Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases
Background: The standard treatment for patients with large brain metastases and limited intracranial disease is surgical resection and post-operative stereotactic radiosurgery (SRS). However, post-operative SRS still has elevated rates of local failure (LF) and is complicated by radiation necrosis (...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630822001033 |
| _version_ | 1811298098785288192 |
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| author | Haley K. Perlow Cindy Ho Jennifer K. Matsui Rahul N. Prasad Brett G. Klamer Joshua Wang Mark Damante Rituraj Upadhyay Evan Thomas Dukagjin M. Blakaj Sasha Beyer Russell Lonser Douglas Hardesty Raju R. Raval Roshan Prabhu James B. Elder Joshua D. Palmer |
| author_facet | Haley K. Perlow Cindy Ho Jennifer K. Matsui Rahul N. Prasad Brett G. Klamer Joshua Wang Mark Damante Rituraj Upadhyay Evan Thomas Dukagjin M. Blakaj Sasha Beyer Russell Lonser Douglas Hardesty Raju R. Raval Roshan Prabhu James B. Elder Joshua D. Palmer |
| author_sort | Haley K. Perlow |
| collection | DOAJ |
| description | Background: The standard treatment for patients with large brain metastases and limited intracranial disease is surgical resection and post-operative stereotactic radiosurgery (SRS). However, post-operative SRS still has elevated rates of local failure (LF) and is complicated by radiation necrosis (RN), and meningeal disease (MD). Pre-operative SRS may reduce the risk of RN and MD, while fractionated therapy may improve local control through delivering a higher biological effective dose. We hypothesize that pre-operative fractionated stereotactic radiation therapy (FSRT) will have less toxicity compared to patients who receive post-operative SRS or FSRT. Methods: A multi-institutional analysis was conducted and included patients who had surgical resection and stereotactic radiation therapy to treat at least one brain metastasis. Pertinent demographic, clinical, radiation, surgical, and follow up data were collected for each patient. The primary outcome was a composite endpoint defined as patients with one of the following adverse events: 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. Results: 279 patients were eligible for analysis. The median follow-up time was 9 months. 87 % of patients received fractionated treatment. 29 % of patients received pre-operative treatment. The composite endpoint incidences for post-operative SRS (n = 10), post-operative FSRT (n = 189), pre-operative SRS (n = 27), and pre-operative FSRT (n = 53) were 0 %, 17 %, 15 %, and 7.5 %, respectively. Conclusions: In our study, the composite endpoint of 7.5% for pre-operative FSRT compares favorably to our post-operative FSRT rate of 17%. Pre-operative FSRT was observed to have low rates of LF, MD, and RN. Prospective validation is needed. |
| first_indexed | 2024-04-13T06:13:32Z |
| format | Article |
| id | doaj.art-8dd01a05f784466ba9c754abee10ed46 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-13T06:13:32Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-8dd01a05f784466ba9c754abee10ed462022-12-22T02:58:55ZengElsevierClinical and Translational Radiation Oncology2405-63082023-01-0138117122Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastasesHaley K. Perlow0Cindy Ho1Jennifer K. Matsui2Rahul N. Prasad3Brett G. Klamer4Joshua Wang5Mark Damante6Rituraj Upadhyay7Evan Thomas8Dukagjin M. Blakaj9Sasha Beyer10Russell Lonser11Douglas Hardesty12Raju R. Raval13Roshan Prabhu14James B. Elder15Joshua D. Palmer16Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USAOhio State University School of Medicine, Columbus, OH, USAOhio State University School of Medicine, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USACenter for Biostatistics, The Ohio State University, Columbus, OH, USADepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USALevine Cancer Institute, Atrium Health, Charlotte, NC, USA; Southeast Radiation Oncology Group, Charlotte, NC, USADepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Corresponding author at: 460 W. 10th Avenue, Columbus, OH 43210, USA.Background: The standard treatment for patients with large brain metastases and limited intracranial disease is surgical resection and post-operative stereotactic radiosurgery (SRS). However, post-operative SRS still has elevated rates of local failure (LF) and is complicated by radiation necrosis (RN), and meningeal disease (MD). Pre-operative SRS may reduce the risk of RN and MD, while fractionated therapy may improve local control through delivering a higher biological effective dose. We hypothesize that pre-operative fractionated stereotactic radiation therapy (FSRT) will have less toxicity compared to patients who receive post-operative SRS or FSRT. Methods: A multi-institutional analysis was conducted and included patients who had surgical resection and stereotactic radiation therapy to treat at least one brain metastasis. Pertinent demographic, clinical, radiation, surgical, and follow up data were collected for each patient. The primary outcome was a composite endpoint defined as patients with one of the following adverse events: 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. Results: 279 patients were eligible for analysis. The median follow-up time was 9 months. 87 % of patients received fractionated treatment. 29 % of patients received pre-operative treatment. The composite endpoint incidences for post-operative SRS (n = 10), post-operative FSRT (n = 189), pre-operative SRS (n = 27), and pre-operative FSRT (n = 53) were 0 %, 17 %, 15 %, and 7.5 %, respectively. Conclusions: In our study, the composite endpoint of 7.5% for pre-operative FSRT compares favorably to our post-operative FSRT rate of 17%. Pre-operative FSRT was observed to have low rates of LF, MD, and RN. Prospective validation is needed.http://www.sciencedirect.com/science/article/pii/S2405630822001033Brain metastasesRadionecrosisLeptomeningeal diseasePre-operativeRadiotherapy |
| spellingShingle | Haley K. Perlow Cindy Ho Jennifer K. Matsui Rahul N. Prasad Brett G. Klamer Joshua Wang Mark Damante Rituraj Upadhyay Evan Thomas Dukagjin M. Blakaj Sasha Beyer Russell Lonser Douglas Hardesty Raju R. Raval Roshan Prabhu James B. Elder Joshua D. Palmer Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases Clinical and Translational Radiation Oncology Brain metastases Radionecrosis Leptomeningeal disease Pre-operative Radiotherapy |
| title | Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases |
| title_full | Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases |
| title_fullStr | Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases |
| title_full_unstemmed | Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases |
| title_short | Comparing pre-operative versus post-operative single and multi-fraction stereotactic radiotherapy for patients with resectable brain metastases |
| title_sort | comparing pre operative versus post operative single and multi fraction stereotactic radiotherapy for patients with resectable brain metastases |
| topic | Brain metastases Radionecrosis Leptomeningeal disease Pre-operative Radiotherapy |
| url | http://www.sciencedirect.com/science/article/pii/S2405630822001033 |
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