title: Resection Followed by Involved-Field Fractionated Radiotherapy in the Management of Single Brain Metastasis.
abstract: BACKGROUND
  We expanded upon our previous experience using involved-field fractionated radiotherapy (IFRT) as an alternative to whole brain radiotherapy or stereotactic radiosurgery for patients with surgically resected brain metastases (BM).
  
  
  METHODS
  All patients with single BM who underwent surgical resection followed by IFRT at our institution from 2006 to 2013 were evaluated. Local recurrence (LR)-free survival, distant failure (DF)-free survival, and overall survival (OS) were determined. Analyses were performed associating clinical variables with LR and DF. Salvage approaches and toxicity of treatment for each patient were also assessed.
  
  
  RESULTS
  Median follow-up was 19.1 months. Fifty-six patients were treated with a median dose of 40.05 Gy/15 fractions with IFRT to the resection cavity. LR-free survival was 91.4%, DF-free survival was 68.4%, and OS was 77.7% at 12 months. No variables were associated with increased LR; however, melanoma histopathology and infratentorial location were associated with DF on multivariate analysis. LRs were salvaged in 5/8 patients, and DFs were salvaged in 24/29 patients. Two patients developed radionecrosis.
  
  
  CONCLUSIONS
  Adjuvant IFRT is feasible and safe for well-selected patients with surgically resected single BM. Acceptable rates of local control and salvage of distal intracranial recurrences continue to be achieved with continued follow-up.
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Shin
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Vatner
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.
authors.forename: Moses
authors.initials: M
authors.lastname: Tam
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Golfinos
authors.affiliation: Department of Radiation Oncology, Greenwich Hospital , Greenwich, CT , USA.
authors.forename: Ashwatha
authors.initials: A
authors.lastname: Narayana
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center , New York, NY , USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kondziolka
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center , New York, NY , USA.
authors.forename: Joshua Seth
authors.initials: JS
authors.lastname: Silverman
keywords: brain metastases; involved-field fractionated radiotherapy; stereotactic radiosurgery; surgical resection