Radiosurgery to the surgical cavity as adjuvant therapy for resected brain metastasis.
BACKGROUND
The standard treatment of resected brain metastasis is whole-brain radiotherapy (WBRT). To avoid the potential toxicity of WBRT and to improve local control, we have used radiosurgery alone to the surgical cavity.


OBJECTIVE
To demonstrate the rates of local control, new intracranial metastasis, and overall survival using this treatment scheme without WBRT.


METHODS
Eighty-five consecutive patients with brain metastasis were treated with surgical resection of at least 1 lesion followed by radiosurgery alone to the surgical cavity and any unresected lesions from August 2000 to March 2011. Sixty-eight percent had gross total resections. After surgery, radiosurgery was delivered to the surgical cavity with a 2- to 3-mm margin. The median marginal radiosurgery dose was 16 Gy, and median target volume was 13.96 cm. Follow-up imaging and clinical examination were obtained every 2 to 3 months.


RESULTS
Median follow-up time was 11.2 months. Overall local control was 81.2%. The 6-month, 1-year, and 2-year rates of local control were 88.7%, 81.4%, and 75.7%, respectively. Forty-seven patients (55%) developed new intracranial metastases at a median time of 5.6 months. For the entire population, the rate of new metastases was 32.1%, 58.1%, and 62.9% at 6 months, 1 year, and 2 years, respectively. Median overall survival time was 12.1 months. From initial treatment until death or last follow-up, only 30 patients (35%) received WBRT as salvage treatment.


CONCLUSIONS
Radiosurgery to the surgical cavity without WBRT achieved excellent local control of resected brain metastasis. Close imaging follow-up allows early intervention for any new metastasis.
Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Jared R
JR
Robbins
Samuel
S
Ryu
Steven
S
Kalkanis
Chad
C
Cogan
Jack
J
Rock
Benjamin
B
Movsas
Jae Ho
JH
Kim
Mark
M
Rosenblum
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000556:secondary / Q000601:surgery; D011183:Postoperative Complications; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome