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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Radiosurgery (RS) and multisession radiosurgery (msRS) of brain metastases – treatment strategies and special aspects

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  • Susanne Fichte - CyberKnife Centrum Mitteldeutschland, im Hauptgebäude des HELIOS Klinikum Erfurt, Erfurt, Deutschland
  • Hans-Ulrich Herold - CyberKnife Centrum Mitteldeutschland, Erfurt, Deutschland
  • Gunnar Surber - CyberKnife Centrum Mitteldeutschland, Erfurt, Deutschland
  • Klaus Hamm - im HELIOS Klinikum Erfurt, Erfurt, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.03.04

doi: 10.3205/17dgnc017, urn:nbn:de:0183-17dgnc0170

Published: June 9, 2017

© 2017 Fichte 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

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Objective: Radiosurgery (RS) is a well-accepted therapeutic option for brain metastases and increasingly used even for multiple metastases. The authors describe the treatment strategies and outcomes of patients treated in our department after implementation of a CyberKnife robotic radiosurgery device, with a special focus on multisession radiosurgery, RS of the resection cavity and repeated radiosurgery.

Methods: From October 2012 to December 2015, 163 patients were treated for brain metastases. Patient data, planning details and imaging were analyzed retrospectively. For follow-ups, contrast-enhanced MRI was fused to the initial imaging. Tumor response was evaluated for each target volume and local control rate was assessed at 3, 6 and 12 months after treatment. Additionally, regional progression (new brain metastases) was documented. Kaplan-Meier estimation was used for statistical analysis of survival and local progression-free survival.

Results: 163 patients underwent radiosurgery for a total of 364 brain metastases (1-9 per session). Multisession RS was used in case of large target volumes and/or neurological deficits in 47 of initial treatments. 23 patients had radiosurgery of resection cavities following neurosurgery. 23, 9 and 2 patients were treated 2, 3 or 4 times, respectively, during the evaluation period. Follow-up was complete for 158 patients. Mean time of follow-up was 12,2 (0,3-45,7) months. Overall survival was 67% and 46% at 6 and 12 months, respectively. Complete imaging was available for 98, 70 and 44 patients at 3, 6 and 12 months. Local control rate was 97,1%, 89,5% and 78,5% at 3, 6 and 12 months. 56 patients had regional progression after a mean time of 7,6 (1-39) months. In 26 patients, repeated radiosurgery was performed up to August 2016.

Conclusion: RS and msRS are safe options for treatment of brain metastases with a good rate of local control. Repeated radiosurgical treatment can be performed in cases of local and distant tumor progression, avoiding or postponing whole-brain radiation. Radiosurgery is also an option for local failure after WBRT.