Surgical bed stereotactic radiotherapy of brain metastases: Clinical outcome and predictors of local and distant brain failure

Mousli, A.; Bihin, B.; Gustin, T.; Koerts, G.; Mouchamps, Micheline; Daisne, J. F.

doi:10.1016/j.canrad.2019.12.002

Article (Scientific journals)

Surgical bed stereotactic radiotherapy of brain metastases: Clinical outcome and predictors of local and distant brain failure

Mousli, A.; Bihin, B.; Gustin, T. et al.

2020 • In Cancer Radiotherapie, 24 (4), p. 298-305

Peer Reviewed verified by ORBi

Permalink
https://hdl.handle.net/2268/262348

DOI
10.1016/j.canrad.2019.12.002

PubMed
32173270

Files (1)Send to Details Statistics Bibliography Similar publications

Files

Full Text

1-s2.0-S1278321820300445-main.pdf

Publisher postprint (1.16 MB)

Request a copy

All documents in ORBi are protected by a user license.

Send to

RIS BibTex APA Chicago Permalink X Linkedin

Details

Keywords :

Brain metastases; Local control; Postoperative; Stereotactic radiotherapy; Article; Adult; Aged; Aged, 80 and over; Brain Neoplasms; Cranial Irradiation; Female; Humans; Male; Margins of Excision; Meningeal Neoplasms; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Progression-Free Survival; Radiation Injuries; Radiosurgery; Radiotherapy Dosage; Retrospective Studies; Salvage Therapy; Treatment Outcome; Tumor Burden

Abstract :

[en] Purpose: To retrospectively analyze the outcomes of stereotactic radiotherapy (SRT) targeted at surgical bed of brain metastases (BM) and identify patterns of local/distant brain relapses (LR/DBR). Patients/methods: Seventy patients were treated with SRT between 2008–2017. Marginal dose prescription on the 70% isodose line depended on the maximal diameter of the target volume and range between 15–18 Gy for single fraction radiosurgery and 23.1–26 Gy in 3–5 fractions for fractionated SRT. Results: At 12 months, the overall survival (OS) was 69% [CI 95% = 59%–81%]. At 6 and 12 months, the cumulative incidence functions (CIF) of local relapse were 4% [1%–13%] and 15% [8%–26%], respectively. According to univariate analysis, factors associated with LR were an initial volume larger than 7cc (hazard ratio: 4.6 [1.0–20.8], P = 0.046) and a positive resection margin [hazard ratio: 3.6 [1.1–12.0], P = 0.037. DBR occurred in 54.3% of patients with a median time of 8 months. None of the variables tested (histology, location or number of lesions) were found correlated with the DBR. Leptomeningeal disease occurred in 12.9% of cases. Salvage whole brain radiotherapy (WBRT) was required in 45.7% of patients and delayed by a median time of 9.6 months. Symptomatic radionecrosis (RN) occurred in 7.1%. Conclusions: Adjuvant SRT was an effective and well-tolerated treatment to control the postoperative risk of recurrence of BM without compromising OS. Positive resection margins and large volumes were predictors factor of local relapse. © 2020

Disciplines :

Oncology

Author, co-author :

Mousli, A.; Radiation Oncology, université catholique de Louvain, CHU-UCL-Namur, site Sainte-Elisabeth, Namur, Belgium, Radiation Oncology Department, centre François-Baclesse, Esch-sur-Alzette, Luxembourg

Bihin, B.; Biostatistics Unit, université catholique de Louvain, CHU-UCL-Namur, site Godinne, Yvoir, Belgium

Gustin, T.; Neurosurgery, université catholique de Louvain, CHU-UCL-Namur, site Godinne, Yvoir, Belgium

Koerts, G.; Neurosurgery, centre hospitalier régional Sambre-et-Meuse, Namur, Belgium

Mouchamps, Micheline ; Université de Liège - ULiège

Daisne, J. F.; Radiation Oncology, université catholique de Louvain, CHU-UCL-Namur, site Sainte-Elisabeth, Namur, Belgium, Radiation Oncology Department, Katholieke Universiteit Leuven, Universitaire Ziekehnhuis, Leuven, Belgium

Language :

English

Title :

Surgical bed stereotactic radiotherapy of brain metastases: Clinical outcome and predictors of local and distant brain failure

Alternative titles :

[fr] Radiothérapie stéréotaxique sur les berges opératoires des métastases cérébrales : résultats thérapeutiques et facteurs prédictifs de rechutes cérébrales locales et à distance

Publication date :

2020

Journal title :

Cancer Radiotherapie

ISSN :

1278-3218

eISSN :

1769-6658

Publisher :

Elsevier Masson, France

Volume :

Issue :

Pages :

298-305

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 31 July 2021

Statistics

Number of views

59 (3 by ULiège)

Number of downloads

3 (3 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Patchell, R.A., Tibbs, P.A., Walsh, J.W., Dempsey, R.J., Maruyama, Y., Kryscio, R.J., et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322 (1990), 494–500.
Brown, P.D., Ahluwalia, M.S., Khan, O.H., Asher, A.L., Wefel, J.S., Gondi, V., Whole-brain radiotherapy for brain metastases: evolution or revolution?. J Clin Oncol 36 (2018), 483–491.
Patchell, R.A., Tibbs, P.A., Regine, W.F., Dempsey, R.J., Mohiuddin, M., Kryscio, R.J., et al. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280 (1998), 1485–1489.
Brown, P.D., Ballman, K.V., Cerhan, J.H., Anderson, S.K., Carrero, X.W., Whitton, A.C., et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18 (2017), 1049–1060.
Aoyama, H., Shirato, H., Tago, M., Nakagawa, K., Toyoda, T., Hatano, K., et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA 295 (2006), 2483–2491.
Kocher, M., Soffietti, R., Abacioglu, U., Villà, S., Fauchon, F., Baumert, B.G., et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 29 (2011), 134–141.
Minniti, G., Clarke, E., Lanzetta, G., Osti, M.F., Trasimeni, G., Bozzao, A., et al. Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol, 6, 2011, 48.
Minniti, G., Esposito, V., Clarke, E., Scaringi, C., Lanzetta, G., Salvati, M., et al. Multidose stereotactic radiosurgery (9 Gy × 3) of the postoperative resection cavity for treatment of large brain metastases. Int J Radiat Oncol Biol Phys 86 (2013), 623–629.
Brennan, C., Yang, T.J., Hilden, P., Zhang, Z., Chan, K., Yamada, Y., et al. A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases. Int J Radiat Oncol Biol Phys 88 (2014), 130–136.
Mahajan, A., Ahmed, S., McAleer, M.F., Weinberg, J.S., Li, J., Brown, P., et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18 (2017), 1040–1048.
Kano, H., Kondziolka, D., Lobato-Polo, J., Zorro, O., Flickinger, J.C., Lunsford, L.D., T1/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery 66 (2010), 486–491 [discussion 491-492].
Robbins, J.R., Ryu, S., Kalkanis, S., Cogan, C., Rock, J., Movsas, B., et al. Radiosurgery to the surgical cavity as adjuvant therapy for resected brain metastasis. Neurosurgery 71 (2012), 937–943.
Soltys, S.G., Adler, J.R., Lipani, J.D., Jackson, P.S., Choi, C.Y.H., Puataweepong, P., et al. Stereotactic radiosurgery of the postoperative resection cavity for brain metastases. Int J Radiat Oncol Biol Phys 70 (2008), 187–193.
Gans, J.H., Raper, D.M.S., Shah, A.H., Bregy, A., Heros, D., Lally, B.E., et al. The role of radiosurgery to the tumor bed after resection of brain metastases. Neurosurgery 72 (2013), 317–325 [discussion 325-326].
Eaton, B.R., Gebhardt, B., Prabhu, R., Shu, H.-K., Curran, W.J., Crocker, I., Hypofractionated radiosurgery for intact or resected brain metastases: defining the optimal dose and fractionation. Radiat Oncol, 8, 2013, 135.
Marcrom, S.R., McDonald, A.M., Thompson, J.W., Popple, R.A., Riley, K.O., Markert, J.M., et al. Fractionated stereotactic radiation therapy for intact brain metastases. Adv Radiat Oncol 2 (2017), 564–571.
Wiggenraad, R., Verbeek-de Kanter, A., Kal, H.B., Taphoorn, M., Vissers, T., Struikmans, H., Dose-effect relation in stereotactic radiotherapy for brain metastases. A systematic review. Radiother Oncol J Eur Soc Ther Radiol Oncol 98 (2011), 292–297.
Kirkpatrick, J.P., Soltys, S.G., Lo, S.S., Beal, K., Shrieve, D.C., Brown, P.D., The radiosurgery fractionation quandary: single fraction or hypofractionation?. Neuro-Oncol 19 (2017), 38–49.
Keller, A., Noël, G., Antoni, D., Délinéation du lit opératoire des métastases cérébrales opérées traitées par irradiation en conditions stéréotaxiques adjuvante : revue de la littérature. Cancer Radiother 21 (2017), 804–813.
Doré, M., Martin, S., Delpon, G., Clément, K., Campion, L., Thillays, F., Stereotactic radiotherapy following surgery for brain metastasis: predictive factors for local control and radionecrosis. Cancer Radiother J Soc Francaise Radiother Oncol 21 (2017), 4–9.
Keller, A., Doré, M., Antoni, D., Menoux, I., Thillays, F., Clavier, J.B., et al. Risque de radionécrose après radiothérapie hypofractionnée en conditions stéréotaxiques du lit opératoire de métastases cérébrales. Cancer Radiother 21 (2017), 377–388.
Soliman, H., Ruschin, M., Angelov, L., Brown, P.D., Chiang, V.L.S., Kirkpatrick, J.P., et al. Consensus Contouring Guidelines for Postoperative Completely Resected Cavity Stereotactic Radiosurgery for Brain Metastases. Int J Radiat Oncol Biol Phys 100 (2018), 436–442.
Prabhu, R.S., Patel, K.R., Press, R.H., Soltys, S.G., Brown, P.D., Mehta, M.P., et al. Preoperative vs postoperative radiosurgery for resected brain metastases: a review. Neurosurgery 84 (2019), 19–29.
Patel, K.R., Burri, S.H., Asher, A.L., Crocker, I.R., Fraser, R.W., Zhang, C., et al. Comparing preoperative with postoperative stereotactic radiosurgery for resectable brain metastases: a multi-institutional analysis. Neurosurgery 79 (2016), 279–285.
Herskind, C., Wenz, F., Giordano, F.A., Immunotherapy combined with large fractions of radiotherapy: stereotactic radiosurgery for brain metastases-implications for intraoperative radiotherapy after resection. Front Oncol, 7, 2017, 147.
Welsh, J.W., Komaki, R., Amini, A., Munsell, M.F., Unger, W., Allen, P.K., et al. trial of erlotinib plus concurrent whole-brain radiation therapy for patients with brain metastases from non-small-cell lung cancer. J Clin Oncol 31 (2013), 895–902.
Tawbi, H.A., Forsyth, P.A., Algazi, A., Hamid, O., Hodi, F.S., Moschos, S.J., et al. Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med 379 (2018), 722–730.
Long, G.V., Atkinson, V., Menzies, A.M., Lo, S., Guminski, A.D., Brown, M.P., et al. A randomized phase II study of nivolumab or nivolumab combined with ipilimumab in patients (pts) with melanoma brain metastases (mets): The Anti-PD1 Brain Collaboration (ABC). J Clin Oncol, 35, 2017, 9508.
Magnuson, W.J., Yeung, J.T., Guillod, P.D., Gettinger, S.N., Yu, J.B., Chiang, V.L., Impact of deferring radiation therapy in patients with epidermal growth factor receptor-mutant non-small cell lung cancer who develop brain metastases. Int J Radiat Oncol Biol Phys 95 (2016), 673–679.
Chen, L., Douglass, J., Walker, A.J., Marciscano, A.E., Lim, M., Kleinberg, L.R., et al. Concurrent immunotherapy and stereotactic radiosurgery for brain metastases is associated with a decreased incidence of new intracranial metastases. Int J Radiat Oncol Biol Phys, 93, 2015, E102.