Predicting Tumor Control After Resection Bed Radiosurgery of Brain Metastases

Luther, Neal; Kondziolka, Douglas; Kano, Hideyuki; Mousavi, Seyed H.; Engh, Johnathan A.; Niranjan, Ajay; Flickinger, John C.; Lunsford, L. Dade

doi:10.1227/neu.0000000000000148

Cited by 51 publications

(42 citation statements)

References 37 publications

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“…Our reported institutional rate was 82% at 1 year, which compared favorably with what others have described 10, 11, 12, 13, 14. Smith et al 11 reported a local control rate of 77% at 1 year in a cohort of 150 patients 12 .…”

Section: Discussionsupporting

confidence: 88%

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Rava

Rosenberg

Jamorabo

et al. 2016

Advances in Radiation Oncology

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ObjectiveOur objective was to report safety and efficacy of stereotactic radiosurgery (SRS) to the surgical bed following resection of brain metastases.MethodsEighty-seven consecutive patients who underwent cavity-directed SRS to the operative bed for the treatment of brain metastases between 2002 and 2010 were evaluated. SRS required a gadolinium-enhanced, high-resolution, T1-weighted magnetic resonance imaging for tumor targeting and delivered a median dose of 18 Gy (14-22 Gy) prescribed to encompass the entire resection cavity. Whole brain irradiation was reserved for salvage. Patients were followed every 3 months with clinical examination and magnetic resonance imaging. Overall survival, local and regional recurrence, and factors affecting these outcomes were evaluated using Kaplan-Meier and log-rank analyses.ResultsThe median imaging follow-up was 7.1 months, with >40% of patients having imaging for ≥1 year. Local control at 1 and 2 years was 82% and 75%, respectively. Cavity recurrence was more common with a tumor diameter >3 cm (P < .020) or resection cavity volume >14 mL (P < .050). One-year local control for tumors <2 cm, 2 cm to 3 cm, and >3 cm were 100%, 86%, and 72%, respectively. Neither subtotal resection nor target margins >2 mm to 3 mm affected local control. The median overall survival was 14.3 months with actuarial 5-year survival of 20%. Actuarial regional central nervous system recurrence was 44% at 1 year. On univariate analysis, only the presence of extracranial disease was associated with survival (P < .001) and central nervous system failure (P < .030).ConclusionsExcellent local control is achievable with cavity-directed SRS in well-selected patients, particularly for lesions with diameter <3 cm and resection cavity volumes <14 mL. Long-term survival is possible for select patients.

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Section: Discussionsupporting

confidence: 88%

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Rava

Rosenberg

Jamorabo

et al. 2016

Advances in Radiation Oncology

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“…Unfortunately, it is well established that surgical resection alone is not an effective treatment for brain metastases, as it is associated with a high local failure rate that exceeds 60% [7]. However, the strategy of combined surgical resection with SRS targeting of residual tumor cells at the resection cavity is a novel approach that has been evaluated by several institutions, and has shown promising local control rates of 80-90% [17][18][19]. Surgery can certainly play an important role for patients with large brain metastases.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiosurgery for large brain metastases

Ebner

Rava

Gorovets

et al. 2015

Journal of Clinical Neuroscience

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“…Others have compared patterns of local recurrence with comparable rates of local control to that used herein of 1-year local control 83% (82% herein) without the additional margins used in the prospective trials [6]. While they note that recurrences were more likely to occur deep within the surgical cavity, there is no description of a distance from the treatment volume, or whether there were recurrences within the surgical tract.…”

Section: Discussionmentioning

confidence: 99%

Tumor Cavity Recurrence after Stereotactic Radiosurgery of Surgically Resected Brain Metastases: Implication of Deviations from Contouring Guidelines

McDermott¹,

Hack²,

Cifarelli³

et al. 2019

Stereotact Funct Neurosurg

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Background: Significant heterogeneity exists in target volumes for postoperative stereotactic radiosurgery (SRS) for brain metastases. A set of contouring guidelines was recently published, and we investigated the impact of deviations. Methods: Patients (n = 41) undergoing single-fraction Gamma Knife SRS following surgical resection of brain metastases from 2011 to 2017 were retrospectively reviewed. SRS included the entire contrast-enhancing cavity with heterogeneity in inclusion of the surgical tract and no routine margin along the dura or clinical target volume margin. Follow-up MR imaging was fused with SRS plans to assess patterns of failure. Results: The median follow-up was 11.1 months with a median prescription of 18 Gy. There were 5 local failures: infield (n = 3, 60%), surgical tract (n = 1, 20%), and marginal > 5 mm from the resection cavity (n = 1, 20%). No marginal failures < 5 mm or dural margin failures were noted. For deep lesions (n = 13), 62% (n = 8) had the entire tract covered. The only tract recurrence was in a deep lesion without coverage of the surgical tract (n = 1/5). Conclusion: In this small preliminary experience, despite no routine inclusion of the dural tract or bone flap, no failures were noted in these locations. Omission of the surgical tract in deep lesions may increase failure rates.

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Predicting Tumor Control After Resection Bed Radiosurgery of Brain Metastases

Abstract: Resection bed SRS for brain metastases provided excellent local control. The cavity PTV is predictive of tumor control. Because failure usually occurs outside the PTV, inclusion of a judicious 2- to 3-mm margin beyond the area of postoperative enhancement may be prudent.

Cited by 51 publications

References 37 publications

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Feasibility and safety of cavity-directed stereotactic radiosurgery for brain metastases at a high-volume medical center

Stereotactic radiosurgery for large brain metastases

Tumor Cavity Recurrence after Stereotactic Radiosurgery of Surgically Resected Brain Metastases: Implication of Deviations from Contouring Guidelines

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