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 |
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container_title | International journal of clinical oncology |
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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 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8882569</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2599181940</sourcerecordid><originalsourceid>FETCH-LOGICAL-c498t-331286eacbf03e007b5a92c9572663e729ba04354dc1eb97a5a0af1143492a6d3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhiNERUvhBVggS2zYhPoWO2aBVFXlIlVlA2tr4kxaHyVxsJ2is--D49NTCmWBbMuW55t_PP6r6hWj7xil-iQxyqSuKWdl0VbU7ZPqiEmha601f1rOQrLaKN4cVs9T2lDKtGr4s-pQSG2UZPyour3EAP1mvYE5kyGCyz7MkLEnKWPEkHc3jkTofcjXGGHZkiGMY_hZkG5LFo8OJ4SRREx4l03CQLoIfiYTZkhl-vSeAHGQkCSMHtMO4ZQskD3OOb2oDgYYE76834-r7x_Pv519ri--fvpydnpRO2naXAvBeKsQXDdQgeUHugYMd6bRXCmBmpsOqBSN7B3DzmhogMLAyo9Iw0H14rj6sNdd1m7C3pXaEUa7RD9B3NoA3j6OzP7aXoUb27Ytb5QpAm_vBWL4sWLKdvLJ4TjCjGFNljfGsJYZSQv65h90E9Y4l_YsV0I0uoydIN9TLoaUIg4Pj2HU7ky2e5NtMdnemWzbkvT67zYeUn67WgCxB1IJzVcY_9T-j-wvnIa1CA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2633575759</pqid></control><display><type>article</type><title>Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Deguchi, Shoichi ; Mitsuya, Koichi ; Yasui, Kazuaki ; Kimura, Keisuke ; Onoe, Tsuyoshi ; Ogawa, Hirofumi ; Asakura, Hirofumi ; Harada, Hideyuki ; Hayashi, Nakamasa</creator><creatorcontrib>Deguchi, Shoichi ; Mitsuya, Koichi ; Yasui, Kazuaki ; Kimura, Keisuke ; Onoe, Tsuyoshi ; Ogawa, Hirofumi ; Asakura, Hirofumi ; Harada, Hideyuki ; Hayashi, Nakamasa</creatorcontrib><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.</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 & 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”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-331286eacbf03e007b5a92c9572663e729ba04354dc1eb97a5a0af1143492a6d3</citedby><cites>FETCH-LOGICAL-c498t-331286eacbf03e007b5a92c9572663e729ba04354dc1eb97a5a0af1143492a6d3</cites><orcidid>0000-0001-8956-5427</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10147-021-02083-8$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10147-021-02083-8$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34796412$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deguchi, Shoichi</creatorcontrib><creatorcontrib>Mitsuya, Koichi</creatorcontrib><creatorcontrib>Yasui, Kazuaki</creatorcontrib><creatorcontrib>Kimura, Keisuke</creatorcontrib><creatorcontrib>Onoe, Tsuyoshi</creatorcontrib><creatorcontrib>Ogawa, Hirofumi</creatorcontrib><creatorcontrib>Asakura, Hirofumi</creatorcontrib><creatorcontrib>Harada, Hideyuki</creatorcontrib><creatorcontrib>Hayashi, Nakamasa</creatorcontrib><title>Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients</title><title>International journal of clinical oncology</title><addtitle>Int J Clin Oncol</addtitle><addtitle>Int J Clin Oncol</addtitle><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.</description><subject>Aged</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - surgery</subject><subject>Cancer Research</subject><subject>Complications</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meninges</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Nausea</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Oncology</subject><subject>Original</subject><subject>Original Article</subject><subject>Paresis</subject><subject>Patients</subject><subject>Postoperative</subject><subject>Prospective Studies</subject><subject>Radiation therapy</subject><subject>Radiosurgery - adverse effects</subject><subject>Retrospective Studies</subject><subject>Seizures</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>1341-9625</issn><issn>1437-7772</issn><issn>1437-7772</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kctu1TAQhiNERUvhBVggS2zYhPoWO2aBVFXlIlVlA2tr4kxaHyVxsJ2is--D49NTCmWBbMuW55t_PP6r6hWj7xil-iQxyqSuKWdl0VbU7ZPqiEmha601f1rOQrLaKN4cVs9T2lDKtGr4s-pQSG2UZPyour3EAP1mvYE5kyGCyz7MkLEnKWPEkHc3jkTofcjXGGHZkiGMY_hZkG5LFo8OJ4SRREx4l03CQLoIfiYTZkhl-vSeAHGQkCSMHtMO4ZQskD3OOb2oDgYYE76834-r7x_Pv519ri--fvpydnpRO2naXAvBeKsQXDdQgeUHugYMd6bRXCmBmpsOqBSN7B3DzmhogMLAyo9Iw0H14rj6sNdd1m7C3pXaEUa7RD9B3NoA3j6OzP7aXoUb27Ytb5QpAm_vBWL4sWLKdvLJ4TjCjGFNljfGsJYZSQv65h90E9Y4l_YsV0I0uoydIN9TLoaUIg4Pj2HU7ky2e5NtMdnemWzbkvT67zYeUn67WgCxB1IJzVcY_9T-j-wvnIa1CA</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Deguchi, Shoichi</creator><creator>Mitsuya, Koichi</creator><creator>Yasui, Kazuaki</creator><creator>Kimura, Keisuke</creator><creator>Onoe, Tsuyoshi</creator><creator>Ogawa, Hirofumi</creator><creator>Asakura, Hirofumi</creator><creator>Harada, Hideyuki</creator><creator>Hayashi, Nakamasa</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><scope>C6C</scope><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>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8956-5427</orcidid></search><sort><creationdate>20220301</creationdate><title>Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients</title><author>Deguchi, Shoichi ; Mitsuya, Koichi ; Yasui, Kazuaki ; Kimura, Keisuke ; Onoe, Tsuyoshi ; Ogawa, Hirofumi ; Asakura, Hirofumi ; Harada, Hideyuki ; Hayashi, Nakamasa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-331286eacbf03e007b5a92c9572663e729ba04354dc1eb97a5a0af1143492a6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Brain Neoplasms - surgery</topic><topic>Cancer Research</topic><topic>Complications</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meninges</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>Nausea</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Recurrence, Local - surgery</topic><topic>Oncology</topic><topic>Original</topic><topic>Original Article</topic><topic>Paresis</topic><topic>Patients</topic><topic>Postoperative</topic><topic>Prospective Studies</topic><topic>Radiation therapy</topic><topic>Radiosurgery - adverse effects</topic><topic>Retrospective Studies</topic><topic>Seizures</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deguchi, Shoichi</creatorcontrib><creatorcontrib>Mitsuya, Koichi</creatorcontrib><creatorcontrib>Yasui, Kazuaki</creatorcontrib><creatorcontrib>Kimura, Keisuke</creatorcontrib><creatorcontrib>Onoe, Tsuyoshi</creatorcontrib><creatorcontrib>Ogawa, Hirofumi</creatorcontrib><creatorcontrib>Asakura, Hirofumi</creatorcontrib><creatorcontrib>Harada, Hideyuki</creatorcontrib><creatorcontrib>Hayashi, Nakamasa</creatorcontrib><collection>Springer Nature OA Free Journals</collection><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>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deguchi, Shoichi</au><au>Mitsuya, Koichi</au><au>Yasui, Kazuaki</au><au>Kimura, Keisuke</au><au>Onoe, Tsuyoshi</au><au>Ogawa, Hirofumi</au><au>Asakura, Hirofumi</au><au>Harada, Hideyuki</au><au>Hayashi, Nakamasa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neoadjuvant fractionated stereotactic radiotherapy followed by piecemeal resection of brain metastasis: a case series of 20 patients</atitle><jtitle>International journal of clinical oncology</jtitle><stitle>Int J Clin Oncol</stitle><addtitle>Int J Clin Oncol</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>27</volume><issue>3</issue><spage>481</spage><epage>487</epage><pages>481-487</pages><issn>1341-9625</issn><issn>1437-7772</issn><eissn>1437-7772</eissn><abstract>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.</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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