nach oben

Erschienen in:

01.11.2018 | Original Article

Cavity volume changes after surgery of a brain metastasis—consequences for stereotactic radiation therapy

verfasst von: Sophia Scharl, Anna Kirstein, Kerstin A. Kessel, Marciana-Nona Duma, Markus Oechsner, Christoph Straube, Univ.-Prof. Dr. Stephanie E. Combs

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

For a large or symptomatic brain metastasis, resection and adjuvant radiotherapy are recommended. Hypofractionated stereotactic radiotherapy (HFSRT) is increasingly applied in patients with a limited number of lesions. Exact target volume definition is critical given the small safety margins. Whilst technical advances have minimized inaccuracy due to patient positioning and radiation targeting, little is known about changes in target volume. This study sought to evaluate potential changes in the resection cavity of a brain metastasis.

Methods

In all, 57 patients treated with HFSRT after surgical resection of one brain metastasis between 2008 and 2015 in our institution were included in this study. Gross tumor volume (GTV) of the initial metastasis and the volume of the resection cavity in the post-operative, planning, and follow-up MRIs were measured and compared.

Results

The mean cavity size decreased after surgery with the greatest change of −23.4% (±41.5%) occurring between post-operative MRI and planning MRI (p < 0.01). During this time period, the cavity volume decreased, remained stable, and increased in 79.1, 3.5, and 17.4%, respectively. A further decrease of −20.7% (±58.1%) was perceived between planning MRI and first follow-up (p < 0.01). No significant difference in pattern of change could be observed depending on the volume of initial GTV, size of the post-operative resection cavity, initial or post-resection FLAIR (fluid-attenuated inversion recovery) hyper-intensity, postsurgical ischemia, or primary tumor. The resection cavities of patients with post-operative ischemia were significantly larger than resection cavities of patients without ischemia.

Conclusion

The resection cavity seems to be very dynamic after surgery. Hence, it remains necessary to use very recent scans for treatment planning.

Al-Omair A, Soliman H, Xu W et al (2013) Hypofractionated stereotactic radiotherapy in five daily fractions for post-operative surgical cavities in brain metastases patients with and without prior whole brain radiation. Technol Cancer Res Treat 12(6):493–499CrossRefPubMedPubMedCentral

Atalar B, Choi CYH, Harsh GR et al (2013) Cavity volume dynamics after resection of brain metastases and timing of postresection cavity stereotactic radiosurgery. Neurosurgery 72(2):180–185 (discussion 185)CrossRefPubMed

Blonigen BJ, Steinmetz RD, Levin L et al (2010) Irradiated volume as a predictor of brain radionecrosis after linear accelerator stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 77(4):996–1001CrossRefPubMed

Broemme J, Abu-Isa J, Kottke R et al (2013) Adjuvant therapy after resection of brain metastases. Frameless image-guided LINAC-based radiosurgery and stereotactic hypofractionated radiotherapy. Strahlenther Onkol 189(9):765–770CrossRefPubMed

Brown PD, Ballman KV, Cerhan JH et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3). Lancet Oncol 18(8):1049–1060CrossRefPubMedPubMedCentral

Pérez-Larraya JG, Hildebrand J (2014) Chapter 77 – Brain metastases. In: Biller J, Ferro JM (Hrsg) Neurologic Aspects of Systemic Disease. Part III. Elsevier, Amsterdam, S 1143–1157CrossRef

Doré M, Martin S, Delpon G et al (2017) Stereotactic radiotherapy following surgery for brain metastasis. Cancer Radiother 21(1):4–9CrossRefPubMed

Frisk G, Svensson T, Bäcklund LM et al (2012) Incidence and time trends of brain metastases admissions among breast cancer patients in Sweden. Br J Cancer 106(11):1850–1853CrossRefPubMedPubMedCentral

Jarvis LA, Simmons NE, Bellerive M et al (2012) Tumor bed dynamics after surgical resection of brain metastases: Implications for postoperative radiosurgery. Int J Radiat Oncol Biol Phys 84(4):943–948CrossRefPubMed

10.

Johnson JD, Young B (1996) Demographics of brain metastasis. Neurosurg Clin N Am 7(3):337–344CrossRefPubMed

11.

Keller A, Doré M, Cebula H et al (2017) Hypofractionated Stereotactic radiation therapy to the resection bed for Intracranial metastases. Int J Radiat Oncol Biol Phys 99(5):1179–1189. https://doi.org/10.1016/j.ijrobp.2017.08.014 CrossRefPubMed

12.

Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: Results of the EORTC 22952-26001 study. J Clin Oncol 29(2):134–141CrossRefPubMed

13.

Kohutek ZA, Yamada Y, Chan TA et al (2015) Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases. J Neurooncol 125(1):149–156CrossRefPubMedPubMedCentral

14.

Lamba N, Muskens IS, DiRisio AC et al (2017) Stereotactic radiosurgery versus whole-brain radiotherapy after intracranial metastasis resection: A systematic review and meta-analysis. Radiat Oncol 12(1):106CrossRefPubMedPubMedCentral

15.

Lima LCS, Sharim J, Levin-Epstein R et al (2017) Hypofractionated Stereotactic Radiosurgery and radiotherapy to large resection cavity of metastatic brain tumors. World Neurosurg 97:571–579CrossRefPubMed

16.

Mahajan A, Ahmed S, McAleer MF et al (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases. Lancet Oncol 18(8):1040–1048CrossRefPubMedPubMedCentral

17.

Mehta MP, Tsao MN, Whelan TJ et al (2005) The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 63(1):37–46CrossRefPubMed

18.

Minniti G, Clarke E, Lanzetta G et al (2011) Stereotactic radiosurgery for brain metastases. Radiat Oncol 6:48CrossRefPubMedPubMedCentral

19.

NCCN (2017) NCCN clinical practice guidelines in oncology (NCCN guidelines ® ) central nervous system cancers. https://education.nccn.org/node/81831

20.

Nussbaum ES, Djalilian HR, Cho KH et al (1996) Brain metastases. Histology, multiplicity, surgery, and survival. Cancer 78(8):1781–1788CrossRefPubMed

21.

O’Neill BP, Iturria NJ, Link MJ et al (2003) A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys 55(5):1169–1176CrossRefPubMed

22.

Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322(8):494–500CrossRefPubMed

23.

Qin H, Wang C, Jiang Y et al (2015) Patients with single brain metastasis from non-small cell lung cancer equally benefit from stereotactic radiosurgery and surgery. Med Sci Monit 21:144–152CrossRefPubMedPubMedCentral

24.

Schouten LJ, Rutten J, Huveneers HAM et al (2002) Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94(10):2698–2705CrossRefPubMed

25.

Shah JK, Potts MB, Sneed PK et al (2016) Surgical cavity constriction and local progression between resection and Adjuvant Radiosurgery for brain metastases. Cureus 8(4):e575PubMedPubMedCentral

26.

Specht HM, Kessel KA, Oechsner M et al (2016) HFSRT der Resektionshöhle bei Patienten mit Hirnmetastasen. Strahlenther Onkol 192(6):368–376CrossRefPubMed

27.

Spencer K, Hall A, Jain P (2014) Brain metastases. Clin Med (lond) 14(5):535–537CrossRef

28.

Steinmann D, Maertens B, Janssen S et al (2012) Hypofractionated stereotactic radiotherapy (hfSRT) after tumour resection of a single brain metastasis: Report of a single-centre individualized treatment approach. J Cancer Res Clin Oncol 138(9):1523–1529CrossRefPubMed

29.

van Leeuwen CM, Oei AL, Crezee J et al (2018) The alfa and beta of tumours. Radiat Oncol 13(1):96CrossRefPubMedPubMedCentral

30.

Walker AE, Robins M, Weinfeld FD (1985) Epidemiology of brain tumors: The national survey of intracranial neoplasms. Baillieres Clin Neurol 35(2):219–226

31.

Wang C‑C, Floyd SR, Chang C‑H et al (2012) Cyberknife hypofractionated stereotactic radiosurgery (HSRS) of resection cavity after excision of large cerebral metastasis: Efficacy and safety of an 800 cGy × 3 daily fractions regimen. J Neurooncol 106(3):601–610CrossRefPubMed

32.

Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901). Lancet Oncol 15(4):387–395CrossRefPubMed

Titel: Cavity volume changes after surgery of a brain metastasis—consequences for stereotactic radiation therapy
verfasst von: Sophia Scharl
Anna Kirstein
Kerstin A. Kessel
Marciana-Nona Duma
Markus Oechsner
Christoph Straube
Univ.-Prof. Dr. Stephanie E. Combs
Publikationsdatum: 01.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 3/2019
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1387-y

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Cavity volume changes after surgery of a brain metastasis—consequences for stereotactic radiation therapy