title: Tumor bed radiosurgery after resection of cerebral metastases.
abstract: OBJECTIVE
  Adjuvant irradiation after resection of brain metastases reduces the risk of local recurrence. Whole-brain radiation therapy can be associated with significant neurotoxicity in long-term survivors of brain metastases. This retrospective study evaluates the role of tumor bed stereotactic radiosurgery as an alternative method of irradiation after initial resection of brain metastases to prevent local recurrence.
  
  
  METHODS
  Forty patients underwent tumor bed radiosurgery after resection of brain metastases at two separate academic medical centers. The median age was 59.5 years. Twenty patients (67.5%) had single metastases. Resection was complete in 80% and partial in 20% of the patients. At the time of radiosurgery, systemic disease was active in 57.5%, inactive in 32.5%, and in remission in 10% of the patients. The median Karnofsky Performance Scale score was 80% (range, 60-100%). Radiosurgery was performed a median of 4 weeks after tumor resection. The median cavity radiosurgery volume was 9.1 ml (range, 0.6-39.9 ml). The median margin and maximum radiation dose were 16 and 32 Gy, respectively.
  
  
  RESULTS
  Local control at the resection site was achieved in 73% of patients at a median follow-up period of 13 months. No variable significantly affected local control. New remote brain metastases occurred in 54% of the patients. Symptomatic radiation effect was seen in 5.4% of the patients. The median survival was 13 months after radiosurgery (range, 2-56 mo).
  
  
  CONCLUSIONS
  Tumor bed radiosurgery provides effective local control of the tumor after resection in most patients. These preliminary data support radiosurgery after resection rather than traditional radiation therapy.
authors.affiliation: Division of Neurosurgery/Neuro-oncology, Centre Hospitalier University of Sherbrooke, Sherbrooke, Canada. david.mathieu@USherbrooke.ca
authors.forename: David
authors.initials: D
authors.lastname: Mathieu
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.forename: David
authors.initials: D
authors.lastname: Fortin
authors.forename: Brendan
authors.initials: B
authors.lastname: Kenny
authors.forename: Karine
authors.initials: K
authors.lastname: Michaud
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mongia
authors.forename: Ajay
authors.initials: A
authors.lastname: Niranjan
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016634:Radiosurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016896:Treatment Outcome