence, and increase survival times. 19 However, surgery alone is associated with a 46%-59% rate of local recurrence, presumably because Early Gamma Knife stereotactic radiosurgery to the tumor bed of resected brain metastasis for improved local control Object. Optimal case management after surgical removal of brain metastasis remains controversial. Although postoperative whole-brain radiation therapy (WBRT) has been shown to prevent local recurrence and decrease deaths, this modality can substantially decrease neurocognitive function and quality of life. Stereotactic radiosurgery (SRS) can theoretically achieve the same level of local control with fewer side effects, although studies conclusively demonstrating such outcomes are lacking. To assess the effectiveness and safety profile of tumor bed SRS after resection of brain metastasis, the authors performed a retrospective analysis of 110 patients who had received such treatment at the Centre Hospitalier Universitaire de Sherbrooke. They designed the study to identify risk factors for local recurrence and placed special emphasis on factors that could potentially be addressed.Methods. Patients who had received treatment from 2004 through 2013 were included if they had undergone surgical removal of 1 or more brain metastases and if the tumor bed was treated by SRS regardless of the extent of resection or prior WBRT. All cases were retrospectively analyzed for patient and tumor-specific factors, treatment protocol, adverse outcomes, cavity outcomes, and survival for as long as follow-up was available. Univariate and multivariate Cox regression analyses were performed to identify risk factors for local recurrence and predictors of increased survival times.Results. Median patient age at first SRS treatment was 58 years (range 37-84 years). The most frequently diagnosed primary tumor was non-small cell lung cancer. The rate of gross-total resection was 81%. The median Karnofsky Performance Scale score was 90%. Tumor bed SRS was performed at a median of 3 weeks after surgery. Median follow-up and survival times were 10 and 11 months, respectively. Actuarial local control of the cavity at 12 months was 73%; median time to recurrence was 6 months. According to multivariate analysis, risk factors for recurrence were a longer surgery-to-SRS delay (HR 1.625, p = 0.003) and a lower maximum radiation dose delivered to the cavity (HR 0.817, p = 0.006). Factors not associated with increased recurrence were subtotal or piecemeal resections, prior WBRT, histology of the primary tumor, and larger cavity volume. No factors predictive of survival were identified. Symptomatic radiation-induced enhancement occurred in 6% of patients and leptomeninge...
Suppl 2 -S8volume ratio (TVR) (0.80 vs. 0.72) were significantly associated with development of edema after SRS (p<0.05, power > 0.8). Conclusion: Volume-based reporting of SRS outcomes for meningiomas is more accurate for reporting tumor control. Conformity index and TVR were identified as predictors of edema following radiosurgery. were included if they had one or more brain metastasis surgically removed, their tumor bed treated by SRS and at least 6 months of available follow-up. Average age at first SRS treatment was 59. At the time of SRS, gross total resection of the brain metastasis had been achieved in 80% of cases and systemic disease was inactive in 59% of patients. Tumor bed SRS was performed on average 3.7 weeks following surgery. Mean cavity volume was 12 cc with an average maximal and marginal dose of 36 Gy and 18 Gy respectively. RESULTS Results for the full cohort will be presented at the meeting. Preliminary analysis of 56 of the 130 patients reveals local control at the tumor bed was achieved in 86% of cases (average follow-up of 13 months). New brain metastases following SRS were identified in 63% of patients. Median survival was 8 months, with 67% of patients dying from a systemic rather than neurological cause. CONCLUSION SRS is a safe and effective adjuvant modality following surgical resection of brain metastasis. Pending completion of randomized control trials, our results support the use of SRS for local control of brain disease. Introduction: Validity assessment of NeuroTouch is important in the goal of using it in neurosurgical training, assessment and curriculum development. Methods: This study was conducted to assess bimanual performance of junior, senior resident and consultant resecting simulated brain tumors. Novel metrics were assessed including: total distance travelled by the tip of the ultrasonic aspirator and sucker (TPL), the maximum and sum of forces generated by instruments, blood loss, efficiency and coordination indexes and total brain tissue removed (BTR). Hypotheses: The complexity of tumor will influence neurosurgical performance and this influence will be greater in residents compare to consultants. Novel metrics will differentiate between groups. Results: All groups showed significant difference in 1) the amount of BTR comparing vague to clear boarder 2) simulated ultrasonic aspirator maximum and sum of forces on hard compare to soft tumors. Junior and senior residents showed more differences including 1) significantly more blood loss operating on hard versus soft tumors. 2) Higher ultrasonic aspirator TPL when operating on hard versus soft tumors. Junior resident also showed applied more sum of forces by the suction on the hard compare to the soft tumors. C4 - C5 -Significant difference between the consultant, senior, and junior residents efficiency index observed (75.6%, 63.4%, 60.3% respectively P=0.001). Discussion: This study is the first to demonstrate significant differences in neurosurgical performance based on the complexity of tumor. Increasing tumor compl...
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