Abstract
Purpose Whole brain radiation (WBXRT) reduces the incidence of local and distant recurrence following resection of metastatic brain disease but does not prolong life and may entail neurocognitive decline. We employed a novel treatment modality of providing a single-session stereotactic radiosurgery (SRS) boost to the surgical resection site to achieve local control without the risk of cognitive effects. Methods We reviewed all patients at our institution that were treated with SRS to the post-operative bed following resection of a metastatic brain deposit. Results There were 32 patients identified (16 F) and median age was 60 years. One lesion was resected in all patients of whom 21 were solitary (eight with two lesions, three with three). Median survival was 16.4 months with a 14 month median follow-up. Factors which improved survival were solitary tumor, age <65 and RPA 1, although none achieved statistical significance. In the Cox multivariate analysis only smaller post-operative treatment volume correlated with survival (P = .04). There were two local recurrences (6.25%) to the surgical site and four patients required SRS for new lesions. Nine patients ultimately required salvage WBXRT (3/21 solitary v. 6/11 multiple lesions, P = .03 χ2), two for local recurrence post resection and seven for diffuse new disease. Conclusion The use of SRS to the surgical site results in local recurrence rates comparable to WBXRT and is associated with excellent survival. Over 70% of patients managed this way were spared WBXRT. The presence of multiple lesions on presentation is predictive of the need for subsequent salvage WBXRT.
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Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Eng J Med 322:494–500
Patchell RA, Tibbs PA, Regine WF et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain. JAMA 280:1485–1489
DeAngelis LM, Delattre JY, Posner JB (1989) Radiation-induced dementia in patients cured of brain metastases. Neurology 39:789–796
Kaplan IW, Meier R (1959) Submucous lipoma of the colon. Am J Gastroenterol 31:673–683
Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751
Aoyama H, Shirato H, Tago M et al (2006) Stereotactic Radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. JAMA 295:2483–2491
Noordijk EM, Vecht CJ, Haaxma-Reiche H et al (1994) The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29:711–717
Bindal RK, Sawaya R, Leavens ME et al (1993) Surgical treatment of multiple brain metastases. J Neurosurg 79:210–216
Bindal AK, Bindal RK, Hess KR et al (1996) Surgery versus radiosurgery in the treatment of brain metastasis. J Neurosurg 84:748–754
Paek SH, Audu PB, Sperling MR et al (2005) Reevaluation of surgery for the treatment of brain metastases: review of 208 patents with single or multiple brain metastases treated at one institution with modern neurosurgical techniques. Neurosurgery 56:1021–1034
Tendulkar RD, Liu SW, Barnett GH et al (2006) RPA classification has prognostic significance for surgically resected single brain metastasis. Int J Radiat Oncol Biol Phys 66:810–817
Regine WG, Huhn JL, Patchell RA et al (2002) Risk of symptomatic brain tumor recurrence and neurologic deficit after radiosurgery alone in patients with newly diagnosed brain metastases: results and implications. Int J Radiat Oncol Biol Phys 52:333–338
Hasegawa T, Kondziolka D, Flickinger JC et al (2003) Brain metastases treated with radiosurgery alone: an alternative to whole brain radiotherapy? Neurosurgery 52:1318–1326
Sneed PK, Suh JH, Goetsch SJ et al (2002) A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases. Int J Radiat Oncol Biol Phys 53:519–526
Mehta MP, Rodrigus P, Terhaard C et al (2004) Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. J Clin Oncol 21: 2529–2536
Mehta MP, Rodrigus P, Terhaard C et al (2002) Neurocognitive changes following whole brain radiation therapy for the treatment of brain metastases [Abstract]. Neuro-Oncology 4:355 (#175)
Li J, Bentzen SM, Renschler M et al (2007) Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function. J Clin Oncol 25:1260–1266
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This paper was presented at the Seventh Biennial Satellite Symposium of the AANS/CNS Joint Section on Tumors, April 13–14, 2007, Washington DC.
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Quigley, M.R., Fuhrer, R., Karlovits, S. et al. Single session stereotactic radiosurgery boost to the post-operative site in lieu of whole brain radiation in metastatic brain disease. J Neurooncol 87, 327–332 (2008). https://doi.org/10.1007/s11060-007-9515-z
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DOI: https://doi.org/10.1007/s11060-007-9515-z