Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients

Background The safety and effectiveness of neoadjuvant fractionated stereotactic radiotherapy (FSRT) before piecemeal resection of brain metastasis (BM) remains unknown. Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection...

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Veröffentlicht in:International journal of clinical oncology 2022-03, Vol.27 (3), p.481-487
Hauptverfasser: Deguchi, Shoichi, Mitsuya, Koichi, Yasui, Kazuaki, Kimura, Keisuke, Onoe, Tsuyoshi, Ogawa, Hirofumi, Asakura, Hirofumi, Harada, Hideyuki, Hayashi, Nakamasa
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container_issue 3
container_start_page 481
container_title International journal of clinical oncology
container_volume 27
creator Deguchi, Shoichi
Mitsuya, Koichi
Yasui, Kazuaki
Kimura, Keisuke
Onoe, Tsuyoshi
Ogawa, Hirofumi
Asakura, Hirofumi
Harada, Hideyuki
Hayashi, Nakamasa
description Background The safety and effectiveness of neoadjuvant fractionated stereotactic radiotherapy (FSRT) before piecemeal resection of brain metastasis (BM) remains unknown. Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy ( n  = 11) or 35 Gy ( n  = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm 3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.
doi_str_mv 10.1007/s10147-021-02083-8
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Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy ( n  = 11) or 35 Gy ( n  = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm 3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.</description><identifier>ISSN: 1341-9625</identifier><identifier>ISSN: 1437-7772</identifier><identifier>EISSN: 1437-7772</identifier><identifier>DOI: 10.1007/s10147-021-02083-8</identifier><identifier>PMID: 34796412</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Aged ; Brain cancer ; Brain Neoplasms - pathology ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - surgery ; Cancer Research ; Complications ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; Meninges ; Metastases ; Metastasis ; Middle Aged ; Nausea ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local - surgery ; Oncology ; Original ; Original Article ; Paresis ; Patients ; Postoperative ; Prospective Studies ; Radiation therapy ; Radiosurgery - adverse effects ; Retrospective Studies ; Seizures ; Surgical Oncology ; Treatment Outcome ; Tumors</subject><ispartof>International journal of clinical oncology, 2022-03, Vol.27 (3), p.481-487</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy ( n  = 11) or 35 Gy ( n  = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm 3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. 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Methods We retrospectively reviewed 20 consecutive patients with BM who underwent neoadjuvant FSRT followed by piecemeal resection between July 2019 and March 2021. The prescribed dose regimens were as follows: 30 Gy ( n  = 11) or 35 Gy ( n  = 9) in five fractions. Results The mean follow-up duration was 7.8 months (range 2.2–22.3). The median age was 67 years (range 51–79). Fourteen patients were male. All patients were symptomatic. All tumors were located in the supratentorial compartment. The median maximum diameter and volume were 3.7 cm (range 2.6–4.9) and 17.6 cm 3 (range 5.6–49.7), respectively. The median time from the end of FSRT to resection was 4 days (range 1–7). Nausea (CTCAE Grade 2) occurred in one patient and simple partial seizures (Grade 2) in two patients during radiation therapy. Gross total removal was performed in seventeen patients and sub-total removal in three patients. Postoperative complications were deterioration of paresis in two patients. Local recurrence was found in one patient (5.0%) who underwent sub-total resection at 2 months after craniotomy. Distant recurrence was found in six patients (30.0%) at a median of 6.9 months. Leptomeningeal disease recurrence was found in one patient (5.0%) at 3 months. No radiation necrosis developed. Conclusions Neoadjuvant FSRT appears to be a safe and effective approach for patients with BM requiring piecemeal resection. A multi-institutional prospective trial is needed.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>34796412</pmid><doi>10.1007/s10147-021-02083-8</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8956-5427</orcidid><oa>free_for_read</oa></addata></record>
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subjects Aged
Brain cancer
Brain Neoplasms - pathology
Brain Neoplasms - radiotherapy
Brain Neoplasms - surgery
Cancer Research
Complications
Humans
Male
Medicine
Medicine & Public Health
Meninges
Metastases
Metastasis
Middle Aged
Nausea
Neoadjuvant Therapy
Neoplasm Recurrence, Local - surgery
Oncology
Original
Original Article
Paresis
Patients
Postoperative
Prospective Studies
Radiation therapy
Radiosurgery - adverse effects
Retrospective Studies
Seizures
Surgical Oncology
Treatment Outcome
Tumors
title Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients
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