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Fractionated stereotactic radiotherapy for local control of resected brain metastases

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Postoperative stereotactic radiosurgery (SRS) has been shown to establish local control in patients with resected brain metastases, yet its efficacy may be limited, particularly for resected lesions with large post-operative resection cavities. We describe the efficacy of postoperative fractionated stereotactic radiotherapy (FSRT) for local control in patients who have undergone resection for brain metastases.

Methods

In this retrospective cohort study, we analyzed patients who received FSRT for resected brain metastases in 3 or 5 fractions. Time to local recurrence was the primary endpoint in this study.

Results

Sixty-seven patients (n = 29 female, n = 38 male) met study criteria for review. The median age of the cohort was 62 years (range 18–79 years). Median preoperative tumor volume was 11.1 cm3 (range 0.4–77.0 cm3). The rate of local control was 91.0% at 6 months, 85.1% at 12 months, and 85.1% at 18 months. Estimates of freedom from local recurrence at 6 and 12 months were 90.9% and 84.3%, respectively. Higher biologically equivalent doses (BED10) were found to be predictive of longer freedom from local recurrence on univariate and multivariable analysis. Larger cavity volumes were found to correspond to longer time to local recurrence on univariate and multivariable analysis.

Conclusion

Our results suggest that postoperative FSRT may be an effective method for providing local control to the surgical bed in patients with resected brain metastases, particularly for larger tumors not amenable to conventional, single-fraction SRS. Additional prospective studies are needed to confirm these findings.

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Abbreviations

WBRT:

Whole-brain radiotherapy

SRS:

Stereotactic radiosurgery

FSRT:

Fractionated stereotactic radiotherapy

MRI:

Magnetic resonance imaging

CT:

Computed tomography

KPS:

Karnofsky performance score

GPA:

Graded prognostic assessment

IRB:

Institutional review board

OS:

Overall survival

T1C+:

T1-weighted post-contrast

BED10 :

Biologically effective dose

EQD2:

equivalent dose in 2 Gy

NSCLC:

Non-small cell lung cancer

CI:

Confidence interval

HR:

Hazard ratio

IORT:

Intraoperative radiotherapy

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Author notes

  1. Jeffrey I. Traylor and Ahmed Habib have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey I. Traylor, Ahmed Habib, Rajan Patel, Matthew Muir, Ron Gadot & Ganesh Rao

  2. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tina Briere

  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Debra N. Yeboa & Jing Li

  4. Department of of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 853, Houston, TX, 77030-4009, USA

    Ganesh Rao

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  1. Jeffrey I. Traylor
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Correspondence to Ganesh Rao.

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Traylor, J.I., Habib, A., Patel, R. et al. Fractionated stereotactic radiotherapy for local control of resected brain metastases. J Neurooncol 144, 343–350 (2019). https://doi.org/10.1007/s11060-019-03233-9

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