Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size
Purpose Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying f...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2013-03, Vol.85 (3), p.650-655 |
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| creator | Hartford, Alan C., MD, PhD Paravati, Anthony J., BS Spire, William J., MD Li, Zhongze, MS Jarvis, Lesley A., MD, PhD Fadul, Camilo E., MD Rhodes, C. Harker, MD, PhD Erkmen, Kadir, MD Friedman, Jonathan, MD Gladstone, David J., ScD Hug, Eugen B., MD Roberts, David W., MD Simmons, Nathan E., MD |
| description | Purpose Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying factors that might predict intracranial disease control and overall survival (OS). Methods and Materials We retrospectively reviewed all patients through December 2008, who, after surgical resection, underwent SRS to the tumor bed, deferring WBRT. Multiple factors were analyzed for time to intracranial recurrence (ICR), whether local recurrence (LR) at the surgical bed or “distant” recurrence (DR) in the brain, for time to WBRT, and for OS. Results A total of 49 lesions in 47 patients were treated with postoperative SRS. With median follow-up of 9.3 months (range, 1.1-61.4 months), local control rates at the resection cavity were 85.5% at 1 year and 66.9% at 2 years. OS rates at 1 and 2 years were 52.5% and 31.7%, respectively. On univariate analysis (preoperative) tumors larger than 3.0 cm exhibited a significantly shorter time to LR. At a cutoff of 2.0 cm, larger tumors resulted in significantly shorter times not only for LR but also for DR, ICR, and salvage WBRT. While multivariate Cox regressions showed preoperative size to be significant for times to DR, ICR, and WBRT, in similar multivariate analysis for OS, only the graded prognostic assessment proved to be significant. However, the number of intracranial metastases at presentation was not significantly associated with OS nor with other outcome variables. Conclusions Larger tumor size was associated with shorter time to recurrence and with shorter time to salvage WBRT; however, larger tumors were not associated with decrements in OS, suggesting successful salvage. SRS to the tumor bed without WBRT is an effective treatment for resected brain metastases, achieving local control particularly for tumors up to 3.0 cm diameter. |
| doi_str_mv | 10.1016/j.ijrobp.2012.05.027 |
| format | Article |
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Harker, MD, PhD ; Erkmen, Kadir, MD ; Friedman, Jonathan, MD ; Gladstone, David J., ScD ; Hug, Eugen B., MD ; Roberts, David W., MD ; Simmons, Nathan E., MD</creator><creatorcontrib>Hartford, Alan C., MD, PhD ; Paravati, Anthony J., BS ; Spire, William J., MD ; Li, Zhongze, MS ; Jarvis, Lesley A., MD, PhD ; Fadul, Camilo E., MD ; Rhodes, C. Harker, MD, PhD ; Erkmen, Kadir, MD ; Friedman, Jonathan, MD ; Gladstone, David J., ScD ; Hug, Eugen B., MD ; Roberts, David W., MD ; Simmons, Nathan E., MD</creatorcontrib><description>Purpose Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying factors that might predict intracranial disease control and overall survival (OS). Methods and Materials We retrospectively reviewed all patients through December 2008, who, after surgical resection, underwent SRS to the tumor bed, deferring WBRT. Multiple factors were analyzed for time to intracranial recurrence (ICR), whether local recurrence (LR) at the surgical bed or “distant” recurrence (DR) in the brain, for time to WBRT, and for OS. Results A total of 49 lesions in 47 patients were treated with postoperative SRS. With median follow-up of 9.3 months (range, 1.1-61.4 months), local control rates at the resection cavity were 85.5% at 1 year and 66.9% at 2 years. OS rates at 1 and 2 years were 52.5% and 31.7%, respectively. On univariate analysis (preoperative) tumors larger than 3.0 cm exhibited a significantly shorter time to LR. At a cutoff of 2.0 cm, larger tumors resulted in significantly shorter times not only for LR but also for DR, ICR, and salvage WBRT. While multivariate Cox regressions showed preoperative size to be significant for times to DR, ICR, and WBRT, in similar multivariate analysis for OS, only the graded prognostic assessment proved to be significant. However, the number of intracranial metastases at presentation was not significantly associated with OS nor with other outcome variables. Conclusions Larger tumor size was associated with shorter time to recurrence and with shorter time to salvage WBRT; however, larger tumors were not associated with decrements in OS, suggesting successful salvage. SRS to the tumor bed without WBRT is an effective treatment for resected brain metastases, achieving local control particularly for tumors up to 3.0 cm diameter.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2012.05.027</identifier><identifier>PMID: 22795806</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; BRAIN ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Cranial Irradiation ; Female ; Follow-Up Studies ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; METASTASES ; Middle Aged ; MULTIVARIATE ANALYSIS ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - radiotherapy ; Neoplasm Recurrence, Local - surgery ; NEOPLASMS ; PATIENTS ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Radiosurgery - methods ; RADIOTHERAPY ; Radiotherapy Dosage ; Retrospective Studies ; REVIEWS ; Salvage Therapy - methods ; SURGERY ; Survival Analysis ; Time Factors ; Tumor Burden ; Young Adult</subject><ispartof>International journal of radiation oncology, biology, physics, 2013-03, Vol.85 (3), p.650-655</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-383edb4d3728c1de15d3c2748a59807f39f4bd52157681956e2bf31ffcdd35b03</citedby><cites>FETCH-LOGICAL-c511t-383edb4d3728c1de15d3c2748a59807f39f4bd52157681956e2bf31ffcdd35b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2012.05.027$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22795806$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22224358$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Hartford, Alan C., MD, PhD</creatorcontrib><creatorcontrib>Paravati, Anthony J., BS</creatorcontrib><creatorcontrib>Spire, William J., MD</creatorcontrib><creatorcontrib>Li, Zhongze, MS</creatorcontrib><creatorcontrib>Jarvis, Lesley A., MD, PhD</creatorcontrib><creatorcontrib>Fadul, Camilo E., MD</creatorcontrib><creatorcontrib>Rhodes, C. Harker, MD, PhD</creatorcontrib><creatorcontrib>Erkmen, Kadir, MD</creatorcontrib><creatorcontrib>Friedman, Jonathan, MD</creatorcontrib><creatorcontrib>Gladstone, David J., ScD</creatorcontrib><creatorcontrib>Hug, Eugen B., MD</creatorcontrib><creatorcontrib>Roberts, David W., MD</creatorcontrib><creatorcontrib>Simmons, Nathan E., MD</creatorcontrib><title>Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying factors that might predict intracranial disease control and overall survival (OS). Methods and Materials We retrospectively reviewed all patients through December 2008, who, after surgical resection, underwent SRS to the tumor bed, deferring WBRT. Multiple factors were analyzed for time to intracranial recurrence (ICR), whether local recurrence (LR) at the surgical bed or “distant” recurrence (DR) in the brain, for time to WBRT, and for OS. Results A total of 49 lesions in 47 patients were treated with postoperative SRS. With median follow-up of 9.3 months (range, 1.1-61.4 months), local control rates at the resection cavity were 85.5% at 1 year and 66.9% at 2 years. OS rates at 1 and 2 years were 52.5% and 31.7%, respectively. On univariate analysis (preoperative) tumors larger than 3.0 cm exhibited a significantly shorter time to LR. At a cutoff of 2.0 cm, larger tumors resulted in significantly shorter times not only for LR but also for DR, ICR, and salvage WBRT. While multivariate Cox regressions showed preoperative size to be significant for times to DR, ICR, and WBRT, in similar multivariate analysis for OS, only the graded prognostic assessment proved to be significant. However, the number of intracranial metastases at presentation was not significantly associated with OS nor with other outcome variables. Conclusions Larger tumor size was associated with shorter time to recurrence and with shorter time to salvage WBRT; however, larger tumors were not associated with decrements in OS, suggesting successful salvage. SRS to the tumor bed without WBRT is an effective treatment for resected brain metastases, achieving local control particularly for tumors up to 3.0 cm diameter.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>BRAIN</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - surgery</subject><subject>Cranial Irradiation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>METASTASES</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - radiotherapy</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>NEOPLASMS</subject><subject>PATIENTS</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radiosurgery - methods</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>Retrospective Studies</subject><subject>REVIEWS</subject><subject>Salvage Therapy - methods</subject><subject>SURGERY</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Tumor Burden</subject><subject>Young Adult</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks1u1DAUhS0EotPCGyBkiQ2bBP_E-WGBVCoKSEWMOoPKznLsG8ZDJg62U2l4B94Zh5Qu2GBZ8sLfuef6HiP0jJKcElq-2ud271075oxQlhORE1Y9QCtaV03Ghfj6EK0IL0nGE3yCTkPYE0IorYrH6ISxqhE1KVfo19qF6EbwKtpbwJsIHlxUOlqNr5WxLkz-G_gjvrFx56aIb3auh-ytV3b4AySdG_B2lyqMR9w5j5e7TxBVSBvCa7x2EYZoVY-vkxi7Dq-Ty73pdjok2cb-hCfoUaf6AE_vzjP05fLd9uJDdvX5_ceL86tMC0pjxmsOpi0Mr1itqQEqDNesKmolmppUHW-6ojWCUVGVNW1ECaztOO06bQwXLeFn6MVSNz3eyqBtBL3TbhhAR8nSKrioE_VyoUbvfkwQojzYoKHv1QBuCpKyumBNmipLaLGg2rsQPHRy9Pag_FFSIue45F4ucck5LkmETHEl2fM7h6k9gLkX_c0nAW8WANI0bi34uVkYNBjr516Ns_9z-LeA7u1gteq_wxHC3k1-SJOWVIakkZv5y8w_hjJCyqZq-G8PbL8J</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Hartford, Alan C., MD, PhD</creator><creator>Paravati, Anthony J., BS</creator><creator>Spire, William J., MD</creator><creator>Li, Zhongze, MS</creator><creator>Jarvis, Lesley A., MD, PhD</creator><creator>Fadul, Camilo E., MD</creator><creator>Rhodes, C. Harker, MD, PhD</creator><creator>Erkmen, Kadir, MD</creator><creator>Friedman, Jonathan, MD</creator><creator>Gladstone, David J., ScD</creator><creator>Hug, Eugen B., MD</creator><creator>Roberts, David W., MD</creator><creator>Simmons, Nathan E., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20130301</creationdate><title>Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size</title><author>Hartford, Alan C., MD, PhD ; Paravati, Anthony J., BS ; Spire, William J., MD ; Li, Zhongze, MS ; Jarvis, Lesley A., MD, PhD ; Fadul, Camilo E., MD ; Rhodes, C. Harker, MD, PhD ; Erkmen, Kadir, MD ; Friedman, Jonathan, MD ; Gladstone, David J., ScD ; Hug, Eugen B., MD ; Roberts, David W., MD ; Simmons, Nathan E., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-383edb4d3728c1de15d3c2748a59807f39f4bd52157681956e2bf31ffcdd35b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>BRAIN</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - surgery</topic><topic>Cranial Irradiation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>METASTASES</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>Neoplasm Recurrence, Local - mortality</topic><topic>Neoplasm Recurrence, Local - radiotherapy</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>NEOPLASMS</topic><topic>PATIENTS</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radiosurgery - methods</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>Retrospective Studies</topic><topic>REVIEWS</topic><topic>Salvage Therapy - methods</topic><topic>SURGERY</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Tumor Burden</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hartford, Alan C., MD, PhD</creatorcontrib><creatorcontrib>Paravati, Anthony J., BS</creatorcontrib><creatorcontrib>Spire, William J., MD</creatorcontrib><creatorcontrib>Li, Zhongze, MS</creatorcontrib><creatorcontrib>Jarvis, Lesley A., MD, PhD</creatorcontrib><creatorcontrib>Fadul, Camilo E., MD</creatorcontrib><creatorcontrib>Rhodes, C. Harker, MD, PhD</creatorcontrib><creatorcontrib>Erkmen, Kadir, MD</creatorcontrib><creatorcontrib>Friedman, Jonathan, MD</creatorcontrib><creatorcontrib>Gladstone, David J., ScD</creatorcontrib><creatorcontrib>Hug, Eugen B., MD</creatorcontrib><creatorcontrib>Roberts, David W., MD</creatorcontrib><creatorcontrib>Simmons, Nathan E., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hartford, Alan C., MD, PhD</au><au>Paravati, Anthony J., BS</au><au>Spire, William J., MD</au><au>Li, Zhongze, MS</au><au>Jarvis, Lesley A., MD, PhD</au><au>Fadul, Camilo E., MD</au><au>Rhodes, C. Harker, MD, PhD</au><au>Erkmen, Kadir, MD</au><au>Friedman, Jonathan, MD</au><au>Gladstone, David J., ScD</au><au>Hug, Eugen B., MD</au><au>Roberts, David W., MD</au><au>Simmons, Nathan E., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>85</volume><issue>3</issue><spage>650</spage><epage>655</epage><pages>650-655</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose Radiation therapy following resection of a brain metastasis increases the probability of disease control at the surgical site. We analyzed our experience with postoperative stereotactic radiosurgery (SRS) as an alternative to whole-brain radiotherapy (WBRT), with an emphasis on identifying factors that might predict intracranial disease control and overall survival (OS). Methods and Materials We retrospectively reviewed all patients through December 2008, who, after surgical resection, underwent SRS to the tumor bed, deferring WBRT. Multiple factors were analyzed for time to intracranial recurrence (ICR), whether local recurrence (LR) at the surgical bed or “distant” recurrence (DR) in the brain, for time to WBRT, and for OS. Results A total of 49 lesions in 47 patients were treated with postoperative SRS. With median follow-up of 9.3 months (range, 1.1-61.4 months), local control rates at the resection cavity were 85.5% at 1 year and 66.9% at 2 years. OS rates at 1 and 2 years were 52.5% and 31.7%, respectively. On univariate analysis (preoperative) tumors larger than 3.0 cm exhibited a significantly shorter time to LR. At a cutoff of 2.0 cm, larger tumors resulted in significantly shorter times not only for LR but also for DR, ICR, and salvage WBRT. While multivariate Cox regressions showed preoperative size to be significant for times to DR, ICR, and WBRT, in similar multivariate analysis for OS, only the graded prognostic assessment proved to be significant. However, the number of intracranial metastases at presentation was not significantly associated with OS nor with other outcome variables. Conclusions Larger tumor size was associated with shorter time to recurrence and with shorter time to salvage WBRT; however, larger tumors were not associated with decrements in OS, suggesting successful salvage. SRS to the tumor bed without WBRT is an effective treatment for resected brain metastases, achieving local control particularly for tumors up to 3.0 cm diameter.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22795806</pmid><doi>10.1016/j.ijrobp.2012.05.027</doi><tpages>6</tpages></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2013-03, Vol.85 (3), p.650-655 |
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| subjects | Adult Aged Aged, 80 and over Analysis of Variance BRAIN Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Brain Neoplasms - surgery Cranial Irradiation Female Follow-Up Studies Hematology, Oncology and Palliative Medicine Humans Male METASTASES Middle Aged MULTIVARIATE ANALYSIS Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - radiotherapy Neoplasm Recurrence, Local - surgery NEOPLASMS PATIENTS Radiology RADIOLOGY AND NUCLEAR MEDICINE Radiosurgery - methods RADIOTHERAPY Radiotherapy Dosage Retrospective Studies REVIEWS Salvage Therapy - methods SURGERY Survival Analysis Time Factors Tumor Burden Young Adult |
| title | Postoperative Stereotactic Radiosurgery Without Whole-Brain Radiation Therapy for Brain Metastases: Potential Role of Preoperative Tumor Size |
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