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Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis.

Shin SM, Vatner RE, Tam M, Golfinos JG, Narayana A, Kondziolka D, Silverman JS - Front Oncol (2015)

Bottom Line: No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis.Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM.Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.

ABSTRACT

Introduction: We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM).

Materials and methods: All patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed.

Results: Median follow-up was 19.1 months. Fifty-six patients were treated with a median dose of 40.05 Gy/15 fractions with IFRT to the resection cavity. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis.

Conclusion: Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.

No MeSH data available.


Related in: MedlinePlus

Treatment planning following GTR of single BM. (A) Pre-operative MRI (T1 post). (B) Post-operative MRI fused with planning CT for treatment planning (magenta = CTV, yellow = 100% isodose line, green = 95% isodose line, blue = 90% isodose line).
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Figure 1: Treatment planning following GTR of single BM. (A) Pre-operative MRI (T1 post). (B) Post-operative MRI fused with planning CT for treatment planning (magenta = CTV, yellow = 100% isodose line, green = 95% isodose line, blue = 90% isodose line).

Mentions: Median time to start radiotherapy following surgery was 29 days (range, 4–107 days). Surgical cavity volume was contoured as a CTV using CT simulation image registered with post-operative MRI. The median volume of the post-operative cavity in all patients was 15 cm3 (range, 3.8–93.3 cm3). Patients were treated with radiotherapy to a median dose of 40.05 Gy/15 daily fractions over 3 weeks at 2.67 Gy per fraction (range, 30–40.05 Gy in 10–15 fractions) (Figure 1). The majority (51/56) were treated to 40.05 Gy/15 fractions.


Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis.

Shin SM, Vatner RE, Tam M, Golfinos JG, Narayana A, Kondziolka D, Silverman JS - Front Oncol (2015)

Treatment planning following GTR of single BM. (A) Pre-operative MRI (T1 post). (B) Post-operative MRI fused with planning CT for treatment planning (magenta = CTV, yellow = 100% isodose line, green = 95% isodose line, blue = 90% isodose line).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4585114&req=5

Figure 1: Treatment planning following GTR of single BM. (A) Pre-operative MRI (T1 post). (B) Post-operative MRI fused with planning CT for treatment planning (magenta = CTV, yellow = 100% isodose line, green = 95% isodose line, blue = 90% isodose line).
Mentions: Median time to start radiotherapy following surgery was 29 days (range, 4–107 days). Surgical cavity volume was contoured as a CTV using CT simulation image registered with post-operative MRI. The median volume of the post-operative cavity in all patients was 15 cm3 (range, 3.8–93.3 cm3). Patients were treated with radiotherapy to a median dose of 40.05 Gy/15 daily fractions over 3 weeks at 2.67 Gy per fraction (range, 30–40.05 Gy in 10–15 fractions) (Figure 1). The majority (51/56) were treated to 40.05 Gy/15 fractions.

Bottom Line: No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis.Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM.Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.

ABSTRACT

Introduction: We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM).

Materials and methods: All patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed.

Results: Median follow-up was 19.1 months. Fifty-six patients were treated with a median dose of 40.05 Gy/15 fractions with IFRT to the resection cavity. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis.

Conclusion: Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.

No MeSH data available.


Related in: MedlinePlus