A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases Journal Article

Authors: Brennan, C.; Yang, T. J.; Hilden, P.; Zhang, Z.; Chan, K.; Yamada, Y.; Chan, T. A.; Lymberis, S. C.; Narayana, A.; Tabar, V.; Gutin, P. H.; Ballangrud, A.; Lis, E.; Beal, K.
Article Title: A phase 2 trial of stereotactic radiosurgery boost after surgical resection for brain metastases
Abstract: Purpose To evaluate local control after surgical resection and postoperative stereotactic radiosurgery (SRS) for brain metastases. Methods and Materials A total of 49 patients (50 lesions) were enrolled and available for analysis. Eligibility criteria included histologically confirmed malignancy with 1 or 2 intraparenchymal brain metastases, age ≥18 years, and Karnofsky performance status (KPS) ≥70. A Cox proportional hazard regression model was used to test for significant associations between clinical factors and overall survival (OS). Competing risks regression models, as well as cumulative incidence functions, were fit using the method of Fine and Gray to assess the association between clinical factors and both local failure (LF; recurrence within surgical cavity or SRS target), and regional failure (RF; intracranial metastasis outside of treated volume). Results The median follow-up was 12.0 months (range, 1.0-94.1 months). After surgical resection, 39 patients with 40 lesions were treated a median of 31 days (range, 7-56 days) later with SRS to the surgical bed to a median dose of 1800 cGy (range, 1500-2200 cGy). Of the 50 lesions, 15 (30%) demonstrated LF after surgery. The cumulative LF and RF rates were 22% and 44% at 12 months. Patients who went on to receive SRS had a significantly lower incidence of LF (P=.008). Other factors associated with improved local control include non-small cell lung cancer histology (P=.048), tumor diameter <3 cm (P=.010), and deep parenchymal tumors (P=.036). Large tumors (≥3 cm) with superficial dural/pial involvement showed the highest risk for LF (53.3% at 12 months). Large superficial lesions treated with SRS had a 54.5% LF. Infratentorial lesions were associated with a higher risk of developing RF compared to supratentorial lesions (P<.001). Conclusions Postoperative SRS is associated with high rates of local control, especially for deep brain metastases <3 cm. Tumors ≥3 cm with superficial dural/pial involvement demonstrate the highest risk of LF. © 2014 Elsevier Inc. All rights reserved.
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 88
Issue: 1
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2014-01-01
Start Page: 130
End Page: 136
Language: English
DOI: 10.1016/j.ijrobp.2013.09.051
PROVIDER: scopus
PUBMED: 24331659
PMCID: PMC5736310
Notes: Export Date: 2 January 2014 -- CODEN: IOBPD -- Source: Scopus
Citation Impact
MSK Authors
  1. Zhigang Zhang
    318 Zhang
  2. Timothy Chan
    295 Chan
  3. Eric Lis
    120 Lis
  4. Viviane S Tabar
    163 Tabar
  5. Yoshiya Yamada
    414 Yamada
  6. Philip H Gutin
    162 Gutin
  7. Cameron Brennan
    184 Brennan
  8. Kathryn Beal
    185 Beal
  9. T. Jonathan Yang
    104 Yang
  10. Kelvin Chan
    19 Chan
  11. Patrick Dale Hilden
    107 Hilden