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01.09.2013 | Original article

Adjuvant therapy after resection of brain metastases

Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy

verfasst von: J. Broemme, J. Abu-Isa, R. Kottke, J. Beck, R. Wiest, M. Malthaner, D. Schmidhalter, A. Raabe, D.M. Aebersold, A. Pica, M.D

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 9/2013

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Abstract

Background

Tumor bed stereotactic radiosurgery (SRS) after resection of brain metastases is a new strategy to delay or avoid whole-brain irradiation (WBRT) and its associated toxicities. This retrospective study analyzes results of frameless image-guided linear accelerator (LINAC)-based SRS and stereotactic hypofractionated radiotherapy (SHRT) as adjuvant treatment without WBRT.

Materials and methods

Between March 2009 and February 2012, 44 resection cavities in 42 patients were treated with SRS (23 cavities) or SHRT (21 cavities). All treatments were delivered using a stereotactic LINAC. All cavities were expanded by ≥ 2 mm in all directions to create the clinical target volume (CTV).

Results

The median planning target volume (PTV) for SRS was 11.1 cm³. The median dose prescribed to the PTV margin for SRS was 17 Gy. Median PTV for SHRT was 22.3 cm³. The fractionation schemes applied were: 4 fractions of 6 Gy (5 patients), 6 fractions of 4 Gy (6 patients) and 10 fractions of 4 Gy (10 patients). Median follow-up was 9.6 months. Local control (LC) rates after 6 and 12 months were 91 and 77 %, respectively. No statistically significant differences in LC rates between SRS and SHRT treatments were observed. Distant brain control (DBC) rates at 6 and 12 months were 61 and 33 %, respectively. Overall survival (OS) at 6 and 12 months was 87 and 63.5 %, respectively, with a median OS of 15.9 months. One patient treated by SRS showed symptoms of radionecrosis, which was confirmed histologically.

Conclusion

Frameless image-guided LINAC-based adjuvant SRS and SHRT are effective and well tolerated local treatment strategies after resection of brain metastases in patients with oligometastatic disease.

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Titel: Adjuvant therapy after resection of brain metastases
Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy
verfasst von: J. Broemme
J. Abu-Isa
R. Kottke
J. Beck
R. Wiest
M. Malthaner
D. Schmidhalter
A. Raabe
D.M. Aebersold
A. Pica, M.D
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 9/2013
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0409-z

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Adjuvant therapy after resection of brain metastases

Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy