Resection of supratentorial brain metastases with intraoperative radiotherapy. Is it safe? Analysis and experiences of a single center cohort

Abstract

IntroductionIntraoperative Radiotherapy (ioRT) is an emerging treatment option in oncologic surgery for various diseases including intraaxial brain lesions to improve surgical outcome and accelerate the adjuvant oncologic therapy. Despite its use in glioma surgery, the application and data regarding ioRT in the treatment of brain metastases (BMs) is sparse. Here were report the largest series of supratentorial BMs treated with resection and ioRT according to functional outcome and adverse events.MethodsWe performed a retrospective chart review analysis of patients undergoing surgery for BMs following an interdisciplinary tumor board decision in every case with ioRT at our institution. Patient properties, functional status (Karnofsky Performance Score/KPS) before and after surgery as well as oncologic (disease, recursive partitioning analysis, lesion size) and operative parameters were analyzed until hospital discharge. Adverse events (AE) were recorded until 30 days after surgery and rated according to the Clavien Dindo Grading (CDG) scale.Results70 patients (40 female) with various oncologic diseases were identified and analyzed. Six underwent prior RT. Mean age was 66 ± 11 years. Preoperative median KPS was 80% with a mean BM volume of 3.2 ± 1.2 cm3. Nine patients (13%) experienced in total 14 AEs, including 2 cases (3%) of postoperative death (CDG5) and 2 with new postoperative epilepsy necessitating additional pharmacotreatment (CDG2). Five patients suffered from new neurologic deficit (CDG1) not needing further surgical or medical treatment. After surgery, the neurological status in 7 patients (10%) deteriorated while it improved in 21 cases (30%). Patients experiencing AEs had longer hospitalization and poorer postoperative KPS mdn. 90 vs. 80%. There was no statistically significant deterioration of the functional status during the immediate postoperative course in the whole patient cohort.ConclusionSurgery for supratentorial BMs with ioRT seems safe and feasible. Further studies on the benefit regarding oncologic outcome need to be performed.

Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases

“…Furthermore, a case report highlighted no additional adverse events when delivering IORT during awake craniotomies [172]. In addition, a safety analysis addressing the neurological functionality of 70 patients found no significant IORT-associated detriment after surgery [173].…”

Intraoperative radiotherapy after neurosurgical resection of brain metastases as institutional standard treatment– Update of the oncological outcome form a single center cohort after 117 procedures

“…IORT did not increase the perioperative complications rate of brain surgery. Although our series contains cases with huge metastases up to 7cm diameter, 12% of the treated patients tted to RPA class 3 and 13% of the metastases were located in the posterior fossa, the 30-days-mortality and complication rate were within the range described in recent publications of patient cohorts after neurosurgical BM resection with or without IORT [3,9,[22][23][24][25][26]. The complete IORT procedure prolonged OR time for 25 minutes in mean including less than 16 minutes radiation time.…”

Neuro-oncologic Emergencies

“…39 Additionally, early transition to radiosurgery to accelerate adjuvant therapy appears promising and safe. 109 Impaired wound healing and infection and perioperative hemorrhagic complications are more common in patients with long-term exposure to corticosteroids and in those with recent exposure to antiangiogenic agents (eg, bevacizumab). 34 PEDIATRIC CONSIDERATIONS Cancer in the pediatric, adolescent, and young adult populations should be recognized as a distinct disease entity because of specific features in each of these age subgroups different from each other and from older adults.…”

“…Outcomes are better if surgery can be performed electively as opposed to emergently 39 . Additionally, early transition to radiosurgery to accelerate adjuvant therapy appears promising and safe 109 . Impaired wound healing and infection and perioperative hemorrhagic complications are more common in patients with long-term exposure to corticosteroids and in those with recent exposure to antiangiogenic agents (eg, bevacizumab) 34 …”