gms | German Medical Science

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

Intraoperative radiotherapy after the resection of brain metastases (INTRAMET) – protocol of a phase 2 feasibility study

Meeting Abstract

  • Stefanie Brehmer - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinischen Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
  • Frank Anton Giordano - Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Deutschland
  • Melanie Welsch - Neurochirurgische Klinik, Mannheim, Deutschland
  • Miriam Ratliff - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinischen Fakultät Mannheim der Universität Heidelberg, Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Mannheim, Deutschland
  • Marcel Seiz-Rosenhagen - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
  • Frederik Wenz - Universitätsmedizin Mannheim, Institut für Klinische Radiologie, Strahlentherapie, Mannheim, Deutschland
  • Daniel Hänggi - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Universitätsmedizin Mannheim, Medizinischen Fakultät Mannheim der Universität Heidelberg, Mannheim, 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. DocP 110

doi: 10.3205/17dgnc673, urn:nbn:de:0183-17dgnc6739

Published: June 9, 2017

© 2017 Brehmer 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: Brain metastases occur in up to 40% of all patients diagnosed with systemic cancer. Without adjuvant radiotherapy after resection of space occupying lesions local recurrence rates are high. That is why guidelines recommend a cavity boosting with x-rays. External beam radiotherapy can lower the risk of local recurrence but means longer hospitalization, prolongs the time to systemic salvage therapies and bears risks of radionecrosis and leucoencephalopathia with neurological and cognitive decline. A solution for this problem could be onetime intraoperative radiotherapy (IORT) with soft x-rays to sterilize the resection cavity, which may provide both: freedom from local recurrence fast track salvage therapy initiation.

Methods: We here introduce for the first time the study protocol of a single institution, open-label, prospective, phase 2 feasibility study for intraoperative radiotherapy immediately following resection of brain metastases. 50 adult patients with not before locally treated, resectable not dural brain metastases should be treated in surgery after tumor resection with IORT with 20-30Gy prescribed to the margin of the resection cavity. The highest dose tolerable to surrounding risk structures (N. opticus, brainstem) should be used.

Results: Primary endpoint will be local progression-free survival (PFS) of the treated metastasis. Secondary endpoints will be overall survival which will be differentiated between death related to global cancer progress and death from brain metastases. Further we will analyze the time to salvage cancer therapy, cognitive performance and the quality of life. Another secondary endpoint will be global and regional PFS to account for possible abscopal effects on the total cancer status and cancer status in the brain. Additional it should be proved that there are no dose limitation toxicities like wound healing disorders, cerebral hemorrhage or ischemia or radionecrosis with the need of surgical intervention.

Conclusion: With our new method we hope to show similar local control rates to postoperative external beam radiotherapy in line with guideline recommendations with less patient hospitalization and faster start of rescue therapies which could lead to a favorable overall outcome and less cognitive side effects.