Involved field radiation therapy after surgical resection of solitary brain metastases—mature results

Abstract

For patients with newly diagnosed single brain metastases treated with surgical resection, postoperative IFRT to the resection cavity achieves reasonable rates of local control and is an excellent alternative to WBRT.

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

“…Accordingly, the present study's median survival time of 18.3 months reasonably consistent with previous reports, particularly in comparison to the approximately 20 month median OS that was observed in a prior study of a similar number of patients [16]. Three retrospective studies of single brain metastases that incorporated the present study's treatment mode reported a median survival time of 20-30.7 months [14][15][16], whereas studies with initial postoperative WBRT reported median survival times of 10.7-12 months [4,13]. Therefore, research on the difference in survival times for patients with single brain metastasis could provide a major argument for proper treatment.…”

“…The median prescription dose of 41.8 Gy was comparable to studies with a wide range of LC rates. For example, in a study with a prescription dose of 40 Gy, Steinmann et al, observed a 73% LC rate [14], while in a study with a prescription dose of 40.5 Gy, Connolly et al, observed an 85% LC rate [15]. Considering the small sizes of study cohorts, the LC rate that was observed in the present study may be not be unusual at all ( Table 2.…”

“…Median OS times have ranged from 18.3 to 30.7 months in studies of patients with single brain metastasis who received focal radiotherapy after resection [14][15][16], including the OS in the present study. In comparison, median OS times have ranged from 11 to 17 months for cohorts that include multiple brain metastases [10][11][12][17][18][19][20][21][22].…”

“…In an excellent study of 33 patients with solitary brain metastases, Connolly et al, reported side effects experienced during and after a hypofractionated radiotherapy regimen (2.67 Gy, 15 times) that was similar to our own. It was observed that none of the patients experienced additional neurological symptoms related to the therapy [15].…”

Brain Metastases of Non–Small Cell Lung Cancer: Prognostic Factors in Patients with Surgical Resection

“…Unlike patients with multiple brain metastases, patients with a single brain metastasis show a longer survival time and a better quality of life. 10 An epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, such as erlotinib, was reported to be an effective treatment for NSCLC patients with brain metastasis and activated mutations in the EGFR. 11 The standard treatment schedule for these patients is still unclear, 12 although recommendation level 1 class I advocates for surgical resection together with postoperative whole-brain radiotherapy in patients with good KPS (those who are functionally independent and spend < 50% of time in bed).…”