title: A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases.
abstract: OBJECTIVE
  To evaluate local control after surgical resection and postoperative stereotactic radiosurgery (SRS) for brain metastases.
  
  
  METHODS
  A total of 49 patients (50 lesions) were enrolled and available for analysis. Eligibility criteria included histologically confirmed malignancy with 1 or 2 intraparenchymal brain metastases, age≥18 years, and Karnofsky performance status (KPS)≥70. A Cox proportional hazard regression model was used to test for significant associations between clinical factors and overall survival (OS). Competing risks regression models, as well as cumulative incidence functions, were fit using the method of Fine and Gray to assess the association between clinical factors and both local failure (LF; recurrence within surgical cavity or SRS target), and regional failure (RF; intracranial metastasis outside of treated volume).
  
  
  RESULTS
  The median follow-up was 12.0 months (range, 1.0-94.1 months). After surgical resection, 39 patients with 40 lesions were treated a median of 31 days (range, 7-56 days) later with SRS to the surgical bed to a median dose of 1800 cGy (range, 1500-2200 cGy). Of the 50 lesions, 15 (30%) demonstrated LF after surgery. The cumulative LF and RF rates were 22% and 44% at 12 months. Patients who went on to receive SRS had a significantly lower incidence of LF (P=.008). Other factors associated with improved local control include non-small cell lung cancer histology (P=.048), tumor diameter<3 cm (P=.010), and deep parenchymal tumors (P=.036). Large tumors (≥3 cm) with superficial dural/pial involvement showed the highest risk for LF (53.3% at 12 months). Large superficial lesions treated with SRS had a 54.5% LF. Infratentorial lesions were associated with a higher risk of developing RF compared to supratentorial lesions (P<.001).
  
  
  CONCLUSIONS
  Postoperative SRS is associated with high rates of local control, especially for deep brain metastases<3 cm. Tumors≥3 cm with superficial dural/pial involvement demonstrate the highest risk of LF.
authors: Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Cameron
authors: C
authors: Brennan
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: T Jonathan
authors: TJ
authors: Yang
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Patrick
authors: P
authors: Hilden
authors: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Zhigang
authors: Z
authors: Zhang
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Kelvin
authors: K
authors: Chan
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Yoshiya
authors: Y
authors: Yamada
authors: Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Timothy A
authors: TA
authors: Chan
authors: Department of Radiation Oncology, New York University Langone Medical Center, New York, New York.
authors: Stella C
authors: SC
authors: Lymberis
authors: Department of Radiation Oncology, Greenwich Hospital, Greenwich, Connecticut.
authors: Ashwatha
authors: A
authors: Narayana
authors: Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Viviane
authors: V
authors: Tabar
authors: Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Philip H
authors: PH
authors: Gutin
authors: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Åse
authors: Å
authors: Ballangrud
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Eric
authors: E
authors: Lis
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: BealK@MSKCC.org.
authors: Kathryn
authors: K
authors: Beal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000528:radiation effects; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011184:Postoperative Period; D011446:Prospective Studies; D011832:Radiation Injuries / Q000473:pathology; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult