Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience
Abstract Background The standard therapy for brain metastasis was surgery combined with whole brain radiotherapy (WBRT). The latter is however, associated with important neurocognitive toxicity. To reduce this toxicity, postoperative stereotactic radiosurgery (SRS) is a promising technique. We asses...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-022-02118-y |
| _version_ | 1828108719571861504 |
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| author | Marie Cantaloube Mohamed Boucekine Anne Balossier Xavier Muracciole Mickael Meyer Christine Delsanti Romain Carron Yassine Mohamed Beltaifa Domnique Figarella-Branger Jean Regis Laetitia Padovani |
| author_facet | Marie Cantaloube Mohamed Boucekine Anne Balossier Xavier Muracciole Mickael Meyer Christine Delsanti Romain Carron Yassine Mohamed Beltaifa Domnique Figarella-Branger Jean Regis Laetitia Padovani |
| author_sort | Marie Cantaloube |
| collection | DOAJ |
| description | Abstract Background The standard therapy for brain metastasis was surgery combined with whole brain radiotherapy (WBRT). The latter is however, associated with important neurocognitive toxicity. To reduce this toxicity, postoperative stereotactic radiosurgery (SRS) is a promising technique. We assessed the efficacy and the tolerance to postoperative Gamma Knife radiosurgery (GK) on the tumor bed after resection of brain metastases. Methods Between February 2011 and December 2016, following macroscopic complete surgical resection, 64 patients and 65 surgical cavities were treated by GK in our institution. The indication for adjuvant radiosurgery was a multidisciplinary decision. The main assessment criteria considered in this study were local control, intracranial metastasis-free survival (ICMFS), overall survival and toxicity. Results Median follow-up: 11.1 months. Median time between surgery and radiosurgery: 35 days. Median dose was 20 Gy prescribed to the 50% isodose line, for a median treated volume of 5.6 cc. Four patients (7%) suffered from local recurrence. Local recurrence-free, intracranial recurrence-free and overall survival at 1 year were 97.5%, 57.6% and 62.4% respectively. In total, 23 patients (41%) suffered from intracranial recurrence outside the tumor bed. In univariate analysis: concomitant GK treatment of multiple lesions and the tumor bed was associated with a decrease in ICMFS (HR = 1.16 [1.005–1.34] p = 0.04). In multivariate analysis: a non-lung primary tumor was significantly associated with a decrease in ICMFS (HR = 8.04 [1.82–35.4] p = 0.006). An increase in performance status (PS) and in the initial number of cerebral metastases significantly reduced overall survival (HR = 5.4 [1.11–26.3] p = 0.037, HR = 2.7 [1.004–7.36] p = 0.049, respectively) and One radiation necrosis histologically proven. Conclusion Our study confirmed that postoperative GK after resection of cerebral metastases is an efficient and well-tolerated technique, to treat volumes of all sizes (0.8 to 40 cc). Iterative SRS or salvage WBRT can be performed in cases of intracranial relapse, postponing WBRT with its potential side effects. |
| first_indexed | 2024-04-11T10:51:16Z |
| format | Article |
| id | doaj.art-a07887eb7d524a7bb78ba2fdbdc9d497 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-11T10:51:16Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-a07887eb7d524a7bb78ba2fdbdc9d4972022-12-22T04:28:55ZengBMCRadiation Oncology1748-717X2022-09-0117111110.1186/s13014-022-02118-yStereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experienceMarie Cantaloube0Mohamed Boucekine1Anne Balossier2Xavier Muracciole3Mickael Meyer4Christine Delsanti5Romain Carron6Yassine Mohamed Beltaifa7Domnique Figarella-Branger8Jean Regis9Laetitia Padovani10Radiotherapy Department, Assistance Publique Des Hôpitaux de MarseilleUnity of Research EA3279, Aix-Marseille UniversitéDepartment of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University HospitalRadiotherapy Department, Assistance Publique Des Hôpitaux de MarseilleDepartment of Neurosurgery, Hôpital de La Timone, Assistance Publique-Hôpitaux de MarseilleDepartment of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University HospitalDepartment of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University HospitalDepartment of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University HospitalNeuropathology Department, Assistance Publique Des Hôpitaux de MarseilleDepartment of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University HospitalRadiotherapy Department, Assistance Publique Des Hôpitaux de MarseilleAbstract Background The standard therapy for brain metastasis was surgery combined with whole brain radiotherapy (WBRT). The latter is however, associated with important neurocognitive toxicity. To reduce this toxicity, postoperative stereotactic radiosurgery (SRS) is a promising technique. We assessed the efficacy and the tolerance to postoperative Gamma Knife radiosurgery (GK) on the tumor bed after resection of brain metastases. Methods Between February 2011 and December 2016, following macroscopic complete surgical resection, 64 patients and 65 surgical cavities were treated by GK in our institution. The indication for adjuvant radiosurgery was a multidisciplinary decision. The main assessment criteria considered in this study were local control, intracranial metastasis-free survival (ICMFS), overall survival and toxicity. Results Median follow-up: 11.1 months. Median time between surgery and radiosurgery: 35 days. Median dose was 20 Gy prescribed to the 50% isodose line, for a median treated volume of 5.6 cc. Four patients (7%) suffered from local recurrence. Local recurrence-free, intracranial recurrence-free and overall survival at 1 year were 97.5%, 57.6% and 62.4% respectively. In total, 23 patients (41%) suffered from intracranial recurrence outside the tumor bed. In univariate analysis: concomitant GK treatment of multiple lesions and the tumor bed was associated with a decrease in ICMFS (HR = 1.16 [1.005–1.34] p = 0.04). In multivariate analysis: a non-lung primary tumor was significantly associated with a decrease in ICMFS (HR = 8.04 [1.82–35.4] p = 0.006). An increase in performance status (PS) and in the initial number of cerebral metastases significantly reduced overall survival (HR = 5.4 [1.11–26.3] p = 0.037, HR = 2.7 [1.004–7.36] p = 0.049, respectively) and One radiation necrosis histologically proven. Conclusion Our study confirmed that postoperative GK after resection of cerebral metastases is an efficient and well-tolerated technique, to treat volumes of all sizes (0.8 to 40 cc). Iterative SRS or salvage WBRT can be performed in cases of intracranial relapse, postponing WBRT with its potential side effects.https://doi.org/10.1186/s13014-022-02118-yBrain metastasisRadiosurgeryGamma KnifeResectionTumor bed |
| spellingShingle | Marie Cantaloube Mohamed Boucekine Anne Balossier Xavier Muracciole Mickael Meyer Christine Delsanti Romain Carron Yassine Mohamed Beltaifa Domnique Figarella-Branger Jean Regis Laetitia Padovani Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience Radiation Oncology Brain metastasis Radiosurgery Gamma Knife Resection Tumor bed |
| title | Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience |
| title_full | Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience |
| title_fullStr | Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience |
| title_full_unstemmed | Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience |
| title_short | Stereotactic radiosurgery for post operative brain metastasic surgical cavities: a single institution experience |
| title_sort | stereotactic radiosurgery for post operative brain metastasic surgical cavities a single institution experience |
| topic | Brain metastasis Radiosurgery Gamma Knife Resection Tumor bed |
| url | https://doi.org/10.1186/s13014-022-02118-y |
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