Hypofractionated adjuvant surgical cavity radiotherapy following resection of limited brain metastasis

Wijetunga, Asanka; Jayamanne, Dasantha; Cook, Raymond; Parkinson, Jonathan; Little, Nicholas; Curtis, J.; Brown, Chris; Back, Michael

doi:10.1016/j.jocn.2020.10.041

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…From the patients' perspective, this is an attractive option, as it is a "one-stop shop" with no further necessity of adjuvant radiotherapy after discharge from hospital. The observed LC in our series is definitively in the upper range of data reported after brain metastasectomy [3,[16][17][18][19][20][21][22][23][24]. When we started using IORT for LBRT in 2013, we applied lower doses of 16 Gy according to the Cleveland protocol [12].…”

Section: Discussionsupporting

confidence: 68%

Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases—an Augsburg University Medical Center experience

et al. 2021

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Purpose External-beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50-kV x‑rays is an alternative way to focally irradiate the resection cavity after BM surgery, with the option of shortening the overall treatment time and limiting normal tissue irradiation. Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50-kV x‑ray IORT between 2013 and 2020 at Augsburg University Medical Center. Results We identified 40 patients with 44 resected BM treated with 50-kV x‑ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3‑monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for alive patients of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1‑year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1‑year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1‑year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%. Conclusion IORT with 50-kV x‑rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM, with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

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Section: Discussionsupporting

confidence: 68%

Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases—an Augsburg University Medical Center experience

et al. 2021

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“…Overall survival in this study was 7.3 months, equivalent to other studies of HFRT in unresected BM: a summary of six cohorts by Murai et al totalling 363 patients demonstrated median OS post-HFRT of 3-15 months [32]. The survival of 7.3 months ought to be considered with the fact that initial management for many patients is resection followed by adjuvant cavity radiotherapy [33]. Only those with advanced extracranial disease, multiple lesions or co-morbidity are selected for non-operative management.…”

Section: Rates Of Transient Pseudoprogression Appear To Be Lower In Hfrtsupporting

confidence: 68%

“…Only those with advanced extracranial disease, multiple lesions or co-morbidity are selected for non-operative management. Despite the range of bene ts of HFRT over SRS, neither appear to confer superior survival, with several retrospective comparative studies of 90-190 patients nding no signi cant difference [19,[34][35][36], which may be due to the competing risk of extracranial disease on OS, but in this study, HFRT conferred a signi cant and consistent volumetric response which was independently predictive of superior OS.…”

Section: Rates Of Transient Pseudoprogression Appear To Be Lower In Hfrtcontrasting

confidence: 58%

Volumetric Response of Brain Oligometastatic Disease to Focal Hypofractionated Radiation Therapy

Wijetunga

Jayamanne

Adams

et al. 2021

Preprint

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Background: This study aimed to assess the volumetric response, morbidity and failure rates of hypofractionated radiation therapy (HFRT) for definitive focal management of brain oligometastatic disease. Methods: Patients managed with HFRT for unresected oligometastatic brain disease were entered into an ethics-approved database. HFRT was delivered using IMRT or VMAT with 30Gy or 25Gy in 5 fractions. Individual lesions had volumetric assessment performed at three timepoints. Primary endpoint was change of volume from baseline (GTV0) to one-month post-HFRT (GTV1); and to seven-months post-HFRT (GTV7). Secondary endpoints were local failure, survival, and rate of radiation necrosis. Results:One hundred and twenty-four patients with 233 lesions were managed with HFRT. Median follow-up was 23.5 months with thirty-two (25.8%) patients alive at censure. Median overall survival was 7.3 months, with 36.3% survival at 12 months, with superior survival predicted by GTV0 (p=0.003) and percentage volumetric response (p<0.001). Systemic therapy was delivered in 81.5% of cases. At one-month post-HFRT 206 metastases (88.4%) were available for assessment; at seven-months post-HFRT this had reduced to 118 metastases (50.6%). Median metastasis volume at GTV0 was 1.6cm3 (range: 0.1-19.1). At GTV1 and GTV7 this reduced to 0.7cm3 (p<0.001) and 0.3cm3 (p<0.001) respectively, correlating to percentage reductions of 54.9% and 83.3%. No significant predictors of volumetric response following HFRT were identified. Local failure was confirmed in 4.3% of lesions and radiation necrosis in 3.9%. Conclusion: HFRT is an effective method for oligometastatic disease in the brain to maximise initial volumetric response whilst minimising pseudoprogression and radiation necrosis.

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“…In patients perspective this is an attractive option, as it is a "one stop shop" with no further necessity of adjuvant radiotherapy after discharge from hospital. The observed LC in our series is de nitively in the "upper range" of data reported after brain metastasectomy [3,[16][17][18][19][20][21][22][23][24]. When we started using IORT for LBRT in 2013 we applied lower doses of 16 Gy following the Cleveland protocol [12].…”

Section: Discussionsupporting

confidence: 54%

Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

Kahl

Balagiannis

Höck

et al. 2021

Preprint

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Purpose External beam radiotherapy (EBRT) is the predominant method for localized brain radiotherapy (LBRT) after resection of brain metastases (BM). Intraoperative radiotherapy (IORT) with 50kV x-rays is an alternative way to irradiate the resection cavity focally after BM surgery with the option to shorten the overall treatment time and limit normal tissue irradiation.Methods We retrospectively analyzed the outcomes of all patients who underwent neurosurgical resection of BM and 50kV x-ray IORT between 2013 and 2020 at Augsburg University Medical Center.Results We identified 40 patients with 44 resected BM treated with 50kV x-ray IORT. Median diameter of the resected metastases was 2.8 cm (range 1.5–5.9 cm). Median applied dose was 20 Gy. All patients received standardized follow-up (FU) including 3-monthly MRI of the brain. Mean FU was 14.4 months, with a median MRI FU for patients alive of 12.2 months. Median overall survival (OS) of all treated patients was 26.4 months (estimated 1-year OS 61.6%). The observed local control (LC) rate of the resection cavity was 88.6% (estimated 1-year LC 84.3%). Distant brain control (DC) was 47.5% (estimated 1-year DC 33.5%). Only 25% of all patients needed WBI in the further course of disease. The observed radionecrosis rate was 2.5%.Conclusion IORT with 50kV x-rays is a safe and appealing way to apply LBRT after neurosurgical resection of BM with low toxicity and excellent LC. Close MRI FU is paramount to detect distant brain failure (DBF) early.

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Hypofractionated adjuvant surgical cavity radiotherapy following resection of limited brain metastasis

Cited by 8 publications

References 29 publications

Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases—an Augsburg University Medical Center experience

Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases—an Augsburg University Medical Center experience

Volumetric Response of Brain Oligometastatic Disease to Focal Hypofractionated Radiation Therapy

Intraoperative radiotherapy with low energy x-rays after neurosurgical resection of brain metastases – Augsburg University Medical Center experience

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