title: Outcome Evaluation of Oligometastatic Patients Treated with Surgical Resection Followed by Hypofractionated Stereotactic Radiosurgery (HSRS) on the Tumor Bed, for Single, Large Brain Metastases.
abstract: OBJECTIVE
  The aim of this study was to evaluate the benefit of a combined treatment, surgery followed by adjuvant hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed, in oligometastatic patients with single, large brain metastasis (BM).
  
  
  METHODS
  Fom January 2011 to March 2015, 69 patients underwent complete surgical resection followed by HSRS with a total dose of 30Gy in 3 daily fractions. Clinical outcome was evaluated by neurological examination and MRI 2 months after radiotherapy and then every 3 months. Local progression was defined as radiographic increase of the enhancing abnormality in the irradiated volume, and brain distant progression as the presence of new brain metastases or leptomeningeal enhancement outside the irradiated volume. Surgical morbidity and radiation-therapy toxicity, local control (LC), brain distant progression (BDP), and overall survival (OS) were evaluated.
  
  
  RESULTS
  The median preoperative volume and maximum diameter of BM was 18.5cm3 (range 4.1-64.2cm3) and 3.6cm (range 2.1-5-4cm); the median CTV was 29.0cm3 (range 4.1-203.1cm3) and median PTV was 55.2cm3 (range 17.2-282.9cm3). The median follow-up time was 24 months (range 4-33 months). The 1-and 2-year LC in site of treatment was 100%; the median, 1-and 2-year BDP was 11.9 months, 19.6% and 33.0%; the median, 1-and 2-year OS was 24 months (range 4-33 months), 91.3% and 73.0%. No severe postoperative morbidity or radiation therapy toxicity occurred in our series.
  
  
  CONCLUSIONS
  Multimodal approach, surgery followed by HSRS, can be an effective treatment option for selected patients with single, large brain metastases from different solid tumors.
authors.affiliation: Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Maggi
authors.affiliation: Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Riva
authors.affiliation: Hematology and Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masci
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.affiliation: Hematology and Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Hematology and Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Neurosurgical Oncology Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications; D016634:Radiosurgery / Q000009:adverse effects* / Q000379:methods