Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases
Abstract Background While the optimal combination of whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgical resection in the treatment of brain metastases, is controversial, the addition of SRS to surgical resction of solitary metastasis may enhance local control while potenti...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-10-01
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| Series: | Chinese Neurosurgical Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41016-017-0092-5 |
| _version_ | 1817999655068237824 |
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| author | Hamidreza Aliabadi Arian M. Nikpour David S. Yoo James E. Herndon John H. Sampson John P. Kirkpatrick |
| author_facet | Hamidreza Aliabadi Arian M. Nikpour David S. Yoo James E. Herndon John H. Sampson John P. Kirkpatrick |
| author_sort | Hamidreza Aliabadi |
| collection | DOAJ |
| description | Abstract Background While the optimal combination of whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgical resection in the treatment of brain metastases, is controversial, the addition of SRS to surgical resction of solitary metastasis may enhance local control while potentially minimizing toxicity associated with adjuvant WBRT. This study seeks to determine whether pre-operative SRS to the lesion versus post-operative SRS to the resection bed may reduce irradiation of adjacent normal brain tissue. Methods A retrospective study of 12 patients with 13 surgically resected cerebral metastases was performed. The pre-operative contrast-enhancing tumors and post-operative resection cavities plus any enhancing residual disease were contoured to yield the gross target volume (GTV). In turn these GTV’s were uniformly expanded by 3-mm to generate the pre-operative, as well as post-operative planning target volume (PTV.) For each lesion, a 7-static-conformal-beam, non-coplanar plan utilizing 6 MV photons was generated to encompass the PTV within the 85% isodose line. Excess normal brain volume irradiated was defined as the volume outside the GTV receiving the prescribed dose. Results When lesions were divided into two groups - Group A (pre-operative GTV’s < 15 cc, n = 9) and Group B (pre-operative GTV’s > 15 cc, n = 4) - the average volume of normal brain irradiated was significantly smaller if pre-operative SRS was used for treatment of lesions in Group A (9.5 vs. 16.8 cc, paired t-test, p = 0.0045). In contrast, this volume was smaller for Group B lesions if post-operative SRS was used for treatment of these lesions (27.6 vs. 51.2 cc, p = 0.252). A comparison of groups with respect to mean volume differences between pre- and post-operative SRS was significantly different (two-sample t-test p = 0.016). GTV and the difference between pre- and post-operative volume were highly correlated (Pearson correlation = −0.875, p < 0.0001). Conclusions Pre-operative treatment of smaller metastases may result in reduced radiation dose to normal tissue and, thus, reduced treatment-related morbidity compared to post-operative irradiation of the resection cavity. |
| first_indexed | 2024-04-14T03:11:36Z |
| format | Article |
| id | doaj.art-68a75a9b20bd46ef8a4692e5b4c6ba9c |
| institution | Directory Open Access Journal |
| issn | 2057-4967 |
| language | English |
| last_indexed | 2024-04-14T03:11:36Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Chinese Neurosurgical Journal |
| spelling | doaj.art-68a75a9b20bd46ef8a4692e5b4c6ba9c2022-12-22T02:15:35ZengBMCChinese Neurosurgical Journal2057-49672017-10-01311810.1186/s41016-017-0092-5Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastasesHamidreza Aliabadi0Arian M. Nikpour1David S. Yoo2James E. Herndon3John H. Sampson4John P. Kirkpatrick5Spine and Neurosurgery AssociatesDepartment of Radiology, UC Davis Medical Center, UC Davis School of MedicineDepartment of Radiation Oncology, Duke University Medical CenterDepartment of Biostatistics and Bioinformatics, Duke University Medical CenterDepartment of Surgery, Division of Neurosurgery, Duke University Medical CenterDepartment of Radiation Oncology, Duke University Medical CenterAbstract Background While the optimal combination of whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgical resection in the treatment of brain metastases, is controversial, the addition of SRS to surgical resction of solitary metastasis may enhance local control while potentially minimizing toxicity associated with adjuvant WBRT. This study seeks to determine whether pre-operative SRS to the lesion versus post-operative SRS to the resection bed may reduce irradiation of adjacent normal brain tissue. Methods A retrospective study of 12 patients with 13 surgically resected cerebral metastases was performed. The pre-operative contrast-enhancing tumors and post-operative resection cavities plus any enhancing residual disease were contoured to yield the gross target volume (GTV). In turn these GTV’s were uniformly expanded by 3-mm to generate the pre-operative, as well as post-operative planning target volume (PTV.) For each lesion, a 7-static-conformal-beam, non-coplanar plan utilizing 6 MV photons was generated to encompass the PTV within the 85% isodose line. Excess normal brain volume irradiated was defined as the volume outside the GTV receiving the prescribed dose. Results When lesions were divided into two groups - Group A (pre-operative GTV’s < 15 cc, n = 9) and Group B (pre-operative GTV’s > 15 cc, n = 4) - the average volume of normal brain irradiated was significantly smaller if pre-operative SRS was used for treatment of lesions in Group A (9.5 vs. 16.8 cc, paired t-test, p = 0.0045). In contrast, this volume was smaller for Group B lesions if post-operative SRS was used for treatment of these lesions (27.6 vs. 51.2 cc, p = 0.252). A comparison of groups with respect to mean volume differences between pre- and post-operative SRS was significantly different (two-sample t-test p = 0.016). GTV and the difference between pre- and post-operative volume were highly correlated (Pearson correlation = −0.875, p < 0.0001). Conclusions Pre-operative treatment of smaller metastases may result in reduced radiation dose to normal tissue and, thus, reduced treatment-related morbidity compared to post-operative irradiation of the resection cavity.http://link.springer.com/article/10.1186/s41016-017-0092-5Stereotactic radiosurgeryBrain metastasesPre-operativeSolitary brain metastases |
| spellingShingle | Hamidreza Aliabadi Arian M. Nikpour David S. Yoo James E. Herndon John H. Sampson John P. Kirkpatrick Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases Chinese Neurosurgical Journal Stereotactic radiosurgery Brain metastases Pre-operative Solitary brain metastases |
| title | Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases |
| title_full | Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases |
| title_fullStr | Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases |
| title_full_unstemmed | Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases |
| title_short | Pre-operative stereotactic radiosurgery treatment is preferred to post-operative treatment for smaller solitary brain metastases |
| title_sort | pre operative stereotactic radiosurgery treatment is preferred to post operative treatment for smaller solitary brain metastases |
| topic | Stereotactic radiosurgery Brain metastases Pre-operative Solitary brain metastases |
| url | http://link.springer.com/article/10.1186/s41016-017-0092-5 |
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