Intracranial control and radiographic changes with adjuvant radiation therapy for resected brain metastases: whole brain radiotherapy versus stereotactic radiosurgery alone

Abstract

The aim of this study was to compare outcomes of postoperative whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) alone in patients with resected brain metastases (BM). We reviewed records of patients who underwent surgical resection of BM followed by WBRT or SRS alone between 2003 and 2013. Local control (LC) of the treated resected cavity, distant brain control (DBC), leptomeningeal disease (LMD), overall survival (OS), and radiographic leukoencephalopathy rates were estimated by the Kaplan-Meier method. One-hundred thirty-two patients underwent surgical resection for 141 intracranial metastases: 36 (27 %) patients received adjuvant WBRT and 96 (73 %) received SRS alone to the resection cavity. One-year OS (56 vs. 55 %, p = 0.64) and LC (83 vs. 74 %, p = 0.31) were similar between patients receiving WBRT and SRS. After controlling for number of BM, WBRT was associated with higher 1-year DBC compared with SRS (70 vs. 48 %, p = 0.03); single metastasis and WBRT were the only significant predictors for reduced distant brain recurrence in multi-variate analysis. Freedom from LMD was higher with WBRT at 18 months (87 vs. 69 %, p = 0.045), while incidence of radiographic leukoencephalopathy was higher with WBRT at 12 months (47 vs. 7 %, p = 0.001). One-year freedom from WBRT in the SRS alone group was 86 %. Compared with WBRT for patients with resected BM, SRS alone demonstrated similar LC, higher rates of LMD and inferior DBC, after controlling for the number of BM. However, OS was similar between groups. The results of ongoing clinical trials are needed to confirm these findings.

Post-treatment neutrophil-to-lymphocyte ratio predicts for overall survival in brain metastases treated with stereotactic radiosurgery

“…SRS was delivered using a linear accelerator with 6 MV photon energies, as described previously [16, 17]. All BM underwent patients underwent high-resolution treatment planning magnetic resonance imaging (MRI) scan with and without contrast within 10 days of computed tomography simulation.…”

Ipilimumab and Stereotactic Radiosurgery Versus Stereotactic Radiosurgery Alone for Newly Diagnosed Melanoma Brain Metastases

“…14,15 In brief, SRS was performed using a linear accelerator with 6 MV photon energies. The T1 postcontrast magnetic resonance imaging (MRI) defined lesion constituted the gross tumor volume (GTV).…”

Angiotensin receptor blockade: a novel approach for symptomatic radiation necrosis after stereotactic radiosurgery

“…Historically, patients with rBM have been treated with whole brain radiation therapy (WBRT) [17, 18]; however, due to results showing worse neurocognitive decline and quality of life following WBRT, clinicians have begun to turns towards post-operative SRS [13, 19, 20]. Postoperative SRS is not without its limitations, with a main dose-limiting toxicity being SRN.…”

“…SRS was performed using a linear accelerator with 6 MV photon energies as previously described [13, 14]. For the post-operative SRS management of rBM, patients underwent high-resolution treatment planning magnetic resonance imaging (MRI) scan with and without contrast immediately before or following CT simulation.…”