Multidose Stereotactic Radiosurgery (9 Gy × 3) of the Postoperative Resection Cavity for Treatment of Large Brain Metastases

• Published in: International journal of radiation oncology, biology, physics Vol. 86; no. 4; pp. 623 - 629
• Main Authors: Minniti, Giuseppe, Esposito, Vincenzo, Clarke, Enrico, Scaringi, Claudia, Lanzetta, Gaetano, Salvati, Maurizio, Raco, Antonino, Bozzao, Alessandro, Maurizi Enrici, Riccardo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2013
• Subjects: Aged; BRAIN; Brain - pathology; Brain - radiation effects; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Breast Neoplasms - pathology; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Colonic Neoplasms - pathology; Female; Hematology, Oncology and Palliative Medicine; HISTOLOGY; Humans; Kidney Neoplasms - pathology; KIDNEYS; LINEAR ACCELERATORS; Lung Neoplasms - pathology; LUNGS; Male; MAMMARY GLANDS; Melanoma - mortality; Melanoma - pathology; Melanoma - secondary; Melanoma - surgery; MELANOMAS; METASTASES; Middle Aged; Neoplasm Recurrence, Local - pathology; PATIENTS; Postoperative Care; Radiation Injuries - pathology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - adverse effects; Radiosurgery - methods; RADIOTHERAPY; Salvage Therapy - methods; SURGERY; TOXICITY; Tumor Burden
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2013.03.037

To evaluate the clinical outcomes with linear accelerator-based multidose stereotactic radiosurgery (SRS) to large postoperative resection cavities in patients with large brain metastases. Between March 2005 to May 2012, 101 patients with a single brain metastasis were treated with surgery and multidose SRS (9 Gy × 3) for large resection cavities (>3 cm). The target volume was the resection cavity with the inclusion of a 2-mm margin. The median cavity volume was 17.5 cm3 (range, 12.6-35.7 cm3). The primary endpoint was local control. Secondary endpoints were survival and distant failure rates, cause of death, performance measurements, and toxicity of treatment. With a median follow-up of 16 months (range, 6-44 months), the 1-year and 2-year actuarial survival rates were 69% and 34%, respectively. The 1-year and 2-year local control rates were 93% and 84%, with respective incidences of new distant brain metastases of 50% and 66%. Local control was similar for radiosensitive (non-small cell lung cancer and breast cancer) and radioresistant (melanoma and renal cell cancer) brain metastases. On multivariate Cox analysis stable extracranial disease, breast cancer histology, and Karnofsky performance status >70 were associated with significant survival benefit. Brain radionecrosis occurred in 9 patients (9%), being symptomatic in 5 patients (5%). Adjuvant multidose SRS to resection cavity represents an effective treatment option that achieves excellent local control and defers the use of whole-brain radiation therapy in selected patients with large brain metastases.