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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Volumetric analysis of edema pre- and post-stereotactic radiosurgery (SRS) in patients with large BM

Volumetrische Analyse des Hirnödems prä- und post- Radiochirurgie (SRS) bei Patienten mit großen Hirnmetastasen

Meeting Abstract

  • presenting/speaker Daniel Rueß - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Stephanie T. Jünger - Universitätsklinikum Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Stefan Hunsche - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Markus Eichner - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Martin Kocher - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
  • Maximilian I. Ruge - Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP043

doi: 10.3205/22dgnc357, urn:nbn:de:0183-22dgnc3570

Veröffentlicht: 25. Mai 2022

© 2022 Rueß 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: Stereotactic radiosurgery (SRS) is a treatment option even for large brain metastasis (BM) when surgical options are limited. As SRS may lead to a temporary disruption of the blood-brain barrier, a higher risk of treatment failure and toxicity is generally assumed in cases with extended pretherapeutic perifocal edema. Therefore, a volumetric analysis of the pre-SRS edema in patients with large BM was performed and included in predictive models assessing the risk for increased post-SRS edema and local tumor control.

Methods: In this single centre retrospective series (2013-2021) we included all patients with previously untreated singular large BM who underwent single session SRS using Cyberknife®. Tumor volumes were calculated pre- and three month post SRS on contrast-enhanced T1 MRI and edema volumes on FLAIR MRI sequences given a minimum of 5 mm slice thickness. Patient data were analyzed with Kaplan-Meier estimates for local control (LC), overall survival (OS) and progression free survival (PFS). An univariate Cox proportional hazard model was used to assess the influence of preSRS edema on post SRS edema, radiation necrosis (RN) and LC.

Results: A total of 18 patients (f/m =8/10, median age 59, range 38-78 years) were identified. A median marginal dose of 19.3 Gy (range, 18-20 Gy¸ 65% isodose level) was administered. Median follow-up was 13.5 months (range, 3-51 months). The initial mean tumor volume was 10.3 ± 2.1 cm3 (range, 8.6 – 13.7 cm3) and showed significant reduction (p=0.04) to 3.3 ± 1.5 cm3 (range, 0.2 – 15.4 cm3) after three months. The mean volume of pre-SRS edema amounted to 38.8 ± 39 cm3 (range, 8.6 – 156 cm3) and was reduced to 26.5 ± 34.1 cm3 (range, 1.2 – 120 cm3) post-SRS. Local control was achived in 93% of the metastases at 6 and in 76% at 12 months. The crude rate of radiation induced changes was 16% (n=3). An increase of postSRS edema volume > 5% was seen in 28% (n=5). PreSRS edema had no significant impact on postSRS edema (p=0,33), LC (p=0,27) or RN (p=0,98).

Conclusion: Our preliminary results show that single session SRS leads to early responses with significant reduction in tumor volume even in large BM. However, the extent of pre-SRS edema volume is not a predictive factor for toxicity.