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

• DOI: 10.1016/j.ijrobp.2013.03.037
• Publication Date: 2013-05-15T02:39:34Z
• Authors: Giuseppe Minniti; Vincenzo Esposito; Enrico Clarke; Claudia Scaringi; Gaetano Lanzetta; Maurizio Salvati; Antonino Raco; Alessandro Bozzao; Riccardo Maurizi ...
• Keywords: adverse effects/methods; aged; brain; brain neoplasms; breast neoplasms; carcinoma; colonic neoplasms; e aged; female; humans; kidney neoplasms; local; lung neoplasms; male; melanoma; methods; mortality/pathology/secondary/surgery; neoplasm recurrence; non-small-cell lung; pathology; pathology/radiation effects; postoperative care; radiation injuries; radiosurgery; renal cell; salvage therapy; tumor burden; Male; Lung Neoplasms; 610; Breast Neoplasms; Radiosurgery; 03 medical and health sciences; 0302 clinical medicine; Carcinoma, Non-Small-Cell Lung; Humans; Radiation Injuries; Carcinoma, Renal Cell; Melanoma; Aged; Postoperative Care; Salvage Therapy; Brain Neoplasms; Brain; Settore MEDS-15/A - Neurochirurgia; Middle Aged; Kidney Neoplasms; Tumor Burden; 3. Good health; Colonic Neoplasms; Female; Neoplasm Recurrence, Local

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 cm(3) (range, 12.6-35.7 cm(3)). 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.