Artikel
Neo-adjuvant radiosurgery prior to resection – an upfront treatment concept for brain metastasis
Präoperative Radiochirurgie: ein neo-adjuvantes Behandlungskonzept für Hirnmetastasen
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Veröffentlicht: | 25. Mai 2022 |
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Objective: After resection of brain metastases (BM), adjuvant radiation therapy is applied to the resection cavity to reduce local recurrence rates. In principle, this goal could also be achieved by combining resection with stereotactic radiosurgery (SRS), a well-established tool for the treatment of BM. Therefore, we combined upfront (neo-adjuvant) SRS with resection of BM in order to (I) reduce overall treatment time and (II) to utilizise the advantage of clear target volume definition for SRS of the BM prior to resection. We investigated feasibility, complications, local control and overall survival in a pilot study.
Methods: In this single center study we included 10 patients with BM who underwent single session SRS prior to resection based on an individual treatment decision. Kaplan Meier was used to analyze local control, overall survival (OS), progression free survival (PFS).
Results: 10 patients (f/m =6/4, median age 59, range 47-71 years) fulfilled the criteria. Mean tumor volume was 17.3 ± 12.3 cm3 (range, 6.5-39.9 cm3), median marginal dose was 19.75 Gy (range, 18-20 Gy) and the prescription isodose was 65%. The entire treatment (from SRS to discharge after surgery) could be completed within a median of 7.5 days (range 5-12). Mean follow-up was 7.5 months (range, 4-51 months). Local control was 90% at 6 and in 74% at 12 months. PFS amounted to 35% after 6 and 12 months, OS was 90% after 6 and 45% after 12 months. Complications were radiation necrosis in one case and wound infection in two patients.
Conclusion: Our preliminary results show that neoadjuvant SRS is feasible and effective with reliable results. Local control was fair even in the setting of large (> 14 cm3) BM. Additionally, patients benefited from a short overall treatment time allowing early adjuvant measures.