Postoperative stereotactic radiosurgery (SRS) utilizing 5 Gy X 5 sessions in the management of brain metastases.

Postoperative stereotactic radiosurgery (SRS) utilizing 5 Gy X 5 sessions in the management of brain metastases.

World Neurosurg. 2016 Feb 24;

Authors: Abuodeh Y, Ahmed KA, Naghavi AO, Venkat PS, Sarangkasiri S, Johnstone PA, Etame AB, Yu HM

Abstract
BACKGROUND: Multiple regimens for stereotactic radiosurgery to the post-operative bed have shown a high local control rate and a low toxicity profile with no decrease in overall survival with the omission of whole brain radiation therapy.
METHODS: In this retrospective analysis, we evaluate our experience with post-operative SRS using a uniform regimen of 25 Gy in 5 sessions.
RESULTS: Between April 2011 to May 2014, a total of 75 patients treated to 77 metastatic brain lesions with post-operative stereotactic radiosurgery in 5 sessions. The median PTV was 13.8 cm3 (1.93-128.43 cm3) with a median follow up for all lesions of 9.5 months (range 1.2-38.2 months). Kaplan-Meier estimates of local control at 1 and 2 years were 88.8% and 83.9%, respectively. On univariate analysis, a trend in decreased survival with multiple brain lesions was noted (HR=2 (95% CI 0.87-4.53), p=0.10). There was a trend towards decreased local control with radioresistant tumors (HR=3.23 (0.7-22.6), p=0.14) and PTV volume ≥ 17 cm3 (HR= 3.07 (0.73-15.23), p=0.12). Two (3%) patients developed radionecrosis, one of them required craniotomy.
CONCLUSION: SRS with a dose of 25 Gy in 5 sessions is associated with excellent local control at the resection site with minimal toxicity in the postoperative settings in our patient population. Further investigation is required to determine if dose escalation to the post-operative cavity of radioresistant tumors improves outcomes.

PMID: 26921701 [PubMed - as supplied by publisher]

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