Single session stereotactic radiosurgery boost to the post-operative site in lieu of whole brain radiation in metastatic brain disease

Quigley, Matthew R.; Fuhrer, Russell; Karlovits, Stephen; Karlovits, Brian J; Johnson, Mark D.

doi:10.1007/s11060-007-9515-z

Cited by 53 publications

(24 citation statements)

References 16 publications

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“…17 We demonstrated a local recurrence rate of 6.25%, which was equivalent to the recurrence rate achieved with WBRT. The median survival was 16.4 months, and 72% of our patients were spared WBRT.…”

supporting

confidence: 57%

“…17 The rationale for adjuvant SRS to the operative bed is to maintain the local control benefits of radiation and surgery without introducing the risks of acute and chronic morbidities associated with WBRT. Our observed local recurrence rate of 7.7% compares favorably with published local failure rates at the surgical site following WBRT (range 10-20%) and is superior to the 46% failure rate reported for resection alone.…”

Section: Discussionmentioning

confidence: 99%

“…7,15,18,22 Although higher than the 28% in our original report, the rate of 44% is more in keeping with what has been reported in other literature and the increase is probably the result of more mature follow-up. 17 Concern regarding distant brain recurrences when omitting WBRT is a source of controversy. Patchell et al 15 and Regine et al 18 reported increased death from neurological causes when omitting WBRT following resection and "decreased neurologic deficit progression-free survival" with SRS alone, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy

Karlovits¹,

Quigley

Karlovits

et al. 2009

FOC

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Object Whole-brain radiation therapy (WBRT) has been the traditional approach to minimize the risk of intracranial recurrence following resection of brain metastases, despite its potential for late neurotoxicity. In 2007, the authors demonstrated an equivalent local recurrence rate to WBRT by using stereotactic radiosurgery (SRS) to the operative bed, sparing 72% of their patients WBRT. They now update their initial experience with additional patients and more mature follow-up. Methods The authors performed a retrospective review of all cases involving patients with limited intracranial metastatic disease (≤ 4 lesions) treated at their institution with SRS to the operative bed following resection. No patient had prior cranial radiation and WBRT was used only for salvage. Results From November 2000 to June 2009, 52 patients with a median age of 61 years met inclusion criteria. A single metastasis was resected in each patient. Thirty-four of the patients each had 1 lesion, 13 had 2 lesions, 3 had 3 lesions, and 2 had 4 lesions. A median dose of 1500 cGy (range 800–1800 cGy) was delivered to the resection bed targeting a median volume of 3.85 cm3 (range 0.08–22 cm3). With a median follow-up of 13 months, the median survival was 15.0 months. Four patients (7.7%) had a local recurrence within the surgical site. Twenty-three patients (44%) ultimately developed distant brain recurrences at a median of 16 months postresection, and 16 (30.7%) received salvage WBRT (8 for diffuse disease [> 3 lesions], 4 for local recurrence, and 4 for diffuse progression following salvage SRS). The median time to WBRT administration postresection was 8.7 months (range 2–43 months). On univariate analysis, patient factors of a solitary tumor (19.0 vs 12 months, p = 0.02), a recursive partitioning analysis (RPA) Class I (21 vs 13 months, p = 0.03), and no extracranial disease on presentation (22 vs 13 months, p = 0.01) were significantly associated with longer survival. Cox multivariate analysis showed a significant association with longer survival for the patient factors of no extracranial disease on presentation (p = 0.01) and solitary intracranial metastasis (p = 0.02). Among patients with no extracranial disease, a solitary intracranial metastasis conferred significant additional survival advantage (43 vs 10.5 months, p = 0.05, log-rank test). No factor (age, RPA class, tumor size or histological type, disease burden, extent of resection, or SRS dose or volume) was related to the need for salvage WBRT. Conclusions Adjuvant SRS to the metastatic intracranial operative bed results in a local recurrence rate equivalent to adjuvant WBRT. In combination with SRS for unresected lesions and routine imaging surveillance, this approach achieves robust overall survival (median 15 months) while sparing 70% of the patients WBRT and its potential acute and chronic toxicity.

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supporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy

Karlovits¹,

Quigley

Karlovits

et al. 2009

FOC

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“…O'Neill and colleagues have shown that SRS is more effective at preventing local recurrences (0 %, 0/26) than surgery (27 %, 19/74). 46 In terms of surgery and SRS used together, a retrospective study has shown that giving a local boost of SRS into the surgical tumor bed has been shown to confer excellent survival and local control rates comparable to WBRT, sparing the patient the neurologic side effects of WBRT [47]. While SRS has been shown to be just as effective as surgery regarding survival, the inherent limitations of the retrospective analyses preclude the establishment of standard guidelines when comparing the two modalities; clearly, data from clinical trials can help resolve any controversy.…”

Section: Surgery and Stereotactic Radiosurgerymentioning

confidence: 99%

Management of Cerebral Brain Metastasis

2014

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Brain metastasis is associated with a poor overall prognosis, but combination therapies have emerged that may prevent recurrence or serve as palliative therapies. There is a wide range of treatment options for those with 1-3 intracranial metastases and stable disease, including combinations of surgery, whole brain radiation therapy (WBRT), and stereotactic radiosurgery (SRS). Those with few, small metastases may be served well by SRS and adjuvant WBRT, whereas those with larger metastases that are amenable to resection may be treated with surgical excision and adjuvant WBRT. Whole brain radiation alone is reserved for individuals with greater than three brain metastases or unstable disease. A number of studies have been conducted to clarify the optimal treatment regimen for patients with varying intracranial disease. This review aims to synthesize the most current findings pertaining to the neurosurgical treatment of brain metastases.

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“…Among such options are post-op SRS 4,15,18,[23][24][25]27,28,30,31,35,39,48,50,55 and intraoperative application of either permanent low-dose 7,12,22,52 or temporary highdose 5,40,44,51,61 radio-isotopes (generally Iodine-125 (I-125)) into the surgical cavity. Postop SRS is the more commonly used of these treatment modalities due to its wider availability.…”

Section: Introductionmentioning

confidence: 99%

Phase I/II Study of Neurosurgical Resection and Intraoperative Cesium-131 Radio-isotope Brachytherapy in Patients With Newly Diagnosed Brain Metastases

Wernicke

Peng

Yondorf

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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Single session stereotactic radiosurgery boost to the post-operative site in lieu of whole brain radiation in metastatic brain disease

Cited by 53 publications

References 16 publications

Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy

Stereotactic radiosurgery boost to the resection bed for oligometastatic brain disease: challenging the tradition of adjuvant whole-brain radiotherapy

Management of Cerebral Brain Metastasis

Phase I/II Study of Neurosurgical Resection and Intraoperative Cesium-131 Radio-isotope Brachytherapy in Patients With Newly Diagnosed Brain Metastases

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