gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Sector irradiation vs. whole-brain irradiation after resection of singular brain metastasis – interim analysis of a prospective randomized monocentric trial

Meeting Abstract

  • Johannes Kerschbaumer - Department of Neurosurgery, Medical University of Innsbruck, Austria
  • Daniel Pinggera - Department of Neurosurgery, Medical University of Innsbruck, Austria
  • Marcel Seiz-Rosenhagen - University Medical Center Mannheim, Germany
  • Meinhard Nevinny-Stickel - Department of Radiotherapy and Radiooncology, Medical University of Innsbruck, Austria
  • Christian F. Freyschlag - Department of Neurosurgery, Medical University of Innsbruck, Austria
  • Claudius Thomé - Department of Neurosurgery, Medical University of Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.17.07

doi: 10.3205/16dgnc341, urn:nbn:de:0183-16dgnc3413

Published: June 8, 2016

© 2016 Kerschbaumer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Microsurgical resection of cerebral metastases leads to prolonged survival and rapid relief of symptoms in selected patients. To minimize the risk of local recurrence whole-brain irradiation (WBRT) has been established as standard adjuvant treatment in these patients. With the advances in systemic cancer treatment and prolonged overall survival, however, deleterious effects of WBRT are becoming more relevant. Sector irradiation aims to spare brain tissue by focusing the irradiation in the area of the tumor bed. The aim of this study is to investigate whether adjuvant “sector” irradiation following microsurgical resection is equivalent to adjuvant WBRT in terms of local control and potentially superior in terms of quality of life and neurocognitive deficits in a prospective randomized trial.

Method: The study is a monocentric, randomized trial in patients with a singular brain metastasis. Efficacy was evaluated by clinical and radiological visits every 3 months. Primary endpoints were overall survival (OS) and local recurrence, secondary endpoints were distant intracranial progression and time to clinical deterioration.

Results: At the time of analysis 28 patients were enrolled in this trial, there were 3 drop-outs. 12 Patients were assigned to standard WBRT and 13 patients were randomized to sector irradiation. Treatment started within 30 days after resection in both groups (29,7 days in sector group and 30 days in WBRT group, n.s.). There was no local recurrence in the sector group, whereas one patient recurred within 3 months after WBRT locally. A distant progression was noted in 3 patients after WBRT within 9 (3-20) months and 4 patients after sector irradiation developed distant metastases after a mean of 5 (1-9) months. The OS was slightly higher in the sector group with 12,2 months (10 of 13 patients still alive) compared to 11,2 months (7 of 12 patients still alive, n.s.). We found no significant differences in terms of OS and local control while we show the sector irradiation to be a reliable, brain sparing method in the treatment of singular brain metastasis.

Conclusions: Sector irradiation as a brain tissue sparing method achieves local control comparable to WBRT after resection of a singular brain metastasis. Our preliminary results thus indicate equivalent efficacy of sector irradiation. With the unexpectedly long average survival (17 of 25 patients alive after an average of 11,66 months), however, long-term follow-up is mandatory to determine any impact of overall survival.