title: Stereotactic radiosurgery boost to the resection cavity for cerebral metastases: Report of overall survival, complications, and corticosteroid protocol.
abstract: BACKGROUND
  This report focuses on the overall survival and complications associated with treatment of cerebral metastases with surgical resection followed by stereotactic radiosurgery (SRS). Management and complications of corticosteroid therapy are underreported in the literature but represent an important source of morbidity for patients.
  
  
  METHODS
  Fifty-nine consecutive patients underwent surgical resection of a cerebral metastasis followed by SRS to the cavity. Patient charts were reviewed retrospectively to ascertain overall survival, local control, surgical complications, SRS complications, and corticosteroid complications.
  
  
  RESULTS
  Our mean follow-up was 14.4 months (median 12.0 months, range 0.9-62.9 months). Median overall survival in this series was 15.25 months and local control was 98.3%. There was a statistically significant survival benefit conferred by Radiation Therapy Oncology Group recursive partitioning analysis Classes 1 and 2. The surgical complication rate was 6.8% while the SRS complication rate was 2.4%. Corticosteroid complications are reported and dependence at 1 month was 20.3%, at 3 months 6.8%, at 6 months 1.7%, and at 12 months no patients remained on corticosteroid therapy.
  
  
  CONCLUSIONS
  Overall survival and local control with this treatment paradigm compare well to the other published literature. Complications associated with this patient population are low. A corticosteroid tapering protocol is proposed and demonstrated lower rates of steroid-related complications and dependence than previously reported.
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Kellogg
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Straus
authors.affiliation: Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Mehee
authors.initials: M
authors.lastname: Choi
authors.affiliation: Medical College, Rush University, Chicago, IL, USA.
authors.forename: Thymur A
authors.initials: TA
authors.lastname: Chaudhry
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Aidnag Z
authors.initials: AZ
authors.lastname: Diaz
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Lorenzo F
authors.initials: LF
authors.lastname: Muñoz
keywords: Cerebral metastases; corticosteroids; stereotactic radiosurgery