Surgically targeted radiation therapy (STaRT) for recurrent brain metastases: Initial clinical experience

Kutuk, Tugce; Tolakanahalli, Ranjini; Chaswal, Vibha; Yarlagadda, Sreenija; Herrera, Roberto; Appel, Haley; La Rosa, Alonso; Mishra, Vivek; Wieczorek, D.Jay J.; McDermott, Michael W.; Siomin, Vitaly; Mehta, Minesh P.; Odia, Yazmin; Gutierrez, Alonso N.; Kotecha, Rupesh

doi:10.1016/j.brachy.2023.08.002

Cited by 3 publications

(1 citation statement)

References 46 publications

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“…The 6-, 12-, and 18-month LC rates were 66.7%, 33.3%, and 25% after the previous EBRT, and in comparison, these rates were 100%, 100%, and 100% after surgery plus GammaTile (p < 0.001). At a median follow up of 14.5 months, there was one instance (8%) of RN (Grade 2) [45].…”

Section: Recurrent Brain Metastasesmentioning

confidence: 99%

The role of GammaTile in the treatment of brain tumors: a technical and clinical overview

Garcia,

Turner,

Brachman

2024

J Neurooncol

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Malignant and benign brain tumors with a propensity to recur continue to be a clinical challenge despite decades-long efforts to develop systemic and more advanced local therapies. GammaTile (GT Medical Technologies Inc., Tempe AZ) has emerged as a novel brain brachytherapy device placed during surgery, which starts adjuvant radiotherapy immediately after resection. GammaTile received FDA clearance in 2018 for any recurrent brain tumor and expanded clearance in 2020 to include upfront use in any malignant brain tumor. More than 1,000 patients have been treated with GammaTile to date, and several publications have described technical aspects of the device, workflow, and clinical outcome data. Herein, we review the technical aspects of this brachytherapy treatment, including practical physics principles, discuss the available literature with an emphasis on clinical outcome data in the setting of brain metastases, glioblastoma, and meningioma, and provide an overview of the open and pending clinical trials that are further defining the efficacy and safety of GammaTile.

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Section: Recurrent Brain Metastasesmentioning

confidence: 99%

The role of GammaTile in the treatment of brain tumors: a technical and clinical overview

Garcia,

Turner,

Brachman

2024

J Neurooncol

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Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities

Kutuk,

Kotecha,

Herrera

et al. 2024

Brachytherapy

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Preoperative stereotactic radiosurgery for patients with 1–4 brain metastases: A single-arm phase 2 trial outcome analysis (NCT03398694)

Agrawal,

Shireman,

Shiue

et al. 2024

Neuro-Oncology Practice

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Background Stereotactic radiosurgery (SRS) following surgical resection is the standard of care for patients with symptomatic oligo brain metastasis (BM), however, it is associated with 10-15% local failure. Targeting a resection cavity is imprecise, thus pre-operative radiosurgery where the target is well defined may be superior, however, the efficacy of pre-operative SRS has not yet been tested in a clinical trial. Methods We conducted a phase II, single-arm trial of pre-operative SRS followed by surgical resection in patients with 1-4 symptomatic oligo BMs (NCT03398694) with the primary objective of measuring 6-month local control (LC). SRS was delivered to all patients utilizing gamma knife or linear accelerator as per RTOG-9005 dosing criteria24 based on tumor diameter with the exception that the largest lesion diameter treated was 5 cm with 15 Gy with all SRS treatment given in single fraction dosing. Results The trial screened 50 patients, 48 patients were treated under the protocol and 32 patients completed the entire follow-up period. Of all the patients who completed the follow-up period, primary endpoint of 6-month LC was 100% (95% CI: 0.891-1.000; p=0.005). Secondary endpoints, presented as medians, were overall-survival (17.6 months), progression-free survival (5.3 months), distant in-brain failure (40.8% at 1 year), leptomeningeal failure (4.8% at 1 year), and radiation necrosis (7.7% at 1 year). Conclusions Our data confirms superior local control in patients who received pre-operative SRS when compared to historical controls. Further study with a larger randomized cohort of patients is warranted to fully understand the benefits of pre-operative SRS.

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Surgically targeted radiation therapy (STaRT) for recurrent brain metastases: Initial clinical experience

Cited by 3 publications

References 46 publications

The role of GammaTile in the treatment of brain tumors: a technical and clinical overview

The role of GammaTile in the treatment of brain tumors: a technical and clinical overview

Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities

Preoperative stereotactic radiosurgery for patients with 1–4 brain metastases: A single-arm phase 2 trial outcome analysis (NCT03398694)

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