title: Postoperative Stereotactic Radiosurgery Using 5-Gy × 5 Sessions in the Management of Brain Metastases.
abstract: BACKGROUND
  Multiple regimens for stereotactic radiosurgery (SRS) at the postoperative bed have shown a high local control rate and a low toxicity profile with no decrease in overall survival with the omission of whole-brain radiation therapy.
  
  
  METHODS
  In this retrospective analysis, we evaluate our experience with postoperative SRS using a uniform regimen of 25 Gy in 5 sessions.
  
  
  RESULTS
  Between April 2011 and May 2014, 75 patients were treated for 77 metastatic brain lesions with postoperative SRS in 5 sessions. The median planning target volume was 13.8 cm(3) (1.93-128.43 cm(3)) with a median follow-up for all lesions of 9.5 months (range, 1.2-38.2 months). Kaplan-Meier estimates of local control at 1 and 2 years were 88.8% and 83.9%, respectively. On univariate analysis, a trend in decreased survival with multiple brain lesions was noted (hazard ratio [HR] = 2; 95% confidence interval [CI], 0.87-4.53; P = 0.10). There was a trend towards decreased local control with radioresistant tumors (HR = 3.23; 95% CI, 0.7-22.6; P = 0.14) and planning target volume ≥17 cm(3) (HR = 3.07; 95% CI, 0.73-15.23; P = 0.12). Two (3%) patients developed radionecrosis, one of whom required craniotomy.
  
  
  CONCLUSIONS
  SRS with a dose of 25 Gy in 5 sessions is associated with excellent local control at the resection site with minimal toxicity in the postoperative settings in our patient population. Further investigation is required to determine if dose escalation to the postoperative cavity of radioresistant tumors improves outcomes.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Yazan
authors.initials: Y
authors.lastname: Abuodeh
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Kamran A
authors.initials: KA
authors.lastname: Ahmed
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Arash O
authors.initials: AO
authors.lastname: Naghavi
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Puja S
authors.initials: PS
authors.lastname: Venkat
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Siriporn
authors.initials: S
authors.lastname: Sarangkasiri
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Peter A S
authors.initials: PAS
authors.lastname: Johnstone
authors.affiliation: Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Arnold B
authors.initials: AB
authors.lastname: Etame
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA. Electronic address: michael.yu@moffitt.org.
authors.forename: Hsiang-Hsuan Michael
authors.initials: HM
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality*; D015995:Prevalence; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000401:mortality*; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain metastases; Radioresistant; Stereotactic radiosurgery