title: HFSRT of the resection cavity in patients with brain metastases.
abstract: OBJECTIVE
  Aim of this single center, retrospective study was to assess the efficacy and safety of linear accelerator-based hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity of brain metastases after surgical resection. Local control (LC), locoregional control (LRC = new brain metastases outside of the treatment volume), overall survival (OS) as well as acute and late toxicity were evaluated.
  
  
  METHODS
  46 patients with large (> 3 cm) or symptomatic brain metastases were treated with HFSRT. Median resection cavity volume was 14.16 cm(3) (range 1.44-38.68 cm(3)) and median planning target volume (PTV) was 26.19 cm(3) (range 3.45-63.97 cm(3)). Patients were treated with 35 Gy in 7 fractions prescribed to the 95-100 % isodose line in a stereotactic treatment setup. LC and LRC were assessed by follow-up magnetic resonance imaging.
  
  
  RESULTS
  The 1-year LC rate was 88 % and LRC was 48 %; 57% of all patients showed cranial progression after HFSRT (4% local, 44% locoregional, 9% local and locoregional). The median follow-up was 19 months; median OS for the whole cohort was 25 months. Tumor histology and recursive partitioning analysis score were significant predictors for OS. HFSRT was tolerated well without any severe acute side effects > grade 2 according to CTCAE criteria.
  
  
  CONCLUSIONS
  HFSRT after surgical resection of brain metastases was tolerated well without any severe acute side effects and led to excellent LC and a favorable OS. Since more than half of the patients showed cranial progression after local irradiation of the resection cavity, close patient follow-up is warranted. A prospective evaluation in clinical trials is currently being performed.
authors.affiliation: Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
authors.forename: Hanno M
authors.initials: HM
authors.lastname: Specht
authors.affiliation: Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.|Institut für Innovative Radiotherapie, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany.
authors.forename: Kerstin A
authors.initials: KA
authors.lastname: Kessel
authors.affiliation: Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Oechsner
authors.affiliation: Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, 81675, Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Abteilung Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, 81675, Munich, Germany.|Deutsches Konsortium für Translationale Krebsforschung, Technische Universität München, 81675, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany. Stephanie.Combs@tum.de.|Institut für Innovative Radiotherapie, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany. Stephanie.Combs@tum.de.|Deutsches Konsortium für Translationale Krebsforschung, Technische Universität München, 81675, Munich, Germany. Stephanie.Combs@tum.de.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D016371:Cranial Irradiation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D018365:Neoplasm, Residual; D015995:Prevalence; D000069473:Radiation Dose Hypofractionation; D016634:Radiosurgery / Q000401:mortality* / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hypofractionated stereotactic radiotherapy; Neoplasm metastasis; Quality of life; Radiosurgery; Survival