Risk of tract recurrence with stereotactic biopsy of brain metastases: An 18-year cancer center experience Journal Article
| Authors: | Carnevale, J. A.; Imber, B. S.; Winston, G. M.; Goldberg, J. L.; Ballangrud, A.; Brennan, C. W.; Beal, K.; Tabar, V.; Moss, N. S. |
| Article Title: | Risk of tract recurrence with stereotactic biopsy of brain metastases: An 18-year cancer center experience |
| Abstract: | OBJECTIVE Stereotactic biopsy is increasingly performed on brain metastases (BrMs) as improving cancer outcomes drive aggressive multimodality treatment, including laser interstitial thermal therapy (LITT). However, the tract recurrence (TR) risk is poorly defined in an era defined by focused-irradiation paradigms. As such, the authors aimed to define indications and adjuvant therapies for this procedure and evaluate the BrM-biopsy TR rate. METHODS In a single-center retrospective review, the authors identified stereotactic BrM biopsies performed from 2002 to 2020. Surgical indications, radiographic characteristics, stereotactic planning, dosimetry, pre- and postoperative CNS-directed and systemic treatments, and clinical courses were collected. Recurrence was evaluated using RANO-BM (Response Assessment in Neuro-Oncology Brain Metastases) criteria. RESULTS In total, 499 patients underwent stereotactic intracranial biopsy for any diagnosis, of whom 25 patients (5.0%) underwent biopsy for pathologically confirmed viable BrM, a proportion that increased over the time period studied. Twelve of the 25 BrM patients had ≥ 3 months of radiographic follow-up, of whom 6 patients (50%) developed new metastatic growth along the tract at a median of 5.0 months post-biopsy (range 2.3-17.1 months). All of the TR cases had undergone pre- or early post-biopsy stereotactic radiosurgery (SRS), and 3 had also undergone LITT at the time of initial biopsy. TRs were treated with resection, reirradiation, or observation/systemic therapy. CONCLUSIONS In this study the authors identified a nontrivial, higher than previously described rate of BrM-biopsy tract recurrence, which often required additional surgery or radiation and justified close radiographic surveillance. As BrMs are commonly treated with SRS limited to enhancing tumor margins, consideration should be made, in cases lacking CNS-active systemic treatments, to include biopsy tracts in adjuvant radiation plans where feasible. © AANS 2022 |
| Keywords: | adult; cancer chemotherapy; human tissue; treatment outcome; aged; cancer surgery; retrospective studies; major clinical study; clinical feature; histopathology; cancer recurrence; bevacizumab; doxorubicin; cancer growth; systemic therapy; cancer adjuvant therapy; radiotherapy, adjuvant; temozolomide; recurrence risk; brain tumor; follow up; brain neoplasms; carboplatin; ipilimumab; etoposide; tumor biopsy; diagnostic imaging; oncology; retrospective study; biopsy; central nervous system; prescription; cancer center; dosimetry; radiosurgery; irradiation; brain metastasis; brachytherapy; stereotactic radiosurgery; stereotactic body radiation therapy; adjuvant radiotherapy; stereotactic biopsy; brain metastases; laser interstitial thermal therapy; systemic disease; procedures; re-irradiation; nivolumab; hypofractionated radiotherapy; humans; human; male; female; article |
| Journal Title: | Journal of Neurosurgery |
| Volume: | 136 |
| Issue: | 4 |
| ISSN: | 0022-3085 |
| Publisher: | American Association of Neurological Surgeons |
| Date Published: | 2022-04-01 |
| Start Page: | 1045 |
| End Page: | 1051 |
| Language: | English |
| DOI: | 10.3171/2021.3.Jns204347 |
| PUBMED: | 34507279 |
| PROVIDER: | scopus |
| PMCID: | PMC9383706 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 May 2022 -- Source: Scopus |
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