Is local radiotherapy a viable option for patients with an opening of the ventricles during surgical resection of brain metastases?

Abstract

Background Local hypofractionated stereotactic radiotherapy (HFSRT) of the resection cavity is emerging as the standard of care in the treatment of patients with a limited number of brain metastases as it warrants less neurological impairment compared to whole brain radiotherapy. In periventricular metastases surgical resection can lead to an opening of the ventricles and subsequently carries a potential risk of cerebrospinal tumour cell dissemination. The aim of this study was to assess whether local radiotherapy of the resection cavity is viable in these cases. Methods From our institutional database we analyzed the data of 125 consecutive patients with resected brain metastases treated in our institution with HFSRT between 2009 and 2017. The incidence of LMD, overall survival (OS), local recurrence (LC) and distant recurrence were evaluated depending on ventricular opening (VO) during surgery. Results From all 125 patients, the ventricles were opened during surgery in 14 cases (11.2%). None of the patients with VO and 7 patients without VO during surgery developed LMD (p = 0.371). OS (p = 0.817), LC (p = 0.524) and distant recurrence (p = 0.488) did not differ in relation to VO during surgical resection. However, the incidence of distant intraventricular recurrence was slightly increased in patients with VO (14.3% vs. 2.7%, p < 0.01). Conclusion VO during neurosurgical resection did not affect the outcome after HFSRT of the resection cavity in patients with brain metastases. Particularly, the incidence of LMD was not increased in patients receiving local HFSRT after VO. HFSRT can therefore be offered independently of VO as a local treatment of tumor bed after resection of brain metastases.

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

“…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].…”

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

“…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].…”

Intraventricular Cerebral Metastases: A Comprehensive Systematic Review

“…Then, another 9 papers were excluded due to incompatibility with our inclusion criteria. Finally, a total of 11 articles were included in this systematic review (Table I) (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The described flowchart is reported in Figure 1.…”

“…The treatment of IVCM is a complex and challenging endeavor. Surgical removal of metastases is considered in select cases (13). However, the proximity of these lesions to critical brain structures and the risk of disrupting CSF flow can render surgery a risky option.…”