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A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence.

Publication ,  Journal Article
Asher, AL; Burri, SH; Wiggins, WF; Kelly, RP; Boltes, MO; Mehrlich, M; Norton, HJ; Fraser, RW
Published in: Int J Radiat Oncol Biol Phys
March 15, 2014

PURPOSE: Resected brain metastases (BM) require radiation therapy to reduce local recurrence. Whole brain radiation therapy (WBRT) reduces recurrence, but with potential toxicity. Postoperative stereotactic radiosurgery (SRS) is a strategy without prospective data and problematic target delineation. SRS delivered in the preoperative setting (neoadjuvant, or NaSRS) allows clear target definition and reduction of intraoperative dissemination of tumor cells. METHODS AND MATERIALS: Our treatment of resectable BM with NaSRS was begun in 2005. Subsequently, a prospective trial of NaSRS was undertaken. A total of 47 consecutively treated patients (23 database and 24 prospective trial) with a total of 51 lesions were reviewed. No statistical difference was observed between the 2 cohorts, and they were combined for analysis. The median follow-up time was 12 months (range, 1-58 months), and the median age was 57. A median of 1 day elapsed between NaSRS and resection. The median diameter of lesions was 3.04 cm (range, 1.34-5.21 cm), and the median volume was 8.49 cc (range, 0.89-46.7 cc). A dose reduction strategy was used, with a median dose of 14 Gy (range, 11.6-18 Gy) prescribed to 80% isodose. RESULTS: Kaplan-Meier overall survival was 77.8% and 60.0% at 6 and 12 months. Kaplan-Meier local control was 97.8%, 85.6%, and 71.8% at 6, 12, and 24 months, respectively. Five of 8 failures were proved pathologically without radiation necrosis. There were no perioperative adverse events. Ultimately, 14.8% of the patients were treated with WBRT. Local failure was more likely with lesions >10 cc (P=.01), >3.4 cm (P=.014), with a trend in surface lesions (P=.066) and eloquent areas (P=.052). Six of the 8 failures had an obvious dural attachment or proximity to draining veins. CONCLUSIONS: NaSRS can be performed safely and effectively with excellent results without documented radiation necrosis. Local control was excellent even in the setting of large (>3 cm) lesions. The strong majority of patients were able to avoid WBRT. NaSRS merits consideration in a multi-institution trial.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2014

Volume

88

Issue

4

Start / End Page

899 / 906

Location

United States

Related Subject Headings

  • Tumor Burden
  • Time-to-Treatment
  • Retrospective Studies
  • Radiotherapy Dosage
  • Radiosurgery
  • Prospective Studies
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Asher, A. L., Burri, S. H., Wiggins, W. F., Kelly, R. P., Boltes, M. O., Mehrlich, M., … Fraser, R. W. (2014). A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys, 88(4), 899–906. https://doi.org/10.1016/j.ijrobp.2013.12.013
Asher, Anthony L., Stuart H. Burri, Walter F. Wiggins, Renee P. Kelly, Margaret O. Boltes, Melissa Mehrlich, H James Norton, and Robert W. Fraser. “A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence.Int J Radiat Oncol Biol Phys 88, no. 4 (March 15, 2014): 899–906. https://doi.org/10.1016/j.ijrobp.2013.12.013.
Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M, et al. A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):899–906.
Asher, Anthony L., et al. “A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence.Int J Radiat Oncol Biol Phys, vol. 88, no. 4, Mar. 2014, pp. 899–906. Pubmed, doi:10.1016/j.ijrobp.2013.12.013.
Asher AL, Burri SH, Wiggins WF, Kelly RP, Boltes MO, Mehrlich M, Norton HJ, Fraser RW. A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):899–906.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

March 15, 2014

Volume

88

Issue

4

Start / End Page

899 / 906

Location

United States

Related Subject Headings

  • Tumor Burden
  • Time-to-Treatment
  • Retrospective Studies
  • Radiotherapy Dosage
  • Radiosurgery
  • Prospective Studies
  • Preoperative Care
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy