Patterns of Failure after Stereotactic Radiosurgery of the Resection Cavity Following Surgical Removal of Brain Metastases

详细信息    查看全文

• 作者：Ido Strauss¹ ; ² ; Benjamin W. Corn³ ; Vibhor Krishna⁴ ; Tal Shahar¹ ; ² ; Diana Matceyevsky³ ; Elijahu Gez³ ; Natan Shtraus³ ; Zvi Ram¹ ; Andrew A. Kanner¹ ; ² ; ^{andrewk@tlvmc.gov.il" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Brain metastases ; Failure ; Post-resection ; Stereotactic radiosurgery
• 刊名：World Neurosurgery
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：84
• 期：6
• 页码：1825-1831
• 全文大小：1674 K

文摘

Whole brain radiation treatment (WBRT) is considered standard treatment for BM. However, exposing large volumes of normal brain tissue to irradiation can cause neurotoxicity. This study describes our experience with 100 consecutive patients with brain metastases who were managed with surgical extirpation followed by stereotactic radiosurgery (SRS) to the resection cavity.

Methods

Patients with 1–3 brain metastases (BM), who underwent resection of 1–2 BM between June 2005 and December 2013, were treated with SRS directed to the tumor cavity and for any synchronous BM. Local and distant treatment failures were determined based on neuroimaging. Kaplan–Meier curves were generated for local and distant failure rates and overall survival.

Results

One hundred and two resection cavities were treated with SRS in 100 consecutive patients. Thirty-two additional synchronous metastases were treated in 27 patients during the same session. The median overall survival was 18.9 months. Local control rate at 1 year was 84%. Longer delays between surgery and SRS were associated with increased risk of local failure (hazard ratio, −1.46; P = 0.02). Distant progression occurred in 44% of the patients at a mean of 8.8 ± 6.6 months after SRS treatment. Ten cases of leptomeningeal spread occurred around the resection cavities (9.8%). Central nervous system failure was not significantly associated with survival. Multivariate Cox regression analysis showed that recursive partitioning analysis and active systemic disease were significantly associated with survival.

Conclusion

The strategy described provides acceptable local disease control when compared with WBRT following surgery. This approach can delay and even annul WBRT in the majority of selected BM patients, especially recursive partitioning analysis class I patients. SRS should be scheduled as soon as possible after surgery.