Skip Navigation LinksHome > November 2012 - Volume 71 - Issue 5 > Radiosurgery to the Surgical Cavity as Adjuvant Therapy for...
Neurosurgery:
doi: 10.1227/NEU.0b013e31826909f2
Research-Human-Clinical Studies

Radiosurgery to the Surgical Cavity as Adjuvant Therapy for Resected Brain Metastasis

Robbins, Jared R. MD*; Ryu, Samuel MD*,‡; Kalkanis, Steven MD; Cogan, Chad MS§; Rock, Jack MD; Movsas, Benjamin MD*; Kim, Jae Ho MD*; Rosenblum, Mark MD

SANS CME
CNS University of Neurosurgery
Collapse Box

Abstract

BACKGROUND: The standard treatment of resected brain metastasis is whole-brain radiotherapy (WBRT). To avoid the potential toxicity of WBRT and to improve local control, we have used radiosurgery alone to the surgical cavity.

OBJECTIVE: To demonstrate the rates of local control, new intracranial metastasis, and overall survival using this treatment scheme without WBRT.

METHODS: Eighty-five consecutive patients with brain metastasis were treated with surgical resection of at least 1 lesion followed by radiosurgery alone to the surgical cavity and any unresected lesions from August 2000 to March 2011. Sixty-eight percent had gross total resections. After surgery, radiosurgery was delivered to the surgical cavity with a 2- to 3-mm margin. The median marginal radiosurgery dose was 16 Gy, and median target volume was 13.96 cm3. Follow-up imaging and clinical examination were obtained every 2 to 3 months.

RESULTS: Median follow-up time was 11.2 months. Overall local control was 81.2%. The 6-month, 1-year, and 2-year rates of local control were 88.7%, 81.4%, and 75.7%, respectively. Forty-seven patients (55%) developed new intracranial metastases at a median time of 5.6 months. For the entire population, the rate of new metastases was 32.1%, 58.1%, and 62.9% at 6 months, 1 year, and 2 years, respectively. Median overall survival time was 12.1 months. From initial treatment until death or last follow-up, only 30 patients (35%) received WBRT as salvage treatment.

CONCLUSION: Radiosurgery to the surgical cavity without WBRT achieved excellent local control of resected brain metastasis. Close imaging follow-up allows early intervention for any new metastasis.

ABBREVIATIONS: GTR, gross total resection

SRS, stereotactic radiosurgery

WBRT, whole-brain radiation therapy

Copyright © by the Congress of Neurological Surgeons

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.