Intraoperative or postoperative stereotactic radiotherapy for brain metastases: time to systemic treatment onset and other patient-relevant outcomes

Abstract

Purpose Intraoperative radiotherapy (IORT) has become a viable treatment option for resectable brain metastases (BMs). As data on local control and radiation necrosis rates are maturing, we focus on meaningful secondary endpoints such as time to next treatment (TTNT), duration of postoperative corticosteroid treatment, and in-hospital time. Methods Patients prospectively recruited within an IORT study registry between November 2020 and June 2023 were compared with consecutive patients receiving adjuvant stereotactic radiotherapy (SRT) of the resection cavity within the same time frame. TTNT was defined as the number of days between BM resection and start of the next extracranial oncological therapy (systemic treatment, surgery, or radiotherapy) for each of the groups. Results Of 95 BM patients screened, IORT was feasible in 84 cases (88%) and ultimately performed in 64 (67%). The control collective consisted of 53 SRT patients. There were no relevant differences in clinical baseline features. Mean TTNT (range) was 36 (9 − 94) days for IORT patients versus 52 (11 − 126) days for SRT patients (p = 0.01). Mean duration of postoperative corticosteroid treatment was similar (8 days; p = 0.83), as was mean postoperative in-hospital time (11 versus 12 days; p = 0.97). Mean total in-hospital time for BM treatment (in- and out-patient days) was 11 days for IORT versus 19 days for SRT patients (p < 0.001). Conclusion IORT for BMs results in faster completion of interdisciplinary treatment when compared to adjuvant SRT, without increasing corticosteroid intake or prolonging in-hospital times. A randomised phase III trial will determine the clinical effects of shorter TTNT.

Intraoperative radiotherapy after neurosurgical resection of brain metastases as institutional standard treatment– Update of the oncological outcome form a single center cohort after 117 procedures

“…Median time from surgery to discharge from hospital was 6 days (range 2-41 days) for our patients, which is as long as it is for patients after BM resection without IORT. Dejonckheere et al [27] compared the mean time to next treatment of patients after BM resection with IORT to patients treated with postoperative SRT to the cavity in a retrospective single center study. They found a signi cant difference in favor of patients treated with IORT (36 (9 − 94) days) versus patients treated with postoperative SRT (52 (11 − 126) days).…”

Cerebellar glioblastoma in adults: a comparative single-center matched pair analysis and systematic review of the literature

“…Glioblastoma ranks among the most aggressive primary malignant brain tumors in adults (Ostrom et al 2020). Numerous studies have been undertaken to hasten the development of more advanced treatment strategies through diverse therapeutic and surgical methods (Potthoff et al 2019, Schneider et al 2019, Venkataramani et al 2022, Dejonckheere et al 2023. Glioblastomas are most commonly found in the supratentorial region, with less than 1% occurring in the cerebellum (Tsung et al 2011).…”