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

被引:39
作者
Quigley, Matthew R. [1 ]
Fuhrer, Russell [1 ]
Karlovits, Stephen [1 ]
Karlovits, Brian [1 ]
Johnson, Mark [1 ]
机构
[1] Allegheny Gen Hosp, Dept Neurosurg, Pittsburgh, PA 15212 USA
关键词
brain metastasis; outcome; radiation; radiosurgery; resection;
D O I
10.1007/s11060-007-9515-z
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Whole brain radiation (WBXRT) reduces the incidence of local and distant recurrence following resection of metastatic brain disease but does not prolong life and may entail neurocognitive decline. We employed a novel treatment modality of providing a single-session stereotactic radiosurgery (SRS) boost to the surgical resection site to achieve local control without the risk of cognitive effects. Methods We reviewed all patients at our institution that were treated with SRS to the post-operative bed following resection of a metastatic brain deposit. Results There were 32 patients identified (16 F) and median age was 60 years. One lesion was resected in all patients of whom 21 were solitary (eight with two lesions, three with three). Median survival was 16.4 months with a 14 month median follow-up. Factors which improved survival were solitary tumor, age < 65 and RPA 1, although none achieved statistical significance. In the Cox multivariate analysis only smaller post-operative treatment volume correlated with survival (P = .04). There were two local recurrences (6.25%) to the surgical site and four patients required SRS for new lesions. Nine patients ultimately required salvage WBXRT (3/21 solitary v. 6/11 multiple lesions, P = .03 chi(2)), two for local recurrence post resection and seven for diffuse new disease. Conclusion The use of SRS to the surgical site results in local recurrence rates comparable to WBXRT and is associated with excellent survival. Over 70% of patients managed this way were spared WBXRT. The presence of multiple lesions on presentation is predictive of the need for subsequent salvage WBXRT.
引用
收藏
页码:327 / 332
页数:6
相关论文
共 17 条
[1]   Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases - A randomized controlled trial [J].
Aoyama, Hidefumi ;
Shirato, Hiroki ;
Tago, Masao ;
Nakagawa, Keiichi ;
Toyoda, Tatsuya ;
Hatano, Kazuo ;
Kenjyo, Masahiro ;
Oya, Natsuo ;
Hirota, Saeko ;
Shioura, Hiroki ;
Kunieda, Etsuo ;
Inomata, Taisuke ;
Hayakawa, Kazushige ;
Katoh, Norio ;
Kobashi, Gen .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 295 (21) :2483-2491
[2]   Surgery versus radiosurgery in the treatment of brain metastasis [J].
Bindal, AK ;
Bindal, RK ;
Hess, KR ;
Shiu, A ;
Hassenbusch, SJ ;
Shi, WM ;
Sawaya, R .
JOURNAL OF NEUROSURGERY, 1996, 84 (05) :748-754
[3]   SURGICAL-TREATMENT OF MULTIPLE BRAIN METASTASES [J].
BINDAL, RK ;
SAWAYA, R ;
LEAVENS, ME ;
LEE, JJ .
JOURNAL OF NEUROSURGERY, 1993, 79 (02) :210-216
[4]   RADIATION-INDUCED DEMENTIA IN PATIENTS CURED OF BRAIN METASTASES [J].
DEANGELIS, LM ;
DELATTRE, JY ;
POSNER, JB .
NEUROLOGY, 1989, 39 (06) :789-796
[5]   Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials [J].
Gaspar, L ;
Scott, C ;
Rotman, M ;
Asbell, S ;
Phillips, T ;
Wasserman, T ;
McKenna, WG ;
Byhardt, R .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1997, 37 (04) :745-751
[6]   Brain metastases treated with radiosurgery alone: An alternative to whole brain radiotherapy? [J].
Hasegawa, T ;
Kondziolka, D ;
Flickinger, JC ;
Germanwala, A ;
Lunsford, LD .
NEUROSURGERY, 2003, 52 (06) :1318-1326
[7]  
KAPLAN I W, 1959, Am J Gastroenterol, V31, P673
[8]   Regression after whole-brain radiation therapy for brain metastases correlates with survival and improved neurocognitive function [J].
Li, Jing ;
Bentzen, Soren M. ;
Renschler, Markus ;
Mehta, Minesh P. .
JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (10) :1260-1266
[9]   Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases [J].
Mehta, MP ;
Rodrigus, P ;
Terhaard, CHJ ;
Rao, A ;
Suh, J ;
Roa, W ;
Soukami, L ;
Bezjak, A ;
Leibenhaut, M ;
Komaki, R ;
Schultz, C ;
Timmerman, R ;
Curran, W ;
Smith, J ;
Phan, SC ;
Miller, RA ;
Renschler, MF .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (13) :2529-2536
[10]  
MEHTA MP, 2002, NEURO-ONCOLOGY, V4, P355