Faculty Collaboration Database

Current dosing paradigm for stereotactic radiosurgery alone after surgical resection of brain metastases needs to be optimized for improved local control. Int J Radiat Oncol Biol Phys 2012 May 01;83(1):e61-6

Date

04/21/2012

Pubmed ID

22516387

DOI

10.1016/j.ijrobp.2011.12.017

Scopus ID

2-s2.0-84859837774 (requires institutional sign-in at Scopus site)   71 Citations

Abstract

PURPOSE: To describe the use of radiosurgery (RS) alone to the resection cavity after resection of brain metastases as an alternative to adjuvant whole-brain radiotherapy (WBRT).

METHODS AND MATERIALS: Sixty-two patients with 64 cavities were treated with linear accelerator-based RS alone to the resection cavity after surgical removal of brain metastases between March 2007 and August 2010. Fifty-two patients (81%) had a gross total resection. Median cavity volume was 8.5 cm(3). Forty-four patients (71%) had a single metastasis. Median marginal and maximum doses were 18 Gy and 20.4 Gy, respectively. Sixty-one cavities (95%) had gross tumor volume to planning target volume expansion of ≥1 mm.

RESULTS: Six-month and 1-year actuarial local recurrence rates were 14% and 22%, respectively, with a median follow-up period of 9.7 months. Six-month and 1-year actuarial distant brain recurrence, total intracranial recurrence, and freedom from WBRT rates were 31% and 51%, 41% and 63%, and 91% and 74%, respectively. The symptomatic cavity radiation necrosis rate was 8%, with 2 patients (3%) undergoing surgery. Of the 11 local failures, 8 were in-field, 1 was marginal, and 2 were both (defined as in-field if ≥90% of recurrence within the prescription isodose and marginal if ≥90% outside of the prescription isodose).

CONCLUSIONS: The high rate of in-field cavity failure suggests that geographic misses with highly conformal RS are not a major contributor to local recurrence. The current dosing regimen derived from Radiation Therapy Oncology Group protocol 90-05 should be optimized in this patient population before any direct comparison with WBRT.

Author List

Prabhu R, Shu HK, Hadjipanayis C, Dhabaan A, Hall W, Raore B, Olson J, Curran W, Oyesiku N, Crocker I

Author

William Adrian Hall MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Analysis of Variance
Brain
Brain Neoplasms
Female
Humans
Male
Middle Aged
Necrosis
Neoplasm Recurrence, Local
Postoperative Period
Radiation Injuries
Radiosurgery
Radiotherapy Dosage
Retrospective Studies
Treatment Failure
Tumor Burden
Young Adult