title: Hypofractionated stereotactic radiotherapy in five daily fractions for post-operative surgical cavities in brain metastases patients with and without prior whole brain radiation.
abstract: Our purpose was to report efficacy of hypofractionated cavity stereotactic radiotherapy (HCSRT) in patients with and without prior whole brain radiotherapy (WBRT). 32 surgical cavities in 30 patients (20 patients/21 cavities had no prior WBRT and 10 patients/11 cavities had prior WBRT) were treated with image-guided linac stereotactic radiotherapy. 7 of the 10 prior WBRT patients had "resistant" local disease given prior surgery, post-operative WBRT and a re-operation, followed by salvage HCSRT. The clinical target volume was the post-surgical cavity, and a 2-mm margin applied as planning target volume. The median total dose was 30 Gy (range: 25-37.5 Gy) in 5 fractions. In the no prior and prior WBRT cohorts, the median follow-up was 9.7 months (range: 3.0-23.6) and 15.3 months (range: 2.9-39.7), the median survival was 23.6 months and 39.7 months, and the 1-year cavity local recurrence progression- free survival (LRFS) was 79 and 100%, respectively. At 18 months the LRFS dropped to 29% in the prior WBRT cohort. Grade 3 radiation necrosis occurred in 3 prior WBRT patients. We report favorable outcomes with HCSRT, and well selected patients with prior WBRT and "resistant" disease may have an extended survival favoring aggressive salvage HCSRT at a moderate risk of radiation necrosis.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. arjun.sahgal@sunnybrook.ca.
authors.forename: Ameen
authors.initials: A
authors.lastname: Al-Omair
authors.forename: Hany
authors.initials: H
authors.lastname: Soliman
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Aliaksandr
authors.initials: A
authors.lastname: Karotki
authors.forename: Todd
authors.initials: T
authors.lastname: Mainprize
authors.forename: Nicolas
authors.initials: N
authors.lastname: Phan
authors.forename: Sunit
authors.initials: S
authors.lastname: Das
authors.forename: Julia
authors.initials: J
authors.lastname: Keith
authors.forename: Robert
authors.initials: R
authors.lastname: Yeung
authors.forename: James
authors.initials: J
authors.lastname: Perry
authors.forename: May
authors.initials: M
authors.lastname: Tsao
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D016879:Salvage Therapy; D055815:Young Adult