gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Early motor function outcome in patients receiving intraoperative radiotherapy (IORT) in highly eloquent brain areas

Frühes motorisches Outcome nach intraoperativer Strahlentherapie in hoch-eloquenten Gehirnarealen

Meeting Abstract

  • presenting/speaker Stefanie Brehmer - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Axel Delhey - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Frank Schneider - Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
  • Sven Clausen - Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
  • Marcel Seiz-Rosenhagen - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Nima Etminan - Universitätsklinikum Mannheim, Klinik für Neurochirurgie, Mannheim, Deutschland
  • Frank Anton Giordano - Universitätsklinikum Mannheim, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP054

doi: 10.3205/20dgnc344, urn:nbn:de:0183-20dgnc3441

Veröffentlicht: 26. Juni 2020

© 2020 Brehmer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Intraoperative radiotherapy (IORT) is a routine procedure in gynecological oncologic surgery. However, IORT gains increasing interest as an innovative approach to reach local tumor control in the treatment of intracranial pathologies. This therapy enables the concomitant radiotherapy of the resection cavity-which is the golden standard- in a single session in patients receiving surgical treatment for brain metastases, which results in shorter length of hospitalization and potentially earlier salvages cancer therapy. The role of IORT in eloquent brain areas is uncertain due to the mere size and thereby local pressure of the radiation applicator and the high single dose. We here report a subgroup analysis of our prospective phase II INTRAMET (intraoperative radiotherapy after the resection of brain metastases) trial for patients undergoing surgical treatment for metastases in the motorcortex area.

Methods: Since 7/2017 6 patients were treated with IORT following resection of lesions in the motorcortex area (3 left and 3 right). Resection was performed using intraoperative neuromonitoring. All patients had frozen section confirmed metastasis and were treated with a single dose of 30 Gy. Neurological outcome was assessed before surgery, immediately after as well as 2 weeks, 6 weeks and 3 months after surgery and IORT.

Results: All patients had preoperative paresis (1 with a complete hemiparesis M4, 3 with arm palsy ranging from M3 to M4, 1 with a facial nerve palsy and 1 with leg palsy M4). Intraoperative neuromonitoring showed no change in MEP or SSEP during surgery and IORT. In all patients complete resection was achieved. Immediately, after treatment 2 patients had a drop of muscle strength of 1 to 5 points, 3 patients had no change in function and 1 improved to full strength. After 2 weeks another patient improved to full strength and 1 to preoperative level. After 6 weeks 3 patients had full strength. After 3 months 5 patients improved to full strength and 1 remained at baseline level. Those patients who suffered from postoperative worsening of motor function improved back to baseline function at 6 weeks after treatment.

Conclusion: In this INTRAMET subgroup analysis no patient receiving tumor resection combined with IORT suffered from a new permanent deficit. Applicator insertion and applicator pressure whilst radiation does not seem to have a detrimental effect in functional outcome. Thus, IORT is a safe and feasible adjunct to metastases resection in eloquent brain areas.