Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal Patient Selection
BACKGROUND:Postoperative stereotactic radiosurgery for brain metastases potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although patients remain at risk for distant brain failure (DBF). OBJECTIVE:To describe clinic...
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| Veröffentlicht in: | Neurosurgery 2015-02, Vol.76 (2), p.150-157 |
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| creator | Ling, Diane C Vargo, John A Wegner, Rodney E Flickinger, John C Burton, Steven A Engh, Johnathan Amankulor, Nduka Quinn, Annette E Ozhasoglu, Cihat Heron, Dwight E |
| description | BACKGROUND:Postoperative stereotactic radiosurgery for brain metastases potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although patients remain at risk for distant brain failure (DBF).
OBJECTIVE:To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain metastases and identify predictors of intracranial failure and their implications on optimal patient selection criteria.
METHODS:We performed a retrospective review on 100 large (>3 cm) brain metastases in 99 patients managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, breast cancer in 18%, and melanoma in 17%. Forty (40%) patients had uncontrolled systemic disease.
RESULTS:With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine patients (9%) developed evidence of radiation injury, and 6 (6%) developed leptomeningeal disease. Uncontrolled systemic disease (P = .03), melanoma histology (P = .04), and increasing number of brain metastases (P < .001) were significant predictors of DBF on Cox multivariate analysis. Patients with |
| doi_str_mv | 10.1227/NEU.0000000000000584 |
| format | Article |
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OBJECTIVE:To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain metastases and identify predictors of intracranial failure and their implications on optimal patient selection criteria.
METHODS:We performed a retrospective review on 100 large (>3 cm) brain metastases in 99 patients managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, breast cancer in 18%, and melanoma in 17%. Forty (40%) patients had uncontrolled systemic disease.
RESULTS:With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine patients (9%) developed evidence of radiation injury, and 6 (6%) developed leptomeningeal disease. Uncontrolled systemic disease (P = .03), melanoma histology (P = .04), and increasing number of brain metastases (P < .001) were significant predictors of DBF on Cox multivariate analysis. Patients with <4 metastases, controlled systemic disease, and nonmelanoma primary (n = 47) had a 1-year DBF of 48.6% vs 80.1% for all others (P = .01).
CONCLUSION:Postoperative stereotactic radiosurgery to the resection cavity safely and effectively augments local control of large brain metastases. Patients with <4 metastases and controlled systemic disease have significantly lower rates of DBF and are ideal treatment candidates.
ABBREVIATIONS:CTV, clinical target volumeDBF, distant brain failureGTR, gross total resectionKPS, Karnofsky Performance StatusLC, local controlOS, overall survivalPTV, planning target volumeRPA, recursive partitioning analysisSRS, sterotactic radiosurgerySTR, subtotal resectionWBRT, whole brain radiotherapy</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000000584</identifier><identifier>PMID: 25549189</identifier><language>eng</language><publisher>United States: Copyright by the Congress of Neurological Surgeons</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Brain cancer ; Brain Neoplasms - mortality ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Breast cancer ; Female ; Histology ; Humans ; Male ; Melanoma ; Metastasis ; Middle Aged ; Multivariate Analysis ; Neurosurgery ; Postoperative Period ; Radiosurgery - methods ; Radiosurgery - mortality ; Retrospective Studies ; Systemic diseases ; Toxicity</subject><ispartof>Neurosurgery, 2015-02, Vol.76 (2), p.150-157</ispartof><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>Copyright © 2014 by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3334-e9230a31c03001cefd008102a6143037f00a0252a29b159f71db60648c0b79ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25549189$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ling, Diane C</creatorcontrib><creatorcontrib>Vargo, John A</creatorcontrib><creatorcontrib>Wegner, Rodney E</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Burton, Steven A</creatorcontrib><creatorcontrib>Engh, Johnathan</creatorcontrib><creatorcontrib>Amankulor, Nduka</creatorcontrib><creatorcontrib>Quinn, Annette E</creatorcontrib><creatorcontrib>Ozhasoglu, Cihat</creatorcontrib><creatorcontrib>Heron, Dwight E</creatorcontrib><title>Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal Patient Selection</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>BACKGROUND:Postoperative stereotactic radiosurgery for brain metastases potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although patients remain at risk for distant brain failure (DBF).
OBJECTIVE:To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain metastases and identify predictors of intracranial failure and their implications on optimal patient selection criteria.
METHODS:We performed a retrospective review on 100 large (>3 cm) brain metastases in 99 patients managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, breast cancer in 18%, and melanoma in 17%. Forty (40%) patients had uncontrolled systemic disease.
RESULTS:With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine patients (9%) developed evidence of radiation injury, and 6 (6%) developed leptomeningeal disease. Uncontrolled systemic disease (P = .03), melanoma histology (P = .04), and increasing number of brain metastases (P < .001) were significant predictors of DBF on Cox multivariate analysis. Patients with <4 metastases, controlled systemic disease, and nonmelanoma primary (n = 47) had a 1-year DBF of 48.6% vs 80.1% for all others (P = .01).
CONCLUSION:Postoperative stereotactic radiosurgery to the resection cavity safely and effectively augments local control of large brain metastases. Patients with <4 metastases and controlled systemic disease have significantly lower rates of DBF and are ideal treatment candidates.
ABBREVIATIONS:CTV, clinical target volumeDBF, distant brain failureGTR, gross total resectionKPS, Karnofsky Performance StatusLC, local controlOS, overall survivalPTV, planning target volumeRPA, recursive partitioning analysisSRS, sterotactic radiosurgerySTR, subtotal resectionWBRT, whole brain radiotherapy</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - secondary</subject><subject>Brain Neoplasms - surgery</subject><subject>Breast cancer</subject><subject>Female</subject><subject>Histology</subject><subject>Humans</subject><subject>Male</subject><subject>Melanoma</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neurosurgery</subject><subject>Postoperative Period</subject><subject>Radiosurgery - methods</subject><subject>Radiosurgery - mortality</subject><subject>Retrospective Studies</subject><subject>Systemic diseases</subject><subject>Toxicity</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kV1rFDEUhoModq3-A5GAN1506snHfHlXl7YurO7SWvBuyGbOuKmZyZhkWvbn9Z-ZulWkF4ZA4OR533OSl5DXDI4Z5-X7L6dXx_Dvyiv5hMxYzmUmQcJTMgMmq0zUxbcD8iKEawBWyLJ6Tg54nsuaVfWM3K1diG5Er6K5QXoZ0aOLSkej6YVqjQuT_45-R6OjcYv0AgOmSzfQuboxcUc75-lSJYZ-9MoM9DNGFdLG8IHOrRmMVpaupqhdj-GIrj22RkfnA3UdXQzRK-3VYBJ0poydPB5RNbR00Y82Se87hd89VmM0faLWqYZDpJdo94O8JM86ZQO-ejgPydXZ6df5p2y5Ol_MT5aZFkLIDGsuQAmmQaR_0Ni1ABUDrgomBYiyA1DAc654vWF53ZWs3RRQyErDpqy7ThySd3vf0bufE4bY9CZotFYN6KbQsCLnoi5lLRP69hF67SY_pOkaLvKEcMZEouSe0t6F4LFrRp-e6HcNg-Y-4iZF3DyOOMnePJhPmx7bv6I_mSag2gO3zqY4ww873aJvtqhs3P7f-xeRrbUE</recordid><startdate>201502</startdate><enddate>201502</enddate><creator>Ling, Diane C</creator><creator>Vargo, John A</creator><creator>Wegner, Rodney E</creator><creator>Flickinger, John C</creator><creator>Burton, Steven A</creator><creator>Engh, Johnathan</creator><creator>Amankulor, Nduka</creator><creator>Quinn, Annette E</creator><creator>Ozhasoglu, Cihat</creator><creator>Heron, Dwight E</creator><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, 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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201502</creationdate><title>Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal Patient Selection</title><author>Ling, Diane C ; Vargo, John A ; Wegner, Rodney E ; Flickinger, John C ; Burton, Steven A ; Engh, Johnathan ; Amankulor, Nduka ; Quinn, Annette E ; Ozhasoglu, Cihat ; Heron, Dwight E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3334-e9230a31c03001cefd008102a6143037f00a0252a29b159f71db60648c0b79ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - secondary</topic><topic>Brain Neoplasms - surgery</topic><topic>Breast cancer</topic><topic>Female</topic><topic>Histology</topic><topic>Humans</topic><topic>Male</topic><topic>Melanoma</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neurosurgery</topic><topic>Postoperative Period</topic><topic>Radiosurgery - methods</topic><topic>Radiosurgery - mortality</topic><topic>Retrospective Studies</topic><topic>Systemic diseases</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ling, Diane C</creatorcontrib><creatorcontrib>Vargo, John A</creatorcontrib><creatorcontrib>Wegner, Rodney E</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Burton, Steven A</creatorcontrib><creatorcontrib>Engh, Johnathan</creatorcontrib><creatorcontrib>Amankulor, Nduka</creatorcontrib><creatorcontrib>Quinn, Annette E</creatorcontrib><creatorcontrib>Ozhasoglu, Cihat</creatorcontrib><creatorcontrib>Heron, Dwight E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ling, Diane C</au><au>Vargo, John A</au><au>Wegner, Rodney E</au><au>Flickinger, John C</au><au>Burton, Steven A</au><au>Engh, Johnathan</au><au>Amankulor, Nduka</au><au>Quinn, Annette E</au><au>Ozhasoglu, Cihat</au><au>Heron, Dwight E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal Patient Selection</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2015-02</date><risdate>2015</risdate><volume>76</volume><issue>2</issue><spage>150</spage><epage>157</epage><pages>150-157</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>BACKGROUND:Postoperative stereotactic radiosurgery for brain metastases potentially offers similar local control rates and fewer long-term neurocognitive sequelae compared to whole brain radiation therapy, although patients remain at risk for distant brain failure (DBF).
OBJECTIVE:To describe clinical outcomes of adjuvant stereotactic radiosurgery for large brain metastases and identify predictors of intracranial failure and their implications on optimal patient selection criteria.
METHODS:We performed a retrospective review on 100 large (>3 cm) brain metastases in 99 patients managed by resection followed by postoperative stereotactic radiosurgery to a median dose of 22 Gy (range, 10-28) in 1 to 5 fractions (median, 3). Primary histology was nonsmall cell lung in 40%, breast cancer in 18%, and melanoma in 17%. Forty (40%) patients had uncontrolled systemic disease.
RESULTS:With a median follow-up of 12.2 months (range, 0.6-87.4), the 1-year Kaplan-Meier local control was 72%, DBF 64%, and overall survival 55%. Nine patients (9%) developed evidence of radiation injury, and 6 (6%) developed leptomeningeal disease. Uncontrolled systemic disease (P = .03), melanoma histology (P = .04), and increasing number of brain metastases (P < .001) were significant predictors of DBF on Cox multivariate analysis. Patients with <4 metastases, controlled systemic disease, and nonmelanoma primary (n = 47) had a 1-year DBF of 48.6% vs 80.1% for all others (P = .01).
CONCLUSION:Postoperative stereotactic radiosurgery to the resection cavity safely and effectively augments local control of large brain metastases. Patients with <4 metastases and controlled systemic disease have significantly lower rates of DBF and are ideal treatment candidates.
ABBREVIATIONS:CTV, clinical target volumeDBF, distant brain failureGTR, gross total resectionKPS, Karnofsky Performance StatusLC, local controlOS, overall survivalPTV, planning target volumeRPA, recursive partitioning analysisSRS, sterotactic radiosurgerySTR, subtotal resectionWBRT, whole brain radiotherapy</abstract><cop>United States</cop><pub>Copyright by the Congress of Neurological Surgeons</pub><pmid>25549189</pmid><doi>10.1227/NEU.0000000000000584</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Brain cancer Brain Neoplasms - mortality Brain Neoplasms - secondary Brain Neoplasms - surgery Breast cancer Female Histology Humans Male Melanoma Metastasis Middle Aged Multivariate Analysis Neurosurgery Postoperative Period Radiosurgery - methods Radiosurgery - mortality Retrospective Studies Systemic diseases Toxicity |
| title | Postoperative Stereotactic Radiosurgery to the Resection Cavity for Large Brain Metastases: Clinical Outcomes, Predictors of Intracranial Failure, and Implications for Optimal Patient Selection |
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