Tumor Bed Radiosurgery following Resection of Brain Metastases: A Review

Roberge, David; Souhami, Luís

doi:10.1177/153303461000900608

Cited by 19 publications

(13 citation statements)

References 25 publications

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“…In this study, the SRS boost to the tumor bed improved the LC (2 years LC 88 vs 32%; p < 0.001) and the OS (1-year OS 66 vs 44%; p < 0.001). These results are in agreement with the publication of Roberge et al [31][32][33], which demonstrate 91% 2-year LC and 17 months median survival in patients who received SRS to the tumor bed as compared with 52 and 33% LC rates after 1 and 2 years, respectively. These data demonstrate that the use of SRS on the postoperative tumor bed may achieve better LC in patients with BM.…”

Section: Treatment Options For Newly Diagnosed Brain Metastasessupporting

confidence: 92%

Salvage stereotactic radiosurgery for brain metastases

Klironomos¹,

Bernstein²

2013

Expert Review of Neurotherapeutics

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Recurrent or progressive brain metastases after initial treatment represent a common clinical entity mainly due to increased survival of cancer patients. From the various available treatment modalities, salvage stereotactic radiosurgery seems to be the most commonly used. Many clinical studies of class of evidence III have demonstrated satisfied results concerning the local brain control and survival of patients with relapsing brain disease. Also stereotactic radiosurgery is considered a relatively safe modality with low incidence of brain toxicity side effects. It is obvious that well-designed, randomized, prospective studies are necessary for the evaluation of the stereotactic radiosurgery as salvage treatment and for the establishment of guidelines for the selection of patients most suitable for this treatment option. The increasing number of patients with relapsing brain metastatic disease will act as a pressure to this direction.

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Section: Treatment Options For Newly Diagnosed Brain Metastasessupporting

confidence: 92%

Salvage stereotactic radiosurgery for brain metastases

Klironomos¹,

Bernstein²

2013

Expert Review of Neurotherapeutics

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“…While some degree of local control may be achieved by adding WBRT, this is associated with high morbidity and intracranial recurrences are common. Randomized phase III trials did not show improved overall survival by adding adjuvant WBRT (2, 3) and most patients now undergo SRS directed to the tumor bed, a procedure that was proposed and developed even before these trials were done (4, 5). Although level I evidence for this treatment is lacking, initial data suggest a low toxicity profile (6–8).…”

Section: Introductionmentioning

confidence: 99%

Immunotherapy Combined with Large Fractions of Radiotherapy: Stereotactic Radiosurgery for Brain Metastases—Implications for Intraoperative Radiotherapy after Resection

2017

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Brain metastases (BM) affect approximately a third of all cancer patients with systemic disease. Treatment options include surgery, whole-brain radiotherapy, or stereotactic radiosurgery (SRS) while chemotherapy has only limited activity. In cases where patients undergo resection before irradiation, intraoperative radiotherapy (IORT) to the tumor bed may be an alternative modality, which would eliminate the repopulation of residual tumor cells between surgery and postoperative radiotherapy. Accumulating evidence has shown that high single doses of ionizing radiation can be highly efficient in eliciting a broad spectrum of local, regional, and systemic tumor-directed immune reactions. Furthermore, immune checkpoint blockade (ICB) has proven effective in treating antigenic BM and, thus, combining IORT with ICB might be a promising approach. However, it is not known if a low number of residual tumor cells in the tumor bed after resection is sufficient to act as an immunizing event opening the gate for ICB therapies in the brain. Because immunological data on tumor bed irradiation after resection are lacking, a rationale for combining IORT with ICB must be based on mechanistic insight from experimental models and clinical studies on unresected tumors. The purpose of the present review is to examine the mechanisms by which large radiation doses as applied in SRS and IORT enhance antitumor immune activity. Clinical studies on IORT for brain tumors, and on combined treatment of SRS and ICB for unresected BM, are used to assess the safety, efficacy, and immunogenicity of IORT plus ICB and to suggest an optimal treatment sequence.

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“…Currently, some investigations focus on SRS of the postoperative resection cavity and replacement of WBRT in patients with an oligometastatic disease [45]. Wang et al recently published an approach with hypofractionated SRT (8 Gy in three fractions) for patients with large cerebral resection cavities [51].…”

Section: Metastasesmentioning

confidence: 99%

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

Münter

Welker

Jensen

et al. 2013

Innovative Neurosurgery

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Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are well established in a high number of neurooncological and neurological lesions. Modern technologies discussed in this review, especially the integration of multimodality imaging in the daily clinical routine, will further improve the results of SRS and SRT. Currently, the different technical methods used are comparable regarding the clinical results in different clinical indications. The technological advances allow high treatment flexibility, and therefore, new treatment indications can be established based on the new technologies. In the future, it has to be defined more clearly whether a single fraction, hypofractionated concepts, or fractionated stereotactic radiotherapy is more effective regarding the clinical results and side effects of the therapy. The main area of development for radiosurgery will be stereotactic body radiosurgery. More randomized clinical studies for all possible indications are needed in the next few decades in order to establish radiosurgery more precisely, and also to determine its true value, especially in normal-fractionated radiotherapy. In technological development, the next step has been completed and proton or particle based stereotactic radiosurgery may have increased use in the future.

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Tumor Bed Radiosurgery following Resection of Brain Metastases: A Review

Cited by 19 publications

References 25 publications

Salvage stereotactic radiosurgery for brain metastases

Salvage stereotactic radiosurgery for brain metastases

Immunotherapy Combined with Large Fractions of Radiotherapy: Stereotactic Radiosurgery for Brain Metastases—Implications for Intraoperative Radiotherapy after Resection

Stereotactic radiosurgery (SRS) and stereotactic radiation therapy (SRT) for neurooncological and neurological diseases: state of the art and future perspectives

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