Image-guided stereotactic radiotherapy of the resection cavity for single resectable brain metastases

Abstract

Objectives: To determine if the postoperative delivery of fractionated stereotactic radiotherapy (FSRT) for resection cavity for patients with single and resectable brain metastases is safe and effective. Methods: A prospective feasibility protocol was set up to include patients with single and resectable brain metastases who underwent surgery and had low risk profile according to RPA classification. Fractionated stereotactic radiotherapy was applied. Single dose: 3.8 Gy, total dose: 41.8 or 49.6 Gy. Results: There was no case of break due to clinical problems. There was no case of delay of FSRT. The onset acute toxicity was observed in 40 cases (76.9%), no grade 3 and more was seen. Local recurrence free survival was 32.6 months, local control rate at 6, 12, 18 and 24 months were 85%, 77.9%, 65.9% and 65.9%. Overall local failure occurred in 34.1% of patients. Overall survival rates at 6, 12, 18 and 24 months were 90.3%, 63.9%, 47.7% and 31.6%. Median survival was 18.3 months (13.8-22.8) and overall 17.3% were living at the time of last analysis. Distant control rates at 6, 12, 18 and 24 months were 49.4%, 38.2%, 25.5% and 22.3%. Median distant recurrence free survival was 6 months (0-12.0) with overall distant failure in 77.7% of patients. Conclusion: FSRT for surgical cavity might be one possible option in treatment of single and resectable brain metastases.