Hypofractionated Stereotactic Radiation Therapy to the Resection Bed for Intracranial Metastases

Keller, A.; Doré, M.; Cébula, H.; Thillays, F.; Francois, Proust; Darié, Ioana; Martin, Sandy Dwayne; Delpon, G.; Lefèbvre, François; Noël, Georges; Antoni, D.

doi:10.1016/j.ijrobp.2017.08.014

Cited by 68 publications

(53 citation statements)

References 41 publications

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“…Furthermore, alongside with the adoption of postoperative SRS for brain metastases during the last decade, alternative strategies have also been developed that could minimize symptomatic radiation-induced injury and leptomeningeal dissemination. These include: multi-fractional postoperative SRS ( 8 , 9 ) and preoperative SRS ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, wider ranges of rates of radiation necrosis have been observed after postoperative SRS. These rates of radionecrosis in tumor bed SRS cases have ranged from 1.5 to 18.5% ( 9 , 27 , 38 – 40 ). As reported by Keller et al, the infratentorial location was predictive of increased radionecrosis (hazard ratio [HR]: 2.97; 95% confidence interval [95% CI]: 1.47–6.01; p = 0.0025) ( 40 ).…”

Section: Introductionmentioning

confidence: 99%

“…Current research has yet to pinpoint whether LMD in the postoperative SRS setting is a manifestation of the tumor's natural history, or if dissemination is secondary to the surgery itself (tumor spill) and whether postoperative SRS may also be indirectly contributing to it (higher incidences of distant tumor progression leading to LMD, etc.) ( 9 ). Several series have reported on this topic; for example, Atalar et al reported a higher rate of LMD in patients with metastatic breast cancer which may be related to tumor biology ( 43 ).…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, Keller et al published a series of 181 patients treated with a 3-fractionation schedule of 33 Gy to the resected cavity. The 1-year local control rate was 88% ( 9 ). Interestingly, on multivariate analysis, tumor contact with the meninges was predictive of increased local failure, which validated the importance of adding generous margin to the CTV in that region as suggested by the consensus guidelines as discussed above ( 33 ).…”

Section: Introductionmentioning

confidence: 99%

“…Crude rates of radiation necrosis were 5.6 and 0% for the preoperative SRS and the postoperative WBRT groups, respectively. Future prospective studies should direct their effort to address whether preoperative SRS may be superior to postoperative SRS, and to evaluate the optimal radiation doses, timing between surgery and SRS treatments, and also salvage options for these patients requiring locoregional control for their limited brain metastases ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases

et al. 2018

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During the past decade, tumor bed stereotactic radiosurgery (SRS) after surgical resection has been increasingly utilized in the management of brain metastases. SRS has risen as an alternative to adjuvant whole brain radiation therapy (WBRT), which has been shown in several studies to be associated with increased neurotoxicity. Multiple recent articles have shown favorable local control rates compared to those of WBRT. Specifically, improvements in local control can be achieved by adding a 2 mm margin around the resection cavity. Risk factors that have been established as increasing the risk of local recurrence after resection include: subtotal resection, larger treatment volume, lower margin dose, and a long delay between surgery and SRS (>3 weeks). Moreover, consensus among experts in the field have established the importance of (a) fusion of the pre-operative magnetic resonance imaging scan to aid in volume delineation (b) contouring the entire surgical tract and (c) expanding the target to include possible microscopic disease that may extend to meningeal or venous sinus territory. These strategies can minimize the risks of symptomatic radiation-induced injury and leptomeningeal dissemination after postoperative SRS. Emerging data has arisen suggesting that multifraction postoperative SRS, or alternatively, preoperative SRS could provide decreased rates of radiation necrosis and leptomeningeal disease. Future prospective randomized clinical trials comparing outcomes between these techniques are necessary in order to improve outcomes in these patients.

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Section: Introductionmentioning

confidence: 99%